Zuo Xin, Hong Jianhe, Liang Di, Cao Wenting, Liang Qiqing, Liu Yumei
School of Public Health, Key Laboratory of Tropical Translational Medicine of Ministry of Education, Hainan Medical University, 3 Xueyuan Road, Longhua District, Haikou, 571199, China.
Prevention and control section, Hainan Provincial Anning Hospital, Haikou, China.
BMC Psychiatry. 2025 Mar 11;25(1):233. doi: 10.1186/s12888-025-06627-4.
The 686 Program in China primarily aims to provide certain health and policy services to individuals with severe mental disorders within the community. As of 2020, a total of 6.43 million patients were registered nationwide under this program. However, there remains a disparity between the actual number of patients covered by the program and the total number of individuals with mental disorders. Factors influencing the engagement in 686 Program among individuals with severe mental disorders remain underexplored in current research.This study aims to understand the barriers and facilitators to program contact, offers implications for the development of targeted interventions for people with severe mental disorders, enabling the creation of more tailored and impactful strategies to enhance the 686 Program's effectiveness and reach.
We aimed to explore the influencing factors associated with the registration and management of the 686 Program in a clinical sample of inpatients with severe mental disorders.
This study employed a cross-sectional study design. Demographic information, behavioral characteristics, and clinical information of inpatients firstly diagnosed with severe mental disorders from 2018 to 2022 were retrieved from the Hainan Provincial Anning Hospital information system, subsequently, registration and management data were matched using resident ID numbers within the 686 Program information system to effectively align independent and dependent variables. Binary logistic regression analysis was utilized to investigate the factors influencing the registration and management of the 686 Program among the first confirmed patients with severe mental disorders.
Between 2018 and 2022, Hainan Provincial Anning Hospital had 3,008 individuals who were first diagnosed with severe mental disorders. Among them, 1135 (37.73%) did not register for 686 Program, and 1873 (62.67%) had registered the 686 Program, of which 82 (4.38%) were unwilling to accept management. Multivariable analysis revealed that older age(OR = 1.010, 95% CI: 1.002-1.019), local (OR = 1.356, 95% CI: 1.014-1.814), longer disease duration (OR = 1.031, 95% CI: 1.015-1.047), total number of hospitalizations (from initial diagnosis onward) > 1 time (OR = 1.362, 95% CI: 1.135-1.635; OR = 3.287, 95% CI: 2.579-4.189) and smoking(OR = 1.383, 95% CI: 1.081-1.769) were associated with a higher likelihood of registering for the 686 Program. Conversely, being ethnic minorities (OR = 0.707, 95% CI: 0.500-0.998), individuals with a middle school education and above(OR = 0.477, 95% CI: 0.276-0.823; OR = 0.357, 95% CI: 0.204-0.623), and those diagnosed with bipolar disorder (OR = 0.459, 95% CI: 0.357-0.590) were less inclined to register for the 686 Program. Furthermore, local resident status (OR = 2.455, 95%CI: 1.212-4.970) and being married (OR = 1.909, 95%CI:1.023-3.564) were associated with a higher likelihood of receiving community health management, while older age (OR = 0.954, 95%CI:0.924-0.986) was associated with a decreased likelihood of accepting management.
We found that older patients, longer disease duration, total number of hospitalizations (from initial diagnosis onward) > 1 time, local resident status, and smokers are more inclined to register for the 686 Program. Ethnic minorities, individuals with a junior high school education or above, and those diagnosed with bipolar affective disorder are more hesitant to register for the 686 Program, additionally, patients who are local residents and married are more likely to receive community health management, older patients are more reluctant to accept community health management. In the future, relevant departments should take targeted measures, especially focusing on promotional efforts for ethnic minorities, individuals with a junior high school education or above, and those diagnosed with bipolar affective disorder to enhance the accessibility and popularity of the 686 Program. Furthermore, it is essential to investigate the reasons behind the reluctance of older patients to accept community health management services, in order to improve the effectiveness of the 686 Program for this demographic.
中国的“686项目”主要旨在为社区内患有严重精神障碍的个人提供特定的健康和政策服务。截至2020年，全国共有643万患者登记参加该项目。然而，该项目覆盖的实际患者数量与精神障碍患者总数之间仍存在差距。目前的研究对影响严重精神障碍患者参与“686项目”的因素探索不足。本研究旨在了解项目接触的障碍和促进因素，为针对严重精神障碍患者制定有针对性的干预措施提供建议，从而制定更具针对性和影响力的策略，以提高“686项目”的有效性和覆盖面。
我们旨在探讨严重精神障碍住院患者临床样本中与“686项目”登记和管理相关的影响因素。
本研究采用横断面研究设计。从海南省安宁医院信息系统中检索2018年至2022年首次诊断为严重精神障碍的住院患者的人口统计学信息、行为特征和临床信息，随后，使用“686项目”信息系统中的居民身份证号码匹配登记和管理数据，以有效对齐自变量和因变量。采用二元逻辑回归分析来研究影响首次确诊的严重精神障碍患者“686项目”登记和管理的因素。
2018年至2022年期间，海南省安宁医院有3008人首次被诊断为严重精神障碍。其中，1135人（37.73%）未登记参加“686项目”，1873人（62.67%）已登记参加“686项目”，其中82人（4.38%）不愿接受管理。多变量分析显示，年龄较大（OR = 1.010，95%CI：1.002 - 1.019）、本地居民（OR = 1.356，95%CI：1.014 - 1.814）、病程较长（OR = 1.031，95%CI：1.015 - 1.047）、住院总次数（从首次诊断起）>1次（OR = 1.362，95%CI：1.135 - 1.635；OR = 3.287，9-5%CI：2.579 - 4.189）和吸烟（OR = 1.383，95%CI：1.081 - 1.769）与登记参加“686项目”的可能性较高相关。相反，少数民族（OR = 0.707，95%CI：0.500 - 0.998）、初中及以上文化程度的个体（OR = 0.477，95%CI：0.276 - 0.823；OR = 0.357，95%CI：0.204 - 0.623）以及被诊断为双相情感障碍的个体（OR = 0.459，95%CI：0.357 - 0.590）登记参加“686项目”的意愿较低。此外，本地居民身份（OR = 2.455，95%CI：1.212 - 4.970）和已婚（OR = 1.909，95%CI：1.023 - 3.564）与接受社区健康管理的可能性较高相关，而年龄较大（OR = 0.954，95%CI：0.924 - 0.986）与接受管理的可能性降低相关。
我们发现老年患者、病程较长、住院总次数（从首次诊断起）>1次、本地居民身份和吸烟者更倾向于登记参加“686项目”。少数民族、初中及以上文化程度的个体以及被诊断为双相情感障碍的个体在登记参加“686项目”时更为犹豫，此外，本地居民和已婚患者更有可能接受社区健康管理，老年患者更不愿意接受社区健康管理。未来，相关部门应采取针对性措施，尤其要加强对少数民族、初中及以上文化程度的个体以及被诊断为双相情感障碍的个体的宣传力度，以提高“686项目”的可及性和知晓度。此外，有必要调查老年患者不愿接受社区健康管理服务的原因，以提高“686项目”对这一人群的有效性。
