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Background: Depression and anxiety often occur in persons with chronic physical illnesses and typically magnify the impairment caused by these physical conditions, but little attention has been paid to this issue in low- and middle-income countries. Aim: Evaluate the effectiveness of a community-based psychological intervention administered by nonspecialized clinicians and volunteers for alleviating depressive and anxiety symptoms in individuals with chronic physical illnesses. Methods: A total of 10,164 community residents receiving treatment for diabetes or hypertension in Shanghai were arbitrarily assigned to a treatment-as-usual condition (n=2042) or an intervention condition (n=8122) that included community-wide psychological health promotion, peer support groups, and individual counseling sessions. The self-report Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and 12-item Short-Form Health Survey (SF-12) assessed depressive symptoms, anxiety symptoms, and quality of life at baseline and after the 6-month intervention. Results: Among the 8813 individuals who completed the baseline assessment, 16% had mild or more severe depressive or anxiety symptoms (PHQ-9 or GAD-7 >5) and 4% had moderate or severe depressive or anxiety symptoms (PHQ-9 or GAD-7 >10). The education component of the intervention was effectively implemented, but only 31% of those eligible for peer-support groups and only 9% of those eligible for individual counseling accepted these interventions. The dropout rate was high (51%), and there were significant differences between those who did and did not complete the follow-up assessment. After adjusting for these confounding factors, the results in individuals who completed both assessments indicated that the intervention was associated with significant improvements in depressive symptoms (F=9.98, p<0.001), anxiety symptoms (F=12.85, p<0.001), and in the Mental Component Summary score of the SF-12 (F=16.13, p<0.001). There was, however, no significant change in the self-reported rates of uncontrolled diabetes or hypertension. Conclusions: These results support the feasibility of implementing community-based interventions to reduce the severity of depressive and anxiety symptoms in persons with chronic medical conditions in lowand middle-income countries where psychiatric manpower is very limited. However, there are substantial methodological challenges to mounting such interventions that need to be resolved in future studies before the widespread up-scaling of this approach will be justified. [ABSTRACT FROM AUTHOR]

Background: The recent adoption of China's new national mental health law provides a good opportunity to obtain baseline information about community mental health literacy in the country. Aim: Assess knowledge and attitudes about mental disorders among residents in Shanghai. Methods: A total of 1953 residents aged 15 or above selected from all 19 districts in Shanghai completed two self-report questionnaires - the Mental Health Knowledge Questionnaire (MHKQ) and the Case Assessment Questionnaire (CAQ). MHKQ total scores range from 0 to 20 (higher scores indicate better mental health literacy). The CAQ presents respondents with five case vignettes and possesses nine questions after each vignette measuring respondents' knowledge and attitudes towards these mental illnesses. Results: Correct response rates for the 20 MHKQ items ranged from 26 to 98%, with a mean rate of 72%. The internal consistency (alpha) of the 20 items on the MHKQ was 0.69, but this decreased to 0.59 after removing four items about mental health promotion. A 5-factor model for the 20 items in the MHKQ was identified using exploratory factor analysis on one-half of the surveys, but the model was only partially validated in the confirmatory factor analysis using the second half of the surveys. On the CAQ, rates of correct recognition of mania, depression, schizophrenia with positive symptoms, schizophrenia with negative symptoms and anxiety were 42%, 35%, 30%, 19% and 21%, respectively. Work stress (37.3%), problems with thinking (30.0%) and negative life events (24.4%) were reported to be the three main causes of mental disorders. Seeing a counselor (34.2%) or a psychiatrist (33.3%) were the two most common suggestions for help-seeking. Higher education and younger age were related with better mental health literacy and higher rates of recognition of common mental disorders. Conclusions: Mental health literacy in Shanghai appears to be increasing, but the reliability and validity of the instruments used to assess mental health literacy (MHKQ and CAQ) have not been adequately assessed so this result must be considered preliminary. Further work, preferably including both qualitative and quantitative components, is needed to revise these instruments before they can be used to assess the effectiveness of mental health promotion campaigns. [ABSTRACT FROM AUTHOR]