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Special article

Translated and annotated version of the 2015-2020 National Mental Health Work Plan of the People’s Republic of China

Wei XIONG, Michael R. PHILLIPS(translators)

The following document is a translation of the 2015-2020 National Mental Health Work Plan of the People’s Republic of China which was issued by the General Office of China’s State Council on June 4, 2015. The original Chinese version of the document is available at the official government website: The translators have added annotations at the end of the document that provide background information to help contextualize content that may be unclear to readers unfamiliar with China and explain their decisions when translating terms that can have multiple interpretations.

Original research article

Effect of group cognitive-behavioral therapy on the quality of life and social functioning of patients with mild depression

Boyuan ZHANG, Xuefan DING, Weihong LU, Jing ZHAO, Qinyu LV, Zhenghui YI, Shaoping ZHANG, Yindi CHEN1

Background: Several studies of moderate-to-severe depression have shown that combined treatment with individual cognitive behavioral therapy (CBT) and antidepressant medication is better than either CBT or antidepressants alone. Less research has focused on the outcomes of group-CBT and antidepressants in persons with mild depression.
Aim: Evaluate the effects of group-CBT in combination with antidepressants on the quality of life and social functioning of outpatients with mild depression.
Methods: We randomized 62 outpatients with mild depression into a control group (n=30) that received antidepressant medication for 12 weeks and an intervention group (n=32) that received antidepressants and group-CBT for 12 weeks; both groups were then continued on antidepressants alone for one year. Blinded evaluators used Chinese versions of the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Social Disability Screening Schedule, Life Satisfaction Rating, Multidimensional Scale of Perceived Social Support, and Short Form Health Survey to assess participants after 12 weeks of treatment and at the end of one year of follow-up.
Results: Repeated measures analysis of variance showed that the depressive and anxiety symptoms of both groups improved significantly during treatment and that the improvement was greater in the CBT+antidepressant experimental group. Almost all of the social functioning, social support, and quality of life measures also showed significantly greater improvement in the CBT+antidepressant group than in the antidepressant-only group. Moreover, even after adjusting for differences in baseline demographic and clinical characteristics and for changes in the severity of depression and anxiety over time using an analysis of covariance, the greater improvement in the CBT+antidepressant group remained statistically significant both after the 12 weeks of group-CBT treatment and one year after the group CBT had ended.
Conclusions: Antidepressants alone or combined treatment with antidepressants and group-CBT can effectively improve the social function, quality of life, and healthy functioning of individuals with mild depression. However, combined treatment with both antidepressants and group CBT is better than treatment with antidepressants alone, and these benefits persist for up to one year after the CBT sessions have ended.
Keywords: group therapy; cognitive-behavioral therapy; antidepressants; depression; quality of life; social function; China


Cross-sectional study of the severity of self-reported depressive symptoms in heroin users who participate in a methadone maintenance treatment program

Yafei WU, Shiyan YAN, Yanping BAO, Zhi LIAN, Zhi QU, Zhimin LIU

Background: Methadone maintenance treatment (MMT) is widely recognized as an effective method of combatting narcotic addiction. MMT reduces heroin withdrawal symptoms and, thus, makes it possible to provide the psychological and social support that is essential to the rehabilitation of drug users.
Aim: Compare the severity of depressive symptoms in heroin users who are currently receiving MMT to that of heroin users who are not receiving MMT.
Methods: We administered the 13-item version of the Beck Depression Inventory (BDI-13) and a demographic history form to 929 heroin users who had been receiving MMT at nine methadone treatment clinics in three Chinese cities for an average of 9 months and to 238 heroin users who had enrolled in a MMT program at the centers but had not yet begun MMT.
Results: Seventy-nine percent (188/238) of the untreated individuals reported depressive symptoms compared to 68% (628/929) of the individuals receiving MMT (X2=11.69, p<0.001). The median (interquartile range) BDI score in the untreated group was 10.4 (7.9-11.4) compared to 8.0 (5.7-11.6) in the MMT group (Z=2.75, p=0.006). In the MMT group, there was a negative correlation between the severity of reported depressive symptoms and the duration of participation in the MMT program (rs=-0.24, Z=2.88, p=0.004). Multivariate linear regression analysis showed that after adjusting for all demographic variables the treated group still had less severe depressive symptoms than the untreated group. After adjusting for the effect of MMT treatment, depressive symptoms were more severe in heroin users who self-reported poor family relationships (standardized regression coefficient [beta]=0.118, t=6.56, p<0.001) and in those who were divorced (beta=0.120, t=3.73, p<0.001).
Conclusions: Moderate to severe depressive symptoms are common in heroin users. MMT is associated with lower levels of depressive symptoms in heroin users, but prospective randomized controlled trials are needed to determine whether or not MMT actually improves depressive symptoms in heroin users. Poor relationships with family members are also associated with depressive symptoms in heroin users; this suggests that treatment of heroin addiction needs to incorporate methods for helping heroin users repair the severed social relationships that their addiction has caused.
Keywords: methadone maintenance treatment; heroin abuse; depression; China


Comparison of cognitive flexibility and planning ability in patients with obsessive compulsive disorder, patients with obsessive compulsive personality disorder, and healthy controls

Negin PAAST, Zohreh KHOSRAVI, Amir Hossein MEMARI, Monir SHAYESTEHFAR, Mohammad ARBABI

Background: Cognitive functioning in individuals with Obsessive Compulsive Disorder(OCD) and with Obsessive Compulsive Personality Disorder (OCPD) has not been adequately studied.
Aim: Examine the cognitive flexibility and planning ability of individuals with OCD and OCPD.
Methods: Twenty patients with OCD and 25 patients with OCPD who had not taken medication in the previous two weeks were identified in an outpatient psychology clinic in Tehran, and 25 healthy control subjects were identified from the university staff and local community residents. All participants were administered the 28-item version of the General Health Questionnaire (GHQ-28), the Wisconsin Card Sorting Test (WCST), and the Tower of London (TOL) test. Two measures of the WCTS (number of perseverative errors and number of categories completed) were used to assess cognitive flexibility and three measures of the TOL (total number of moves in 12 trials, total response time, and planning time) were used to assess planning ability.
Results: The level of current psychological distress in the two patient groups was significantly greater than that in the control group. After adjusting for demographic variables and the level of psychological distress, both OCD patients and OCPD patients made more perseverative errors on the WCST than control subjects, and the OCD patients (but not the OCPD patients) completed significantly fewer categories than the control subjects. Both the OCD patients and OCPD patients required significantly more moves than control subjects to complete the 12 TOL tasks and OCD patients took significantly longer than both OCPD patients and control subjects to complete the tasks.
Conclusions: Individuals with OCD and OCPD have impaired cognitive flexibility and planning ability compared to healthy controls, and there are some differences in these measures of cognitive functioning between OCD and OCPD. Long term follow-up studies of OCD and OCPD that assess changes in cognitive measures as the severity of obsessive compulsive symptoms wax and wane will be needed to determine whether or not such cognitive measures have diagnostic or clinical relevance for obsessive compulsive disorders.
Keywords: obsessive compulsive disorder; obsessive compulsive personality disorder; executive function; neuropsychology; Iran


Genetic findings are challenging the symptom-based diagnostic classification system of mental disorders


Summary: The present diagnostic classification of mental illnesses is primarily based on symptomatology. A recent cross-disorder genome-wide association study revealed that there were genetic similarities between multiple clinically defined diagnoses (including schizophrenia, bipolar disorder, depression, attention deficit hyperactivity disorder, and autism spectrum disorder) on regions of chromosomes 3p21 and 10q24 and single-nucleotide polymorphisms (SNPs) within two L-type voltage-gated calcium channel subunits of CACNA1C and CACNB2. These findings suggest that the pathogenesis of these five independent disorders are related. Such cross-disorder genetic studies challenge the current symptom-based diagnostic classification of mental disorders. Researchers need to identify creative ways to bridge the gap between these two approaches to understanding and labelling mental disorders.
Keywords: diagnostic classification; cross-disease; genetics


Influence of cross-disorder analyses on the diagnostic criteria of mental illnesses

Meiti WANG, Donghong CUI

Summary: Cross-disorder studies are identifying shared genetic variations among common mental illnesses – including schizophrenia, bipolar disorder, and major depression – which are classified as independent disorders in the current diagnostic system. These cross-disorder studies are challenging the traditional system of diagnosing mental disorders based on clinical symptoms, but it remains to be seen whether or not they will lead to an improved method of classifying psychiatric disorders that can, in turn, lead to better outcomes for individuals suffering from these conditions.
Key words: cross-disorder analyses; mental illness; genetics; diagnoses

Case report

Case report of a child’s anxiety disorder precipitated by tremors from a distant earthquake that was extensively covered in local news stories


Summary: Earthquakes are relatively common natural disasters in many parts of the world, but research about the mental health effects of earthquakes remains limited. Individuals experiencing an earthquake often suffer significant loss and are at increased risk for developing mental disorders. However, the prevalence of mental disorders following less dramatic or non-destructive earthquake phenomena is unknown. We report the case of a 10-year-old girl who came to a psychiatric outpatient department with a 2-week history of severe, disabling anxiety symptoms precipitated by non-destructive tremors from a distant earthquake that received extensive coverage in the local press. Her condition did not meet criteria for any of the specific anxiety-related disorders, so the non-specific DSM-5 category ‘Other Specified Anxiety Disorder’ was considered most appropriate. Her symptoms resolved over 4 weeks when treated with both a benzodiazepine and a selective serotonin reuptake inhibitor.
Keywords: earthquake; news reports; natural disaster; other specified anxiety disorder; selective serotonin reuptake inhibitor; children; India


Case report of body dysmorphic disorder in a suicidal patient

Yingfeng ZHANG, Hongxia MA, Yanbin WANG

Summary: Few reports exist about the treatment of body dysmorphic disorder (BDD) in patients who are suicidal. This case report describes a 19-year-old male with BDD who had delusional-intensity beliefs about facial disfigurement that had gradually intensified over a 2-year period. However, he was initially misdiagnosed with depression partly because he was admitted immediately after a suicide attempt that was associated with depressive symptoms and social withdrawal, symptoms that subsequently proved to be secondary to his BDD. The symptoms resolved completely and his social functioning returned to normal after 8 weeks of inpatient treatment with fluoxetine and cognitive behavioral therapy. This report is a reminder that suicidal behavior and ideation can have many causes; to avoid misdiagnosis and inappropriate treatment, clinicians should consider other possibilities before assuming that suicidal behavior or ideation is the direct result of depression. We discuss the many changes in the understanding and diagnostic classification of BDD since it was first reported by Enrico Morselli in 1886.
Keywords: body dysmorphic disorder; major depressive disorder; suicidal behavior; misdiagnosis; China

Biostatistics in psychiatry

Relationships among three popular measures of differential risks: relative risk, risk difference, and odds ratio

Changyong FENG, Hongyue WANG, Bokai WANG, Xiang LU, Hao SUN, and Xin M. TU

Summary: The relative risk, risk difference, and odds ratio are the three most commonly used measures for comparing the risk of disease between different groups. Although widely popular in biomedical and psychosocial research, the relationship among the three measures has not been clarified in the literature. Many researchers incorrectly assume a monotonic relationship, such that higher (or lower) values in one measure are associated with higher (or lower) values in the other measures. In this paper we discuss three theorems and provide examples demonstrating that this is not the case; there is no logical relationship between any of these measures. Researchers must be very cautious when implying a relationship between the different measures or when combining results of studies that use different measures of risk.
Keywords: odds ratio; relative risk; risk difference