Three essays about the community mental health in China

Abstract

People with schizophrenia have long-term impairments and suffer from severe social cognition deficits. This thesis used multiple sources of data (empirical data, extracted data from literatures), applied econometric models, and described the living conditions, treatment situation, and effectiveness of treatment of patients with schizophrenia in a certain area of rural China, Ningxia Hui Autonomous Region.

In Chapter two, we used multi-level models to analysis the determinants of mental health service utilization in the patients with schizophrenia who had registered the community mental health systems. Determinants were categorized into multiple levels, personal, environmental, and health service. This study confirmed that the treatment gap of mental service had been significantly reduced in rural China, and concluded that individual characteristics were more related to the initiation of treatment while environmental and service characteristics were more relevant to maintain good treatment adherence.

Chapter three is meta-analysis to quantify the social deficits of patients with schizophrenia and identify the effect of both age and years of schooling on social cognition in healthy controls. By combining the RMET (Reading the mind in the Eyes Test) score of over 200 studies, we not only estimated the pooled the impairment of social cognition in patients with schizophrenia, but also modeled the non-linear change of social cognition over age using meta-regression with line construction (the social cognition peaks at around age of 30 and gradually decreases after it).

Chapter four collected empirical data of three groups of individuals, a group of drug-naïve patients with schizophrenia, a group of treatment controls, and a group of healthy controls. Beyond the direct comparison among three groups using fixed-effect models, we considered the completion status of scale as a proxy measurement of general cognition and used Heckman estimation to adjust the large precent of uncompletion rate. This study confirmed that drug-naïve patients with schizophrenia had poorer social cognition then treated controls and appealed that we should design new tools to evaluate the social cognition for patients with lower level of education.

Chapter five concludes the whole thesis by summarising the main findings and future research directions.

Date of Award	Nov 2023
Original language	English
Awarding Institution	University of Nottingham
Supervisor	Richard Hubbard (Supervisor), Zhuo Chen (Supervisor) & Chew Chua (Supervisor)