Background: multimorbidity contributes to a large portion of the disease burden in low- and middle-income countries. However, limited research has been undertaken in China. This study has investigated the prevalence of multimorbidity and the associations of multimorbidity with activities of daily living (ADL), instrumental activities of daily living (IADL) and depression in China. Methods: the study participants included 10,055 adults aged 45 years and older from three rounds of the China Health and Retirement Longitudinal Study 2011–2015. Random-effects logistic regression models were used to examine the association of multimorbidity with ADL limitation, IADL limitation and mental disease. Results: the prevalence of multimorbidity amongst adults in China aged 45 years and older was 62.1% in 2015. The prevalence of multimorbidity was increased with older age, among women, in a higher socio-economic group and in the most deprived regions. Multimorbidity is associated with an increased likelihood of experiencing ADL limitation (adjusted odds ratio [AOR] = 5.738, 95% confidence intervals (CI) = 5.733, 5.744) and IADL limitation (AOR = 2.590, 95% CI = 2.588, 2.592) and depression (AOR = 3.352, 95% CI = 3.350, 3.354). Rural–urban disparities in functional difficulties and depression were also found amongst patients with multimorbidity. Conclusions: the burden of multimorbidity is high in China, particularly amongst the older population. Multimorbidity is associated with higher levels of functional limitations and depression. China healthcare reforms should introduce integrated care models and patient-centred healthcare delivery. The increasing need for reorientation of healthcare resources considering the distribution of multimorbidity and its adverse effect requires more attention from health policymakers in China and other developing countries.

This scoping review maps population-based surveys and mental health literacy (MHL) interventions undertaken in China during 1997–2018 in order to identify research gaps. Following Arksey and O’Malley’s framework for a scoping review, five English databases (Medline, PsycINFO, Cochrane library, Web of Science and CINAHL) and two Chinese ones (CNKI and WanFang) were systematically searched, identifying both reports of surveys and evaluation of interventions from Jan 1997 to Oct 2018. MHL research has developed rapidly in China in terms of numbers of studies and geographic coverage over the past two decades. There were 350 peer-reviewed publications included in this review, covering diverse settings and participants. Of these publications, 313 (89.4%) were published in Chinese-language journals and 37 in English-language journals; 303 (86.6%) reported on survey findings and 47 reported on the evaluation of MHL interventions. MHL research in China has mainly focused on the assessment of mental health-related knowledge and beliefs. Much less attention has been given to developing and evaluating relevant interventions. MHL related to general mental health and suicide were most commonly studied, with less focus on specific disorders, although some studies covered depression, psychosis and anxiety disorders. The majority of MHL tools utilized in the studies reported in this review were developed in China (n = 97, 80.2% ) and almost half of these studies (57.8%) did not provide enough details concerning psychometrics. More interventions targeting the general public and aiming to improve MHL and promote behaviour change, are needed in China. These should be evaluated with high-quality study designs, such as randomised controlled trials. Proper validation of tools used for measuring MHL should also be addressed in future studies.

Purpose This study aimed to assess the prevalence of depression and to investigate its associated factors and impacts on daily life functioning among the general adult population in Jiangsu Province of China. Methods As part of the Jiangsu Provincial Survey on Chronic Disease and Behavioural Risk Factors (2010), a sample of 8400 community residents aged ≥ 18 years were recruited. Study data were collected through a questionnaire-administered face-to-face interview. Depression was measured by the Patient Health Questionnaire. Results The estimated prevalence of depression was 0.56% (0.54% in men and 0.58% in women). Increased risk of depression was found to be associated with rural residents (OR 2.24, 95% CI 1.33–3.78) and the comorbidity of chronic diseases (OR 3.83, 95% CI 1.33–11.02). Respondents with depression reported an average of 11.75 unhealthy days caused by physical illnesses and 8.31 unhealthy days by mood problems within the previous 30 days. Depression was also found to be related to worse self-ranked health status, worse relationships with families and lower life satisfaction. Conclusions A low prevalence of depression was found in this population of China, though it is not clear the extent to which it reflects issues related to the measurement and/or other factors of the survey. Depression was found to be related to poorer health and poorer life functioning. Further research into the link between depression and access to mental health services in rural areas is necessary. Meanwhile, depression among chronic disease patients should be addressed in clinical settings, health plans and resources allocation.

Self-reported height, weight, and waist circumference (WC) are widely used to estimate the prevalence of obesity, which has been increasing rapidly in China, but there is limited evidence for the accuracy of self-reported data and the determinants of self-report bias among the general adult Chinese population. Using a multi-stage cluster sampling method, 8399 residents aged 18 or above were interviewed in the Jiangsu Province of China. Information on self-reported height, weight, and WC, together with information on demographic factors and lifestyle behaviors, were collected through structured face-to-face interviews. Anthropometrics were measured by trained staff according to a standard protocol. Self-reported height was overreported by a mean of 1.1 cm (95 % confidence interval [CI]: 1.0 to 1.2). Self-reported weight, body mass index (BMI), and WC were underreported by −0.1 kg (95 % CI: −0.2 to 0.0), −0.4 kg/m2 (95 % CI: −0.5 to −0.3) and −1.5 cm (95 % CI: −1.7 to −1.3) respectively. Sex, age group, location, education, weight status, fruit/vegetable intake, and smoking significantly affected the extent of self-report bias. According to the self-reported data, 25.5 % of obese people were misclassified into lower BMI categories and 8.7 % of people with elevated WC were misclassified as normal. Besides the accuracy, the distribution of BMI and WC and their cut-off point standards for obesity of a population affected the proportion of obesity misclassification. Amongst a general population of Chinese adults, there was rather high proportion of obesity misclassification using self-reported weight, height, and WC data. Self-reported anthropometrics are biased and misleading. Objective measurements are recommended.

Background: Suicide is a significant public health concern in China and there is a need for evidence-based suicide prevention programs to assist people in the community who may be in a position to support those in their social networks who are at risk of suicide. English-language mental health first aid guidelines for this purpose have been developed. However, due to differences in culture, language and health systems, guidelines for English-speaking countries require cultural adaptation for use in China. Methods: A Delphi expert consensus study was conducted among mainland Chinese panellists with a diverse range of expertise in suicide crisis intervention (n = 56). Using the mental health first aid guidelines used in English-speaking countries as a basis, a questionnaire containing 141 statements on how to help a person at risk of suicide was developed and translated. Panellists were asked to rate the importance of each item for inclusion in the Chinese guidelines. They were also encouraged to suggest any additional statements that were not included in the original questionnaire. Statements were accepted for inclusion in the adapted guidelines if they were endorsed by at least 80% of panellists as essential or important. Results: Consensus was achieved after two survey rounds on 152 statements for inclusion in the adapted guidelines for China, with 141 adopted from the guidelines for English-speaking countries and 11 generated from the comments of panellists. Conclusions: While the adapted guidelines were similar to the guidelines for English-speaking countries, they also incorporated actions specific to the Chinese context, including Chinese attitudes towards suicide, the role of families and friends and removal of the means of suicide. Further research is needed to investigate the use of the guidelines by the Chinese public and the implementation of Mental Health First Aid training in appropriate settings in China.

Background: Most people who meet the criteria for a diagnosis of depression in China do not receive treatment.Family and friends can play a role in recognising the signs of depression and encouraging the person to seek treatment. However, many of them may lack the knowledge and skills to offer such help. The aim of this study was to culturally adapt the existing English-language mental health first aid (MHFA) guidelines for helping a person with depression to the Chinese context.Methods: A Delphi expert consensus study was conducted, in which two Chinese expert panels of mental health professionals (with experience in the field of clinical management of depression,n = 37) and consumers and carers (with lived experience,n = 30) rated the importance of actions that could be taken to help a person experiencing depression in mainland China.Results: Data were collected over 3 survey rounds. In the 1st round questionnaire, 175 statements translated into Chinese from the English-language guidelines were presented to the expert panels and 12 new statements were generated from panellists’ comments. Of these 187 statements, 173 were endorsed for inclusion in the adapted guidelines for China.Conclusions: Although the adapted guidelines were still quite similar to the guidelines for English-speaking countries, they also incorporated some new actions for the Chinese context, including those relating to different ways of respecting the autonomy of a person with depression and the role of their families. Further research is needed to explore the use of these guidelines by the Chinese public, including how they may be incorporated in Mental Health First Aid training.