title: Pathways to psychiatric care of patients from rural regions: a general-hospital-based study.
abstract: BACKGROUND
  Pathway studies highlight the help-seeking behaviours of patients with physical and mental illness. A number of these studies have been completed in other countries, but there have been few reports from China. Therefore, this study was planned to explore the characteristics of the help-seeking pathways of patients with mental illness from rural regions of China through the mental health professionals and treatment at the General Hospital of the People's Liberation Army (PLAGH).
  
  
  METHODS
  The pathway diagrams were documented for 203 subjects with various mental disorders using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns of help-seeking and durations were analysed, and the χ(2) test and Mann-Whitney U test were employed as needed.
  
  
  RESULTS
  On average, each patient consulted 3.6 caregivers. The vast majority of patients first visited local secondary general hospitals (SGHs) (35.5%, χ(2) = 41.93, p < .0001) or local tertiary general hospitals (TGHs) (32%, χ(2) = 36.21, p < .0001); however, 75.4% of them had not received professional diagnosis and treatment. The patients who first contacted the psychiatric service, finally reached the PLAGH, because of poor treatment or the high cost of medical care.
  
  
  CONCLUSIONS
  The subjects first seek the help of various sources before attending PLAGH due to a lack of awareness of the treatment services and the fear of the stigma associated with mental disorders. The primary care, even the local general hospital, did not act as a gatekeeper to psychiatric services.
authors.affiliation: 1Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Li
authors.forename: Weijun
authors.initials: W
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Xiulan
authors.initials: X
authors.lastname: Zhang
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Qu
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wang
authors.forename: Yurong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Huiwen
authors.initials: H
authors.lastname: Xu
authors.forename: Shuliang
authors.initials: S
authors.lastname: Zhao
authors.forename: Yafang
authors.initials: Y
authors.lastname: Li
authors.forename: Donghua
authors.initials: D
authors.lastname: Tian
mesh_terms: D000328:Adult; D002681:China; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors
keywords: Help-seeking pathway; mental health professional; psychiatric care; rural region