title: Pathways to psychiatric care in urban north China: a general hospital based study.
abstract: BACKGROUND
  Pathway studies highlight the help-seeking behaviors of patients with physical and mental illnesses. A number of studies in this field have been completed in various parts of the world. The purpose of this study is to explore the characteristics of the help-seeking pathways of patients with mental illness from urban north China at Mental Health Professional (MHP).
  
  
  METHODS
  The pathway diagrams, which accounted for more than five percent of patients, were documented for 441 subjects using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns and durations of care-seeking were analyzed in different diagnostic groups. The χ2-test and the Mann-Whitney U test were employed, as needed.
  
  
  RESULTS
  Respondents visited the MHP through a variety of pathways. Approximately three-quarters of the patients took an indirect pathway (74.8% vs 25.2%, χ2 = 108.8, p < 0.0001), and on average, each patient consulted 3.4 caregivers. The vast majority of patients first visited local tertiary general hospitals (56.4% vs 4.1%, χ2 = 138.3, p < 0.0001) or local secondary general hospitals (24.8% vs 4.1%, χ2 = 40.96, p < 0.0001). However, only 9.6% of patients were diagnosed with mental disorders for the patients who first visited non-psychiatric hospitals. Of the patients who first contacted with psychiatry hospital, 55.6% received a professional diagnosis and finally reached the MHP because of the poor treatment or high-cost medical care.
  
  
  CONCLUSIONS
  The majority of patients seek other pathways than to go to MHP directly and this may be due to stigma, and/or lack of knowledge. The study gives emphasis on the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders in the community health centers, the general hospitals system and by private practitioners. The pathway described by this study may be helpful while preparing mental health programs in the future.
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army, Beijing 100853, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Li
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Xiulan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Qu
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wang
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Huiwen
authors.initials: H
authors.lastname: Xu
authors.affiliation: Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544-1013, USA.
authors.forename: Alvina
authors.initials: A
authors.lastname: Jiao
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Mengqi
authors.initials: M
authors.lastname: Guo
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Yurong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Yafang
authors.initials: Y
authors.lastname: Li
authors.affiliation: School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China.
authors.forename: Donghua
authors.initials: D
authors.lastname: Tian
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