The heavy burden of cardiovascular disease as the world's number one killer is no longer a secret. Formerly regarded as mainly a problem of the richest nations in the world, low- and middle-income countries have surpassed the developed world and now have the lion's share of these chronic, disabling, and deadly diseases. Mental illness is slightly more under-appreciated, even though it is increasing as a major cause of DALYs worldwide and is expected to become number one by 2030. Combined, cardiovascular disease and mental illness form a cycle of ill health: having depression makes one more at risk for a cardiovascular event, and having a cardiovascular event makes one more likely to suffer from depression. Effective interventions for managing these illnesses independently exist, and there is already evidence in some countries such as the US that managing both conditions together can improve health outcomes. However, a model of healthcare service delivery for both mental illness and cardiovascular conditions like acute coronary syndromes (ACS) in China has not been developed. The overall goal of this study is to develop, pilot test, implement, and evaluate a nurse-coordinated depression care model integrated into ACS care, with rigorous assessment of effectiveness and cost-effectiveness through a large scale, randomized controlled trial involving a well-established research network of rural hospitals in 15 provinces across China. This study will train nurses in cardiology wards in low-resource hospitals in China to use validated mental health screening and treatment tools among patients with ACS. Specifically, the study will determine if the integrated model can: reduce symptoms and severity of depression following ACS, improve cardiovascular health by reducing the incidence of major cardiovascular events and re-hospitalization, improve patients'quality of life, and finally whethe the model can improve other issues related to their health such as increasing physical activity and better adherence to cardiovascular medications. The long-term object of the study is to find a way to provide mental health services for patients with any chronic illness - whether it be ACS, diabetes, stroke, or cancer - in a sustainable and cost-effective manner that can be implemented in low-resource hospitals lacking in mental health specialists. This study will fill ina knowledge gap in bridging two health fields in low-resource conditions and will pave the way for an integrated service model customized to low-resource settings that can be replicated or tested in other low-resource environments. This study represents a strong local and international collaboration of researchers and academics from around the world, including The George Institute for Global Health in China, Australia and India, Peking University Institute of Mental Health, the Chinese Ministry of Health, and Duke University.

Public Health Relevance

Heart disease and mental illness are a major problem for health systems, physicians, and patients and their families in countries all around the world. There are no treatment options for patients with heart disease suffering from depression in low-resource hospitals in China. The proposed research will design and evaluate a healthcare solution that brings mental health and cardiovascular treatment together in hospitals lacking top- of-the-line equipment and trained mental health specialists in order to improve the mental and physical well- being of patients with both depression and heart disease. A model of care that works and is inexpensive to implement in China will have lessons for health systems in other countries, whether high- or low-income, and potentially improve the health of millions of people with heart disease around the world.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1)
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Pringle, Beverly
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George Institute China
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Zhu, Yidan; Blumenthal, James A; Shi, Chuan et al. (2018) Sedentary Behavior and the Risk of Depression in Patients With Acute Coronary Syndromes. Am J Cardiol 121:1456-1460
Wu, Yangfeng; Benjamin, Emelia J; MacMahon, Stephen (2016) Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China. Circulation 133:2545-60