Chinese Medicine, 2011, 2, 32-35
doi:10.4236/cm.2011.21006 Published Online March 2011 (
Copyright © 2011 SciRes . CM
A Survey of Mental Health of New Patients at Traditional
Chinese Medical Clinics
Siu Man Ng, Ted Chun Tat Fong, Xiao Lu Wang
Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China
Received October 4, 2010; revised December 5, 2010; accepted December 9, 2010
In Chinese society, traditional Chinese medical clinics are popular and play a significant role in primary
healthcare. The curr e nt st ud y ai med to examine the mental health of new patients at Chinese medical clinics.
A cross-sectional questionnaire survey was conducted. Subjects were new patients of a Chinese medical
clinic recruited through 100% consecutive sampling during a 5-week period. A response rate of 84.2% and a
sample size of 367 were achieved. Samples included 111 (30.2%) men and 256 (69.8%) women. Mean age
was 44.0 (SD = 17.1). Presenting problems were all somatic, with 68.3% lasted over 1 month and 37.1%
lasted over 1 year. In the month prior to the first consultation, 26.4%, 33.2% and 19.3% patients consulted
other public, private and Chinese medical clinics on average 1.5, 1.9 and 3.0 times respectively. Besides,
7.4% and 6.5% patients self-administered Western and Chinese drugs on average 1.3 and 2.4 times respect-
ti vely. Using a cut-off of 5 on GHQ-12, prevalence of common mental disorders was estimated at 21.0%.
In conclusion, findings revealed that common mental disorders were prevalent among new Chinese medicine
patients although presenting problems of subjects were all somatic. Many of t hese presenting medical condi-
tions were chronic, with 68.3% lasting over 1 month and 37.1% lasting over 1 year. Over 70% patients had
been seeking various forms of treatment in the month prior to first consultation. Mental health and illness
behavior of Chinese medicine patients warrants further research and attention.
Keywords: Alternative Medicine, Mental Health, Primary Healthcare
1. Introduction
Mental disorde rs are common among the Chinese people
[1]. Adopting a 2-stage design, that is a questionnaire
screening followed by a standardized diagnostic inter-
view, the overall lifetime prevalence of mental disorders
among adults in the community was repor ted at 18.9% in
Hong Kong [2]. If to bacco dependence and pathological
gambling were included, the overall prevalence was
29.1%. Since most people with mental disorders will
show up in primary healthcare, although largely for so-
matic discomforts, primary healthcare theoretically may
play a pivotal role in the community psychiatry frame-
work [3,4].
Despite rapid modernization and socioeconomic
changes, traditional Chinese medicine (TCM) remains
popular among the Chinese people and is generally per-
ceived as “better in treating chronic illnesses”, “curing
underlying causes” and “more gentle and having fewer
side effects” [5]. Over the past decade in Hong Kong,
TCM has been systematically formalized and incorpo-
rated into modern healthcare system. According to the
Chinese Medicine Council of Hong Kong, there were
about 5,853 registered Chinese medicine practitioners
(RCMP) as at April 2009. For a city of seven million
people, the figure translates into one RCMP per popula-
tion of about 1,200, suggesting that TCM clinics are
playing a significant role in primary healthcare.
A key characteristic of the illness behavior of the
Chinese people is a strong tendency to express concern
or solicit attention through somatic discomforts (e.g. see
the classic work of Kleinman & Kleinman, 1985 [6]).
With a root in Chinese culture, TCM has evolved to
manage this ‘soma tizatio n’ tend ency t hrough a strategic-
holistic appro ach. While the so matic co mplaints are full y
acknowledged, the higher goal is to treat both mind and
body. For example, depression is generally considered as
equivalent to the ‘stagnation syndrome’ of TCM [7]. A
Copyright © 2011 SciRes . CM
key d iffere nce, howe ver, is that stagna tion synd ro me ha s
a prominent somatic component characterized by ob-
struction-like discomforts at throat, chest, stomach or
abdomen. An emphasis on somatic symptoms makes it
socially legitimate to seek medical care. Stagnation syn-
drome and other ‘mind/body disorders’ are often exam-
ined by general Chinese medicine practitioners in the
community. It is thus reasonable to expect that many
Chinese people with mental disorders turn up at TCM
clinics. Ho wever, systematic studies on this area are still
The objective of the current study is to investigate the
incoming pathways and overall prevalence of common
mental disorders of new pati ents of a TCM clinic of a
major healthcare provider in Hong Kong. The scope of
the study did not include returning patients mainly be-
cause of methodological considerations. Returning pa-
tient s had big heterogeneity in terms of stage of recovery
and duration of treatment at the clinic. Besides, there
might be significant systemic differences between re-
turning and defaulting patients. Access to defaulting pa-
tients for making such assessment would be difficult.
From a methodological research perspective, the mental
healt h pro file o f retur ning p atie nts had to be i nves tigated
by a substantially more sophisticated design in future
Ethical approval for this study was sought from the
Joint Institutional Review Board of the University of
Hong K ong a nd the Hosp ita l Aut hori ty Hon g Ko ng Wes t
Cluster, with compliance to the Declaration of Helsinki.
2. Methods
1) Participants: current study adopted a cross-sectional
questionnaire survey design. Participants were recruited
through 100% consecutive sampling of new patients o f a
TCM c linic during a pre-designated 5-week period. In-
clusion criteria were: 1) b e ing a ‘new case’ in accordance
to the clinic’s ad ministra tive definition, i.e. a patient who
is seeking treatment for a certain medical condition for
the first time, or presenting at a particular sub-specialty
of the clinic for the first time; 2) if the patient is aged
under 13 or mentally unfit to be interviewed, he/she is
accompanied by a carer who can be the informant; and 3)
the patient or, if applicable, his/her carer can communi-
cate effectively in Cantonese or Putonghua. During the
designated study period, 436 subjects meeting inclusion
criteria were approached. A response rate of 84.2% was
achieved, resulting in 367 completed questionnair e s.
There were 111 (30.2%) male and 256 (69.8%) female.
Mean age was 44.0 years (SD = 17.1).
2) Interviewers: six part-time interviewers were spe-
cifically employed for the study by the investigating in-
stitution. All o f them were retired nurses with around 20
to 30 years of clinical and management experience in
public hospitals in Hong Kong. They were trained on
administering the questio nnaires b y the fir st a utho r, pri n-
cipal investiga t or of the study.
3) measures:
Demographic data: These included gender, age,
marital status, educational lev el, personal and fam-
ily income, type of housing, religious beliefs and
household composition.
Incoming pathway: This section captured p a tie nt s’
help-seeking behaviors in the month prior to first
consultation at the TCM clinic, i.e. (1) methods
used to deal with the presenting health problem,
and (2) frequency of using the me t h o d(s).
Mental Health: The 12-Item General Health Ques-
tionnaire (GHQ-12) [8] is a self-administered
screening instrument for identifying non-psychotic
psychiatric disorders in community settings. It has
been widely used in primary care settings and its
measurement properties have been studied in di-
verse cultur al set tings [ 3]. T he Chinese vers ion ha s
been validated and found to have satisfactory psy-
chometric properties, with sensitivity and specific-
ity at 78% and 77% respectively [9,10]. For esti-
mation of overall prevalence of common mental
disorders, current study adopted the 0-0-1 -1 coding
and a cut-off point of 5 [11].
4) procedures: At any one time during the 5 -week data
collection period, two to three interviewers stationed at
the clinic for conducting interviews following a struc-
tured question naire. All ne w patients were invite d to par-
ticipate in the study. Consented patients were inter-
viewed individually in a room with privacy inside the
clinic. All completed questionnaires were sent to the
principal investigator directly. The clinic had no access
to the collected data.
3. Results
1) Dur ation o f Presenting Problems: Rega rdin g the d ura-
tion of the presenting problems, the key findings are
sum marized in Table 1 b elow.
2) Results sho wed a wide range in the dur atio n of pre-
senting problems. While 31.7% presenting problems had
lasted for less than a month at first consultation, 37.8%
had lasted for over 1 year. Overall, 68.3% presenting
problems had lasted for over 1 month.
3) Treatments Used Prior to First Consultations: Par-
ticipants were asked whether they had employed any
methods to deal with their presenting health problems in
the mo nth pri or to t he first consultation. The major find-
ings are summarized in Table 2 below.
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Table 1. Frequency counts of duration of presenting prob-
lems at first consultation.
f %
1 wk 36 14.6
1-2 wks 14 5.7
2wks -1 mth 28 11.4
1-6 mths 41 16.7
6 mt h s-1 yr 34 13.8
1-5 yrs 40 16.7
5-10 yrs 18 7.3
>10 yrs 34 13.8
Note: f = frequency count.
Table 2. Treatments used on presenting problems in the
month prior to first consultati on.
Methods u sed Pa tie nts reporte d us e
Mean no.
of times
n n/N (%)
Public clinic 97 26.4% 1.5
Private clinic 122 33.2% 1.9
Chinese med i cal clinic 71 19.3% 3.0
Self-m edication: western drug 27 7.4% 1.3
Self-medication: Chinese medicine
24 6.5% 2.4
Others 13 3.5% -
No acti on 89 24.3% -
Note: N = 367. Since some participants had used more than one method to
deal with their presenting pr oble ms, the per centa g es added over 100%.
4) Many patients (75.7%) had sought other treatments
in the month prior to first consultation at the clinic. Us-
ing other private, public and TCM clinics was common
(26.4%, 33.2% and 19.3% patients respectively). These
patients on average had 2.0 consultations elsewhere in
the previous month. Regarding self-medication, 7.4%
and 6.5% patients self-administered Western and Chi-
nese drugs respectively.
5) Mental Health: Mean GHQ-12 score of the sample
was 2.67 (SD 2.91). If a cut-off of 5 was adopted, the
implied overall prevalence of common mental disorders
among new patients of the TCM clinic was 21.0%.
4. Discussions
The clinic handled a significant amount of chronic con-
ditions. Sixty eight percent patients had their presenting
problems which had lasted for over a month at first con-
sultation. Thirty eight percent had even lasted for over a
year. Most patients had sought other treatments and/or
used sel f- medicat ion prior to consultatio n. From an effi-
ciency and effectiveness perspective, it seems necessary
to explore alternative intervention modalities for sup-
plementing the conventional one-to-one medical consul-
tation model. In light of the promising results of the
chronic illness self-management (CISM) model in west-
ern countries [12], it seems worthwhile experimenting
similar programs at TCM clinics. By incorporating cul-
turally relevant elements into CISM, such as some tradi-
tional herbal, dietary and physical health practices, the
programs may be more appealing and motivational to
local patients, leading to better long-ter m compliance.
The findings suggested that common mental disorders
were common amon g new TCM patients, with a n over all
prevalence estimated at 21.0%. Theoretically TCM c lin-
ics may play a role in a community psychiatry frame-
work and help people with mental health problems [13].
To realize these potentials, however, much further work
is st ill ne ed e d . I n li ght o f t he e xp er ie nce i n t he we st, s ub-
stant ial en hance ment o f Chine se medicine undergraduate
syllabus and continued professional training of practicing
RCMPs seems necessary. At the systemic level, it seems
desirable to enco urage multid i sciplinar y co llabor ations at
TCM clinics so as to better addressing the multidimen -
sional needs of patients.
5. Conclusions
Findings of the current study revealed that although the
presenting problems of new patients were all somatic,
common mental disorders were prevalent among them. A
substantial proportion of the presenting problems were
chronic conditions. Chinese medical clinics may pote n -
tially be a good contact point for delivering integrative
mental health care and chronic disease management in
the community.
6. Acknowledgements
The study was funded by Tung Wah Hospital, a non-
profit organiz ation in Hong Kong.
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