Skip to main content Accessibility help

Implementing collaborative care for older people with comorbid hypertension and depression in rural China

  • Lydia W. Li (a1), Jiang Xue (a2), Yeates Conwell (a3), Qing Yang (a4) and Shulin Chen (a2)...



Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team—village doctor (VD), aging worker (AW), and psychiatrist consultant—provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation.


Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis.


COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders’ support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members’ caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs.


COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.


Corresponding author

Correspondence should be addressed to: Lydia W. Li, School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109-1106, USA. Phone: +1 734 936 4850, Fax: +1 734 763-3372. Email:


Hide All
Archer, J. et al. (2012). Collaborative care for depression and anxiety problems. Cochrane Database System Review, 10, Cd006525.
Chen, S. et al. (2018). Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study. BMC Geriatrics, 18, 124.
Chobanian, A.V. et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA, 289, 25602572.
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 15691577.
Ho, C., Feng, L., Fam, J., Mahendran, R., Kua, E.H. and Ng, T.P. (2014). Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults. International Psychogeriatrics, 26, 12211229.
Komaromy, M. et al. (2016). Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders. Substance Abuse, 37, 2024.
Krousel-Wood, M.A. and Frohlich, E.D. (2010). Hypertension and depression: coexisting barriers to medication adherence. Journal of Clinical Hypertension, 12, 481486.
Li, Z., Li, Y., Chen, L., Chen, P. and Hu, Y. (2015). Prevalence of depression in patients with hypertension: a systematic review and meta-analysis. Medicine, 94, e1317.
Liu, L.S. (2011). 2010 Chinese guidelines for the management of hypertension. Zhonghua xin xue guan bing za zhi, 39, 579615.
May, C. and Finch, T. (2009). Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology, 43, 535554.
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V. and Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet, 370, 851858.
Overbeck, G., Davidsen, A.S. and Kousgaard, M.B. (2016). Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review. Implementation Science, 11, 165.
Patel, V. and Hanlon, C. (2018). Where There Is No Psychiatrist: A Mental Health Care Manual. Cambridge: Royal College of Psychiatrists.
Ramos-Rios, R., Mateos, R., Lojo, D., Conn, D.K. and Patterson, T. (2012). Telepsychogeriatrics: a new horizon in the care of mental health problems in the elderly. International Psychogeriatrics, 24, 17081724.
Rubio-Guerra, A.F., Rodriguez-Lopez, L., Vargas-Ayala, G., Huerta-Ramirez, S., Serna, D.C. and Lozano-Nuevo, J.J. (2013). Depression increases the risk for uncontrolled hypertension. Experimental and Clinical Cardiology, 18, 1012.
Sandstrom, Y.K., Ljunggren, G., Wandell, P., Wahlstrom, L. and Carlsson, A.C. (2016). Psychiatric comorbidities in patients with hypertension—a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden. Journal of Hypertension, 34, 414420; discussion 420.
Scalco, A.Z., Scalco, M.Z., Azul, J.B. and Lotufo Neto, F. (2005). Hypertension and depression. Clinics (Sao Paulo), 60, 241250.
Scherrer, J.F. et al. (2003). A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosomatic Medicine, 65, 548557.
The Lancet. (2015). Mental health in China: what will be achieved by 2020? The Lancet, 385, 2548.
Tse, S., Ran, M.S., Huang, Y. and Zhu, S. (2013). Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in China. Psychiatric Services, 64, 613616.
Unutzer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 28362845.
Unutzer, J. et al. (2008). Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care, 14, 95100.
von Humboldt, S. (2016). Demographic change: an aging world. In: von Humboldt, Conceptual and Methodological Issues on the Adjustment to Aging (pp. 119). Dordrecht: Springer.
Wagstaff, A., Yip, W., Lindelow, M. and Hsiao, W.C. (2009). China’s health system and its reform: a review of recent studies. Health Economics, 18, S7S23.
Wang, P.S., Bohn, R.L., Knight, E., Glynn, R.J., Mogun, H. and Avorn, J. (2002). Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. Journal of General Internal Medicine, 17, 504511.
Wilberforce, M., Tucker, S., Abendstern, M., Brand, C., Giebel, C.M. and Challis, D. (2013). Membership and management: structures of inter-professional working in community mental health teams for older people in England. International Psychogeriatrics, 25, 14851492.
Wood, E., Ohlsen, S. and Ricketts, T. (2017). What are the barriers and facilitators to implementing collaborative care for depression? A systematic review. Journal of Affective Disorders, 214, 2643.
Zhang, J., Ye, M., Huang, H., Li, L. and Yang, A. (2008). Depression of chronic medical inpatients in China. Archives of Psychiatric Nursing, 22, 3949.


Implementing collaborative care for older people with comorbid hypertension and depression in rural China

  • Lydia W. Li (a1), Jiang Xue (a2), Yeates Conwell (a3), Qing Yang (a4) and Shulin Chen (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed