Tibetan primary care providers' work conditions and patient depression management: a quantitative analysis using job...

Exacerbated by the COVID-19 pandemic, depression is an increasing global challenge, mainly treated by primary care providers (PCPs) in China. China's national health plans are interpreted, piloted and integrated at the local level, where Tibet's geographical remoteness, economic underdevelopment and a shortage of skilled PCPs create unique challenges to managing depression. Using the job demands-resources model, this study aims to assess the competency of PCPs in Tibetan primary health centres (PHCs) to deliver depression-related services and explores factors related to their competency.

A cross-sectional survey was conducted from October to December 2023, with 121 PCPs from 22 PHCs in Tibet. The study gathered data on work intensity (WI), work stress, job satisfaction (JS), work engagement and competency in depression-related services. Analyses included descriptive statistics, Spearman rank correlation coefficients and mediation regression using bias-corrected bootstrapping.

Only 21% of PCPs achieved the maximum competency score in delivering depression-related services, while 41% scored 0, indicating substantial knowledge gaps. WI (p < 0.05) was negatively associated, and JS (p < 0.05) positively associated, with competency. Work stress (p < 0.05) partially mediated the negative relationship between WI and competency, and work engagement (p < 0.05) partially mediated the positive relationship between JS and competency. PCPs who had read depression clinical guidelines or received training demonstrated significantly higher competency.

The findings identified the need to improve the capacity of PCPs to deliver effective depression-related services. We recommend implementing policies to reduce excessive WI and work stress, to enhance JS through a supportive work environment and to develop comprehensive depression training to bridge PCPs' knowledge gaps.