Impact of the Population Medicine Multimorbidity Intervention in Xishui County (POPMIX) on People at High Risk for Chronic Obstructive Pulmonary Disease Who Experience Mental Health Symptoms: Protocol for the POPMIX-MH Cluster Randomized Controlled Trial.

A large-scale screening of rural residents identified a substantial proportion at high risk for COPD and with mental health symptoms.

• A total of 44,000 residents aged ≥35 years were screened using the Chronic Obstructive Pulmonary Disease Screening Questionnaire.
• Screening identified 10,000 individuals at high risk of COPD.
• Among high-risk individuals, 3,807 were identified with Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) scores below 45 and enrolled as trial participants.
• The study is conducted across 26 townships in Xishui County, Guizhou Province, China.

The POPMIX-MH trial uses a cluster randomized controlled trial design with a 12-month follow-up period.

• The trial is a 12-month, 2-arm cluster randomized controlled trial.
• Randomization occurs at the township level across 26 townships.
• Data collection began in June 2024.
• Baseline, 3-month, and 6-month assessments have been completed, with 12-month follow-up planned for completion in March 2026.

The intervention package integrates multiple components targeting both mental and physical health within a population medicine framework.

• Intervention components include digital cognitive behavioral therapy (CBT)-based mental health support, community screening, chronic disease management, patient education, digital follow-up, and team-based care.
• The intervention is designed to be scalable and applicable within primary care systems in low-resource settings.
• The framework applies population medicine principles emphasizing integrated, preventive, and population-level care.

The primary outcomes of the trial are depressive symptoms, anxiety symptoms, and mental well-being.

• Depressive symptoms are measured using the 9-item Patient Health Questionnaire (PHQ-9).
• Anxiety symptoms are measured using the 7-item General Anxiety Disorder scale (GAD-7).
• Mental well-being is measured using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).
• Enrollment criterion for mental health was a WEMWBS score below 45.

The trial includes a broad set of secondary outcomes spanning physical health, quality of life, health care utilization, and economic productivity.

• Secondary outcomes include control of chronic diseases, physiological and functional indicators such as lung function, and health-related quality of life.
• Additional secondary outcomes include mental and behavioral health, health care utilization, knowledge of COPD and asthma, and productivity loss.
• Care cascade indicators for chronic conditions are also included as secondary outcomes.

The authors describe POPMIX-MH as the first study to integrate psychological support, chronic disease management, and community-based screening into a single scalable intervention package targeting multimorbidity in China.

• The study targets the intersection of COPD risk and mental health conditions, which are described as 'intersecting public health challenges, especially in resource-limited rural China.'
• The authors note that 'existing care models often neglect the psychosocial needs of populations at high risk for COPD.'
• The study aims to redefine 'chronic care beyond traditional organ-specific approaches' by targeting both mental and physical health simultaneously.
• The trial tests the feasibility of population medicine principles within primary care systems in low-resource settings.