Factors associated with primary care workers’ willingness for mental health services

Residents’ mental health problems have become increasingly prevalent in recent years, accompanied by younger onset ages and rising incidence. Psychological distress among the elderly, emotional disorders in adolescents and mental stress in patients with chronic diseases¹ have gradually become prominent public health issues across communities. Against this backdrop, public demand for accessible and convenient mental health services has grown rapidly. As the first point of contact for community residents, primary healthcare institutions play a core role in early screening, preliminary intervention, health education and two-way referral of mental disorders.² Frontline medical workers are the main executors of these services, and their willingness to participate directly determines the implementation quality and sustainability of grassroots mental health care.

This cross-sectional study was conducted among medical staff from 49 community health service centers in Chaoyang District, Beijing. Participants included general practitioners, public health physicians, community nurses and other on-the-job personnel with working experience of no less than one year. We adopted an online anonymous questionnaire for data collection in December 2025. All questionnaires were designed on the basis of literature review and expert consultation. A 5-point Likert scale was used for item scoring. Staff who chose “very willing” and “willing” were defined as the willing group, while others were classified as unwilling. SPSS 26.0 was applied for statistical analysis, and unconditional Logistic regression was used to explore independent influencing factors of service willingness. The survey strictly followed ethical principles. All participants completed the electronic questionnaire anonymously after giving informed consent.

A total of 1840 valid questionnaires were included in the final analysis. The results showed obvious differences in service willingness among different occupational groups: 57.7% of general practitioners, 59.6% of public health physicians and 71.4% of community nurses were willing to carry out mental health work, and the inter-group difference was statistically significant (P < 0.001). Multivariate regression analysis further identified key positive influencing factors. Occupational type was closely related to willingness; community nurses showed significantly higher enthusiasm than other groups (OR = 2.405, 95% CI: 1.504–3.846, P < 0.001). Having professional mental health certificates also greatly improved staff willingness (OR = 2.285, 95% CI: 1.419–3.680, P = 0.001), which is consistent with previous research on general practitioners’ self-efficacy in mental health work.³ In addition, working in institutions with established or under-construction psychological departments effectively promoted participation (OR = 1.996, 95% CI: 1.486–2.692, P < 0.001; OR = 1.918, 95% CI: 1.178–3.122, P = 0.009). By contrast, working years, educational background and professional title exerted no significant effect on willingness (P > 0.05), See Table 1.

Table 1.

Influencing factors of community medical staff's willingness to engage in mental health services.

Variables	B	S.E.	Wald	df	P	OR	95% CI for OR
							Lower	Upper
Occupation category			17.681	3	0.001
Others	ref					1
General practitioner	0.288	0.241	1.427	1	0.232	1.334	0.831	2.141
Public health physician	0.281	0.272	1.071	1	0.301	1.325	0.777	2.258
Community nurse	0.877	0.240	13.412	1	<0.001	2.405	1.504	3.846
Years of working in primary medical care			2.795	4	0.593
≤1 year	ref					1
>1 year and ≤3 years	−0.498	0.378	1.735	1	0.188	0.608	0.290	1.275
>3 years and ≤5 years	−0.490	0.376	1.693	1	0.193	0.613	0.293	1.281
>5 years and ≤10 years	−0.282	0.361	0.610	1	0.435	0.754	0.372	1.530
>10 years	−0.449	0.353	1.618	1	0.203	0.638	0.320	1.275
Certificates (no)	0.826	0.243	11.543	1	0.001	2.285	1.419	3.680
Highest academic degree			0.269	2	0.874
Junior college and below	ref					1
Undergraduate (bachelor's degree)	−0.093	0.180	0.269	1	0.604	0.911	0.640	1.297
Post graduate (master or doctor degree)	−0.081	0.256	0.101	1	0.750	0.922	0.558	1.522
Professional title			0.954	4	0.917
No professional title	ref					1
Primary	−0.149	0.365	0.166	1	0.684	0.862	0.421	1.763
Intermediate	−0.168	0.377	0.199	1	0.655	0.845	0.403	1.770
Associate senior	−0.315	0.442	0.507	1	0.477	0.730	0.307	1.736
Senior	−0.444	0.545	0.664	1	0.415	0.642	0.221	1.866
Psychological departments			21.739	2	0.000
Unestablished	ref				1
Establishing	0.651	0.249	6.864	1	0.009	1.918	1.178	3.122
Established	0.691	0.153	20.534	1	<0.001	1.996	1.480	2.692

More than 60% of respondents reported multiple obstacles to delivering mental health services. The main constraints included insufficient professional capabilities, excessive daily workload, imperfect incentive mechanisms, unclear job responsibilities and worries about occupational risks.⁴ Similar challenges of talent shortage and imperfect service mechanisms have also been reported in primary care settings in other regions.⁵ Although most frontline staff hold a positive attitude towards grassroots mental health work, the above practical difficulties severely restrict the long-term development of such services.

In conclusion, primary care medical staff generally maintain a relatively high willingness to provide mental health services. Professional qualification, occupational category and the construction of on-site psychological departments are critical favorable factors. To meet the growing community needs, targeted professional training systems, reasonable incentive policies and clear responsibility division should be established. Learning from mature collaborative service models abroad⁶ and optimizing supporting conditions will help give full play to the role of primary care teams and promote the steady development of grassroots mental health services.

Ethical considerations

This survey was approved by the Medical Ethics Committee of Capital Medical University (Approval No. Z2025SY036).

Declaration of generative AI and AI-assisted technologies in the writing process

Deepseek (www.deepseek.com) was used to translate into English and polish the sentences of the manuscript. However, it does not fully rely on the AI; all authors reviewed it and made linguistic revisions before submission.

Funding

This project was supported by the Capital Medical University Cooperative Scientific Research Project (CYSYHTZY2025142).

Conflict of interest

The author and corresponding author declare no competing interests.