Background: Chronic obstructive pulmonary disease (COPD) and mental health conditions represent intersecting public health challenges, especially in resource-limited rural China. Existing care models often neglect the psychosocial needs of populations at high risk for COPD, resulting in limited effectiveness of prevention and management strategies. This study evaluates an integrated intervention designed to improve both mental and physical health outcomes among high-COPD-risk individuals with mental health symptoms, using a population medicine framework.
Objective: This study aims to evaluate the effect of an integrated, population medicine-based multimorbidity intervention package among high-COPD-risk individuals with mental health symptoms in Xishui County, Guizhou Province, China.
Methods: We are conducting a 12-month, 2-arm cluster randomized controlled trial across 26 townships in Xishui County, Guizhou, China. A total of 44,000 residents aged ≥35 years were screened using the Chronic Obstructive Pulmonary Disease Screening Questionnaire, identifying 10,000 individuals at high risk of COPD. Among them, 3807 individuals with Warwick-Edinburgh Mental Well-Being Scale scores below 45 were enrolled as participants. Intervention components include digital cognitive behavioral therapy-based mental health support, community screening, chronic disease management, patient education, digital follow-up, and team-based care. The primary outcomes are depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item General Anxiety Disorder), and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes are control of chronic diseases, physiological and functional indicators such as lung function, health-related quality of life, mental and behavioral health, health care utilization, knowledge of COPD and asthma, productivity loss, and care cascade indicators for chronic conditions.
Results: Data collection for the POPMIX-MH trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and the 12-month follow-up assessments are planned to be completed in March 2026.
Conclusions: This study is the first to integrate psychological support, chronic disease management, and community-based screening into a single scalable intervention package targeting multimorbidity in China. It tests the feasibility of applying population medicine principles, emphasizing integrated, preventive, and population-level care, within primary care systems in low-resource settings. By targeting both mental and physical health, it redefines chronic care beyond traditional organ-specific approaches.
Trial registration: ClinicalTrials.gov NCT06458218; https://clinicaltrials.gov/ct2/show/NCT06458218.
International registered report identifier (irrid): DERR1-10.2196/85853.
Keywords: COPD; China; anxiety; cluster randomized trial; depression; digital health; multimorbidity; population medicine.
©Yuhao Liu, Wenjin Chen, Shiyu Zhang, Yingping Wang, Zhoutao Zheng, Ke Huang, Xingyao Tang, Zhong Cao, Xunliang Tong, Lei Tang, Jinghan Zhao, Liu He, Lirui Jiao, Tianying Zhao, Yingchi Luo, Qiande Lai, Xiangqin Lyu, Qiushi Chen, Aditi Bunker, Sebastian Vollmer, Pascal Geldsetzer, Dean Jamison, Till Bärnighausen, Ting Yang, Simiao Chen, Chen Wang, POPMIX Group. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 06.03.2026.