Daoxin Yin: A long way to go to help people with depression in China

daoxin_yinAt the last mid Autumn festival holiday—a traditional festival for a family reunion in China—a young actor and singer with a promising future committed suicide at the age of 28. He had been diagnosed with depression and treated for many years. In response to his last blog on Sina Weibo—a hybrid of Twitter and Facebook with hundreds of millions of users in China—over one million of his followers mourned his death. 

His death also triggered a new round of online discussions about depression. In 2005, a famous Chinese talk show host, Yongyuan Cui, admitted that he had suffered from severe depression. Back then, many Chinese people heard about depression for the first time. Ten years have passed and knowledge about depression among the public is still limited. Misunderstandings due to social stigma form barriers for people seeking help. A common perception of depression is that it is an emotional disorder, and not a disease, and merely affects people who are “mentally weak or hypersensitive.” Another misunderstanding about depression is that it can be self-treated by using willpower. An online survey of mental disorders in 2012 illustrated that three-fourths of respondents claimed that they would not need mental health services. Social stigma against mental illness causes a sense of shame and makes people reluctant to look for mental health services. Uncontrolled depression makes patients more emotionally and socially isolated.

According to an epidemiological survey published in 2009, the prevalence of depression is 1.8% to 3.6%. These numbers seem to be far below the average prevalence of depression around the world. However, the survey was only conducted in Shanghai and Beijing, which meant around 70% of the Chinese population who live in rural areas were not represented. Another survey done on a larger scale conducted during a similar period found that rural residents were affected much more by depression than urban residents.

Based on a WHO report, mental illnesses account for approximately 18% of the global burden of disease in China, but the current surveillance system to monitor this and the resources available to treat mental disorders are insufficient. In an annual report released by the National Health and Family Planning Commission of the People’s Republic of China in 2013, only an aggregated prevalence for mental diseases was reported, which is obviously insufficient to map the current epidemic and treatment for depression as well as other mental disorders across the country. Mental health professionals are limited in China. There are only 1.57 psychiatrists to provide specialized mental health services for every 100,000 people, and the number of psychologists is 0.18 per 100,000 people. Besides, the quality of mental health services varies geographically with the majority of trained mental health professionals working in big cities.

Relevant policies and financial support are crucial and work as the foundation for systematic improvements in depression treatment and control. A sophisticated surveillance system should be developed to collect data and better understand the current conditions in diagnosing and treating mental illnesses. Resources should go to building up social support mechanisms for helping patients with mental illness adapt to changes in their lives. Currently, few individuals, such as social workers receiving professional training, and specialized facilities provide sustainable social supports for those patients in China. Education campaigns can help in raising awareness and eliminating the stigma against people with depression and other mental illnesses.

Daoxin Yin, the China editor of The BMJ.

Competing interests: None.