"I could never remember what happened the day before, and in the afternoon I would forget what I did in the morning. I would fall asleep during class and my classmates couldn't wake me up," she told ThePaper.cn.

Then she was diagnosed with depression. Thunderstruck at first, she gradually traced her symptoms of depression to her high school years. She recalled that at that time she was bullied by other students but the teachers and her family ignored it. She often felt a sharp pain in her chest, especially during exams. She still managed to finish high school and go to university. But this time she felt so awful that she decided to take a break.

Zhang is part of a rapidly rising community of people in China and elsewhere in the world who suffer from depression. Depression is a growing global phenomenon. According to a news release by the World Health Organization (WHO) in 2019, about 54 million people in China suffer from depression and another 41 million from anxiety disorders, while globally more than 264 million people of all ages suffer from depression.

Rising incidence

Mental disorders have been on the rise for three decades, according to the China Mental Health Survey, the first nationwide survey of the kind, whose findings were published in 2019 in health journal Lancet Psychiatry. The survey was funded by the National Health Commission (NHC) and the Ministry of Science and Technology.

More than 16.6 percent of the adults surveyed said they experienced mental illness at some point in their lives. Anxiety disorders were the most common among the disorders, with nearly 7.6 percent of respondents saying they had suffered anxiety disorders, while cases of depression too had increased.

The survey, conducted from 2013 to 2015, was led by Huang Yueqin, Director of the Division of Social Psychiatry and Behavioral Medicine at Peking University's Institute of Mental Health. Over 32,000 people in 31 provincial-level regions were interviewed for mood, anxiety and alcohol- and drug-use disorders, schizophrenia and other psychotic disorders, eating disorders, impulse-control disorder and dementia.

The report warned "rapid social change is likely to bring about a general increase in psychological pressure and stress." Also, with a rapidly aging population, mental healthcare for the elderly will come under serious strain.

People are most susceptible to depression during three periods in their life: when they are between 20 and 30 years, between 50 and 60 years, and when they become senior citizens, Qu Shan, an associate senior physician with the psychiatry department of Peking University People's Hospital, told China News Service.

Depression can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, it can lead to suicide. Suicide is the second leading cause of death for people aged 15-29 years old, according to WHO.

WHO also noted that a majority of people affected by mental disorder in low- and middle-income countries receive no treatment because of inaccurate assessment, social stigma, and a lack of resources or trained healthcare providers.

COVID-19 effect

This year, depression, anxiety and other mental illnesses have been compounded by an unexpected factor, the novel coronavirus disease (COVID-19) epidemic. There have been several studies on the mental conditions of the people in Wuhan and Hubei, where the disease was the most severe, and on the frontline medical workers.

Many COVID-19 survivors and frontline healthcare professionals are struggling with depression, anxiety, and post-traumatic stress disorder, while the general public faces the psychosocial impacts, ranging from the effects of the lockdown to the effects on the economy.

A report titled Epidemic of COVID-19 in China and Associated Psychological Problems, published in the Asian Journal of Psychiatry in June, said a sudden outbreak of a disease always poses a threat to the mental health of those affected and their close contacts, including their families and medical personnel. A similar situation arose during the outbreak of the severe acute respiratory syndrome in 2003 too.

Some of the key findings of the study were a higher rate of anxiety, depression and lower mental wellbeing among the respondents. Depression and harmful alcohol use were higher in Hubei residents while people aged 21-40 were more affected mentally.

The study noted that the NHC has introduced guidelines for emergency psychological crisis intervention and an online counseling platform.

Tackling challenges

For those with depression, it is important to have other people's understanding, especially from their families. But understanding does not come easily. One month after Zhang went back home from her university in Wuhan, her condition deteriorated. She couldn't read or think and found it hard to communicate with other people. It would take her a long time to say a simple sentence. She said her parents didn't believe she had depression and told others she had come home to rest.

Yao Zhijun, a psychologist specializing in psychological counseling for university students, told ThePaper.cn some parents don't accept the diagnosis that their children have depression and don't agree that they should take medicines. As a result, medical treatment is delayed.

Shi Shen, Director of the psychiatry department of Huashan Hospital Affiliated with Fudan University in Shanghai, added that while depression can be controlled through standard treatment, only 20 percent of the people with depression get treated. Although the treatment rate has improved with the dissemination of information and education among the public, it's still not very high.

There is also a shortage of professional doctors for mental disorders. According to the Mental Health Atlas 2017 published by WHO, there were only 2.2 psychiatrists for every 100,000 people in China.

The geographical distribution of medical resources is also uneven. Of the 10 best psychiatry hospitals in China, seven are in the east. The 11 provinces and cities in east China have nearly half of all psychiatry medical institutions, psychiatrists, psychiatric nurses and hospital beds.

The government has stepped up measures to address the challenges. The Healthy China 2030 Initiative published by the NHC in 2019 has set a goal: The percentage of those suffering from depression that receive treatment will increase by 30 percent by 2022, and by 80 percent by 2030.

It also targets ensuring the number of psychiatrists per 100,000 people is at least 3.3 by 2022 and 4.5 by 2030.

Besides, a community mental disorder rehabilitation and service system will be built, involving psychiatrist institutions, community rehabilitation institutions, social organizations and families.

The NHC released a plan on prevention and treatment of depression on September 11, focusing on students. It said high schools and colleges should include screening for depression in students' checkups, evaluate students' psychological health, and pay special attention to students identified with psychological problems.

It also set the target of increasing the public's awareness of depression prevention and treatment knowledge.

(Print Edition Title: Coming Out of The Shadows)  

Copyedited by Sudeshna Sarkar

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