Everyone experiences periods of sadness and grief, which may last a few days and then go away. Depression, however, is a mental health disorder characterized by a persistent low mood that is accompanied by feelings of guilt, low self-esteem and a loss of interest in normally enjoyable activities. It is a serious, and common, mental health disorder that may lead to suicide in some and has significant economic and social costs.
China’s rapid economic growth, as well as growing social and economic pressures, has increased the awareness about depression, and the number of people it affects. The World Health Organization (WHO) estimates that 350 million people from all ages suffer from depression. Although reliable statistics are difficult to obtain, it is estimated that in China more than 26 million people are affected by depression. The U.S. National Institute of Mental Health (NIMH) estimated in that in the U.S. 16 million adults had had at least one major depressive episode in 2012.
In 2009, the World Health Organization (WHO) stated that mental illness – which affected 7% of the population — had overtaken heart disease and cancer as the biggest burden on China’s health care system. Among its causes are psychological, psychosocial, genetic, and biological factors. In addition, long-term substance abuse may cause or worsen depression symptoms.
People who have experienced adverse life events such as unemployment, bereavement and psychological trauma are more likely to develop depression. Depression can also lead to increased stress and dysfunction, and thus worsen the individual’s life situation. It becomes a vicious cycle that needs to be broken.
Diagnoses of depression go as far back as to the ancient Greek physician Hippocrates who described a condition called melancholia, characterized by mental and physical symptoms. The 16th American president, Abraham Lincoln, suffered from what now may be referred to as clinical depression. Former British Prime Minister Sir Winston Churchill also suffered from it, and popularized the term “the black dog” in reference to it.
Depression is particularly common among those over 65 years of age, for whom unexplained memory loss, sleep problems or withdrawal may be signs of depression. This is particularly relevant in the case of China, since the number of Chinese older than 65 is expected to rise from approximately 100 million in 2005 to more than 329 million in 2050, which is more than the combined populations of Germany, Japan, France and Britain.
Increasingly, however, younger people also are affected by depression. It is possible that changing economic and social dynamics are responsible. The recent economic slowdown in the country, plus changes in the education and social front place increasing stress in the younger generations, some among whom struggle to cope. Anxiety and depression are frequent consequences.
Among adolescents, symptoms of depression include insomnia, fatigue, loss of appetite, lower attention span, apathy and lack of positive expectations. If they suffer from these symptoms for more than two weeks, they are probably suffering from depression.
In some cases, depression can lead to suicide, which has different characteristics than in Europe or the U.S. While in Western countries suicide is more common among men than women, in China suicide is more common among women, particularly rural women. Unlike in the U.S., where men kill themselves with firearms, rural women in China use strong agricultural pesticides that are kept in the house.
It is estimated that 90 percent of Chinese who have committed suicide have never sought psychological care, a situation that needs to be urgently addressed since it can help prevent this kind of outcome. Those living in rural areas also suffer from inadequate emergency care.
Stigma against mental disease –including depression- is still prevalent in China, as well as in most countries around the world. Clinical depression is treatable and, if not addressed, can give rise to serious complications, including suicide.
Effective treatments that include psychotherapy and the use of medication should be made readily available, wherever possible. In addition, the use of local health educators who can outreach to rural communities would be an important step in identifying depression among those who do not have access to mental health resources close to home.