Campaigners are calling for better treatment of the 30 million people in China who have been diagnosed as clinically depressed. Wang Xiaodong reports.
Mo Qing (not his real name), a 30-year-old university teacher in Zunyi, Guizhou province in southwest China, was diagnosed as being clinically depressed 10 years ago, but his life has frequently been subject to bouts of despondency and dejection.
His condition began to stabilize about a year ago, but he occasionally still experiences temporary outbreaks. "Things are getting much better than before," he said. "Nowadays I can sense every impending outbreak from the symptoms, so I adjust my medication accordingly to handle it."
Although Mo can keep his condition under control and thinks he looks no different from his colleagues, he remembers clearly how he felt when a black depression hit him.
"It is a feeling of endless loss and perplexity. You feel absolutely uncertain about your life, your family, your relationships with others and your future," he said. "You cannot make choices because you believe that whatever decisions you make will result in things getting worse. You feel exhausted, absent-minded, in a melancholy state. You don't know what to do and frequently forget things."
Although he believes he inherited the condition, Mo also suspects that the family environment in which he was raised - during which he was frequently locked in his room by his parents when they went out - contributed to his depression.
"Many patients find it very difficult to seek help from others. I believe it is because, like me, they have very low self-esteem, because they think they are no good, incapable and useless. They firmly believe they will bring trouble to others and they are not worth helping," Mo said.
Patient numbers rise
The number of patients diagnosed with depression in China is estimated to be 30 million, and two-thirds of them are adult women, according to Gao Xiaojun, a spokesman for the Beijing Municipal Commission of Health and Family Planning, who cited a national survey.
However, medical experts say the true figure is likely to be much higher as a result of the low rate of diagnosis.
Earlier this month, the National Health and Family Planning Commission, the nation's top health authority, and 21 other ministries and central government departments jointly released a guideline about improving mental health in China.
The paper called for greater efforts to prevent and lessen the impact of mental illnesses and for improved mental health services at medical institutions and other places, including schools, universities and work places, by 2030.
"Because of the more intense pressure of life in an era of accelerated economic and social transformation, the number of people in China with mental health issues keeps rising year after year, resulting in obvious social problems," the commission said.
At Sunofus, an online forum in China for people with depression, the number of registered members has reached 130,000. Most of them have been diagnosed with depression and are undergoing treatment, according to Mo, who helps to manage the forum.
Most people visit the forum for medical advice, such as seeking the right drugs and how to reduce the side effects of their medication, he said.
"They also communicate and vent their complaints. Here, they find they have met comrades and are not alienated, as they feel they are in society," he added.
Du Xia, a psychiatrist who specializes in the diagnosis and treatment of depression at Beijing Huilongguan Hospital, a leading center for the treatment of depression and mental health issues, said the number of people with depression in the capital is rising. Du receives more than 10 patients on average during each half-day shift, twice as many as 10 years ago, and most of them are women.
More than 90 percent of the patients who consult Du already have serious conditions, and some have repeatedly attempted to take their own lives, she said.
According to research conducted in several hospitals in Shanghai, only one in five people with depression is given a correct diagnosis by non-psychiatric specialist, she said.
"It is very difficult to diagnose depression, even for psychiatrists, because patient may display many different symptoms," she added.
In addition to the most-frequent symptoms, such as loss of appetite, sustained low spirits and loss of interest in life in general, depression can also manifest itself via physical illness such as headaches and diarrhea, she said.
"Patients with these symptoms most likely go to see doctors who specialize in internal diseases, which can often lead to an incorrect diagnosis."
The lively personalities and optimism displayed by some patients may also be deceptive. "Some of my patients look very active and outgoing. But they may become very pessimistic during depressive episodes, as if they have become a different person. According to what they have told me, they feel entirely hopeless, helpless, and the whole world becomes gray," she said.
Zhang Juyi, a psychiatrist at Beijing Anding Hospital, said the exact cause of depression is still unknown, but research suggests that it may be inheritable because people who have close relatives with depression are more likely to have the condition.
Other high-risk factors include malfunctions in certain nerve centers and a change in the level of hormones in the body. However, the most noticeable causes are the psychological impacts that result from traumatic incidents such as the death of a spouse, divorce, unemployment and serious physical disease, according to Zhang.
"Depression not only affects mood, it also results in physical conditions such as loss of appetite, sleep disorders, lack of sexual desire and constant symptoms such as headaches and shortness of breath," he added.
"It's possible that patients can be cured without intervention, but the symptoms can worsen if not treated properly, and that can result in serious consequences, such as suicide."
Support services lacking
Du, from the Beijing Huilongguan Hospital, said that while many patients receive psychological counseling, medication is also necessary for those with serious depression.
In addition to a lack of diagnosis and treatment, a shortage of support services mean patients face major dilemmas when they are sent back to their communities or homes to recover. "Patients with depression should not stay in big hospitals for too long," she said.
Instead, patients are encouraged to recover within their communities and at home, where they can have more social interaction. The approach can be successful, but sometimes support services are lacking.
"Many communities don't have any psychiatrists, or they lack nurses trained to deal with mental health issues. It is not feasible for doctors at big hospitals, who are already extremely busy coping with their own patients, to go into communities regularly to take care of patients," Du said.
Xie Bin, a mental health expert at the Shanghai Mental Health Center, said China faces a shortage of psychiatrists, given the large number of people with mental health issues.
Figures released by the National Health and Family Planning Commission show that there were 27,000 qualified psychiatrists in China at the end of 2015.
However, more than 40,000 psychiatrists are needed to meet the basic demand, according to Xie, and as few universities in China provide majors in fields such as clinical psychology there is a marked scarcity of talent.
"In this area, we need to learn more from developed countries to cultivate specialists," he said. "The government also needs to formulate favorable polices to import such talent from overseas."
According to Du, in addition to the lack of trained professionals, many people have scant knowledge of depression, and show little understanding of their family members, which can result in patients visiting hospitals repeatedly.
"How can a patient recover if he or she returns to their family after treatment, living in the same environment that caused the illness?" she said. "Family members should be more tolerant and understanding and care more about relatives with depression, rather than complaining about them."
Mo, the university teacher who has depression, said patients need strong family support. "Many people develop depression because of the people they are closest to, so all family members should take part in the treatment," he said.
According to Du, women experiencing painful periods, pregnancy or have recently given birth are more likely to suffer from depression, and one possible cause may be a sudden change in the level of hormones in their systems.
"We receive a lot of mothers with depression who have just given birth at the Beijing Obstetrics and Gynecology Hospital. Women in such situations require more attention and understanding from their family members," she said.