Yao Zhijian, a professor at the Nanjing Neurological and Mental Disease Institution, knows the importance of empathy in treating depression. Provided to China Daily

A scene from the memorial ceremony for Sienna Sai Na in Beijing. The Beijing resident, who suffered from depression, took her own life on Feb 16. Zhang Jin / for China Daily

Top: A doctor plays cards with patients at the Nanjing Brain Hospital. Above: A patient uses embroidery as part of the treatment for her illness at the hospital, which has treated more than 6,000 depressed patients during the past four years. Provided to China Daily

Scourge of depression sees rising number of suicides, report Cang Wei and Song Wenwei in Nanjing.

Every three minutes, a person suffering from depression commits suicide in China and a further 11 people attempt to take their own lives.

Every year in China, 287,000 people end their lives by suicide, while another 2 million contemplate the act, 70 percent of them because of depression.

Sienna, who lived in Beijing's Chaoyang district, was one of these statistics. On Feb 16, the woman in her mid-20s, whose Internet identity was Sienna Sai Na, posted her last message on Weibo before committing suicide.

"Sorry that I'm leaving when so many things have been left untreated and unexplained. Depression is too painful. The world becomes dark and distorted. I can't feel anything beautiful, no matter how hard I try. Death is the only thing I can think of. Grandma is calling me. I'm probably about to become schizophrenic, and I can't take it anymore. Goodbye, everybody."

Statistics from Beijing Anding Hospital, a leading psychiatric institution, show that the number of people with depression in China rises every year.

"A survey conducted by authoritative departments shows that 2.5 percent of the Chinese population suffers from severe depression," said Yao Zhijian, a professor at Nanjng Neurological and Mental Disease Institution.

He added that approximately 100,000 people consult doctors who specialize in treating depression at Nanjing Brain Hospital every year.

"In the past four years, 6,329 patients with depression have been admitted to Nanjing Brain Hospital," he said.

According to the Chinese Center for Disease Control and Prevention, depression increases the risk of attempted suicide by as much as 20 times. Suicide is currently the top cause of death in people aged 15 to 34.

'A crazy dog'

In one post, Sienna described her symptoms and expressed her despair.

"I've been depressed for many years and cannot feel normal people's happiness or enjoy their pursuits. I think I was born indifferent and negative with recent developments, I've almost lost the ability to memorize, think, communicate and behave. I have no sense of direction and cannot organize language. It's like my brain has been kidnapped. I can't even order a meal or send an e-mail. The side effects of the medicine used to alleviate the depression are like a crazy dog that bites my body and soul. Even if I'm lucky enough to be cured, a former mental illness patient who has lost the ability to work cannot make a living in modern society. I'm really afraid of taking the medicine over a long period and of the shadow of a recurrence that may happen any time. I know I'm not one of those strong-willed people. I'm exhausted by dealing with the terrors that haunt me day and night. I'm not willing to live amid people's discussions and sympathy, nor do I want to increase the spiritual and financial burden on my fragile family who have to take care of me."

Qiu, a 33-year-old bank employee in Suzhou in East China's Jiangsu province, who did not want his full name disclosed, said he cried when he read Sienna's words on the Internet.

"Like many depressed patients in China, Sienna was misled and didn't get the right information. If she had known more about depression and had taken the initiative to deal with it, her story might not have ended so tragically."

Qiu was talking from grim personal experience; he struggled with depression for around two years. "It was like I was in hell," he recalled. "Every time I was near a window, no matter whether at home or in the office, I had to suppress a strong desire to jump out of it."

The problem was exacerbated by Qiu's reluctance to discuss his illness with other people, including doctors. "The condition is often considered by many to be connected with other mental disorders such as schizophrenia," he said. "I couldn't imagine being able to lead a normal life if people thought I was mad. I couldn't even let them see me walk into a specialist hospital to seek help."

Qiu admitted that his neglect of treatment, and a tendency to deny that he was severely depressed, led to the deterioration of the illness and drove him to despair.

"Depression is not neuropathy," said He Ruifang, deputy director of Gansu Mental Health Center. "Like a cold or fever, it's an illness and needs to be treated. Patients with depression should not have to struggle with the pressures caused by misunderstanding and discrimination. The patients, their family members and the public need to adopt the correct attitude toward depression."

She added that effective, professional diagnosis and treatment are crucial, to help minimize the risk of patients' self-harming or committing suicide.

Qiu, who has now returned to work, said he deeply regretted his delay in seeking professional help. "A man I met in the hospital spent just six weeks recovering from depression because he didn't feel it shameful to be a patient, so he received immediate and proper treatment."

Zhang Chun, director of Nanjing's Psychological Crisis Intervention Center, said the treatment of depression in China lags far behind that in some developed countries.

"Depression and other mental disorders haven't received enough attention from the government," he said. "The expenses (for the treatment) of depression and related illnesses are not covered by China's medical insurance system, which is partly why some patients choose not to seek treatment."

For Yao, increased awareness of psychological health is the crucial issue. "In some countries, many volunteers living in the community offer help to patients with depression when they are discharged from the hospital. But in China, most patients just stay at home and nobody knows what they're going through. The situation is made worse if they don't have family members around them."

Limited support

Adding to the problems, Chinese doctors are placed under extra pressure by the large numbers of patients they have to treat. "When I stayed in the UK with my supervisor, we only needed to treat two people a day, but in China I usually treat more than 30 patients in a morning," said Yao.

Zhang said, "Compared with general hospitals, mental health hospitals generally receive little government funding and so they are under greater pressure to make ends meet. Limited government support hinders the development of these hospitals and in turn further weakens their ability to meet the patients' needs."

Yao explained that there are two main treatments for depression in China - one relies on the prescription of medicine, while the other is rooted in psychotherapy.

"Both of them come up short. Some doctors just spend a few minutes listening to the patient before scribbling a prescription, while some psychologists, who lack medical school training, insist that depressed patients don't need to consult qualified doctors," he said.

Under Chinese law, psychologists are not allowed to interfere with the medicinal treatment of depression, nor do they have the right to prescribe medicines.

"Because of financial reasons or overconfidence in their diagnosis, some psychologists, who have received short-term training from related organizations or in hospitals, have delayed the necessary treatment of patients with depression," said Yao, who added that many cases have been diagnosed by psychologists who then suggested to the patients that hospitalization was unnecessary.

To tackle the situation in China, in November, Nanjing Brain Hospital adopted new measures to combat depression by establishing a special zone containing 30 beds, where patients can take part in a range of group activities including karaoke, watching movies and playing mahjong or chess, depending on their preference.

Unlike traditional mental health hospitals that have adopted a "closed" management system, under which patients are confined to their rooms, or a "fully open" system, where patients are free to come and go as they please, Nanjing Brain Hospital is the first in China to implement a "semi-open" regime.

"Emotionally stable patients are allowed to leave the hospital for a specified time if their guardians request it, but a return time must be guaranteed and guardians must contact the medical staff if the patients exhibit alarming symptoms when outside the hospital. The aim is to create a comfortable, relaxing environment for them," said Yao, who is in charge of the zone.

"Apart from the semi-open system, our key principle is the provision of individual treatment for each patient under a strict monitoring regime. The doctors and nurses are required to fully understand the patients' conditions and are usually able to predict the development of each patient's illness," he said

However, the limited number of medical staff means that in general doctors are often in charge of more than 10 inpatients at any one time. However, at Nanjing Brain Hospital, each medical worker has fewer patients under his or her control. Staff members are required to identify and understand the patients' strong points and persuade them to develop hobbies.

For example, patients with knowledge of makeup are encouraged to use their skills on the doctors and nurses, while those who play instruments are guaranteed to find an audience for their musical talents.

One woman in her 20s, who attempted suicide by cutting her wrists, refused to listen to anyone when she was first hospitalized. Her depression stemmed from the difficulties she had encountered in finding a job and which resulted in the belief that she was a burden on others.

"Through conversation we discovered that she was a very talented artist, so we suggested that she should draw pictures on the zone's blackboard," said Yao. "Through a combination of praise from a large number of people and the effects of the medicine, she gradually got her confidence back."

The woman has now left the hospital and leads a normal life, but also serves as a volunteer for other patients at the zone.

"In 2012, more than 1,400 patients with depression were admitted to Nanjing Brain Hospital," said Yao. "Although it required the staff to develop higher skill levels, the one-on-one treatment has proved very effective."

Zhang said, "Living in a hospital with a relaxing environment may ameliorate the tensions between the families and the patients, many of whom were straitjacketed and sent to hospital by force. However, ensuring the safety of patients when they are allowed to leave remains a problem."

He suggested that greater public awareness and understanding of depression, allied to government support, early diagnosis and treatment and the adoption of Western psychological principles are of prime importance if the situation facing depressed patients in China is to improve.

"The government, the medical departments and the public have a long way to go," he said. "In China, there's still a great deal to be done."

Contact the writers at cangwei@chinadaily.com.cn and songwenwei@chinadaily.com.cn

(China Daily 02/27/2013 page6)