Suicide: China's Great Wall of Silence

Despite the high rate of such deaths, depression is still largely ignored. But Beijing may slowly be waking up to mental-health issues

By Bruce Einhorn

By now, readers of BusinessWeek are no doubt accustomed to seeing articles touting China as the new economic superpower that's leading the world in this or that. Biggest cell-phone population. Fastest-growing Internet population. Manufacturing mecca. Favorite location for foreign direct investment. The list goes on and on. But here's one tag the Chinese government could do without: China, suicide center.

Citing the Beijing Suicide Research & Prevention Center, the official China Daily newspaper reported on Nov. 1 that China had 22 suicides for every 100,000 people. The global average is 15 per 100,000. When it comes to Chinese women, it's even worse. In the countryside, where the majority of China's 1.3 billion people live, 30 suicides occur for every 100,000 women, according to Teh-wei Hu, a professor of health economics at the University of California Berkeley, who recently co-wrote a report on the economic costs of depression in China.


  Hu, who along with several colleagues was in Hong Kong last week for a mental-health conference, says the high suicide rates are not only a matter of personal tragedy but one that has economic consequences, too. Hu was the lead researcher in a recently released report that concluded suicide and other consequences of depression cost China at least $3.5 billion a year, placing it second only to the U.S.

The American figure is $43 billion, but the Chinese economy is much smaller. Moreover, $3.5 billion is a preliminary -- and low-end -- estimate, believes Hu. "We want to be conservative," the professor says. "We expect the [actual] number will be much higher."

For years, Western pharmaceutical companies have been looking at China as a potentially lucrative market for antidepressants like Prozac, Paxil, and Zoloft (see BW Online, 04/24/02, "An Attitude with a Fatal Flaw"). Indeed, the organization that sponsored Hu's research, the Social & Economic Burden of Depression Initiative (known as SEBoD), is an Asia-wide group that receives funding from Wyeth Pharmaceuticals (WYE ), which makes the antidepressant Effexor. But even though a market clearly exists, companies have had a hard time in China.


  One reason is that Chinese traditionally have treated mental illness the simple way -- by ignoring it, says He Yanling, the chief doctor at the Shanghai Mental Health Center who worked with Hu on the SEBoD report. "Chinese usually think that psychological problems are shameful to mention," she says.

That's especially dangerous for the rural women, who belong to the highest-risk suicide group in China, she adds. "Usually, women have lower education or no education," He explains. Sometimes their husbands go off to jobs -- and second families -- in the city, leaving their wives behind on the farm, where they have easy access to deadly pesticides. Those women "have less information and less knowledge about how to seek help," says He.

And because of the lack of emergency medical care in the countryside, it's hard for doctors to save those women after they've tried to kill themselves, so attempted suicides succeed.


  Over the years, the Chinese have had political reasons to deny the country's mental-health problems. SEBoD founder Norman Sartorius, former director of the World Health Organization's mental-health program, points out that the Chinese and other Asians have tended to regard depression as something that plagued other places but not their own countries.

"It's a problem of the West," he says of the way the argument is characterized. "The Americans have depression. The English have depression. It's their disease." China has just 1 psychiatrist for every 100,000 people. The Geneva-based Sartorius says in Europe, the average ratio ranges from 1 in 3,000 to 1 in 5,000.

That's a reason that Sartorius, 69, launched SEBoD two years ago. The goal is to help doctors in China and seven other Asian countries fight those ideas and help people with depression get the help they need. (SEBoD sponsor Wyeth would probably like to see that increased awareness turn into increased antidepressant sales.) Sartorius' group is trying to educate doctors and policymakers, reducing the stigma of mental illness and highlighting the need for action.


  Some hopeful signs are emerging that Beijing is more willing to take action. The Shanghai Mental Health Center's He says the government launched its first national mental-health plan in 2002, with a focus on depression, along with schizophrenia and dementia. The same year, China opened its first suicide-prevention center, at Huilongguan Hospital in Beijing. Last month, the State Council (China's Cabinet) unveiled its mental-health policy, spotlighting proposals to target resources at high-risk groups and make it easier for people to get treatment.

China is also upgrading its training for mental-health workers. Until recently, doctors couldn't easily specialize in psychiatry, He says. "If you worked in a psychiatric hospital, you were a psychiatrist," she says. That's now changing, with doctors now getting specialized training.

The attention to mental-health issues and the way China has started dealing with AIDS suggest that Beijing is beginning to behave more responsibly in health policy. Indeed, with the SARS epidemic, the government had a lesson in the costs of pretending that medical emergencies don't exist.


  Yet for all the attention lawmakers are paying to the issue of China's mental-health needs, there's still no great sense of urgency. A proposed mental-health law to protect the rights of patients and provide better access to care has been in the works for 15 years, says He, and chances of any progress in the short term are slim. "It's something in process," she says. "We hope it can be [passed] in five years."

Meanwhile, China's mental-health problems are likely to get worse. When it comes to depression, demographics aren't on the country's side. "The more middle-aged people you have, the more depression you have," says Sartorius. And the wealthier a society is, the more at risk the population is. "As you develop more, depression becomes more and more prominent," he says.

Since depression is already a major problem, the Chinese government will need to do a lot more if it wants to prevent its citizens from taking their own lives.

Einhorn is BusinessWeek's Asia Economics correspondent, based in Hong Kong. Follow the China Journal column every week, only on BW Online

Edited by Patricia O'Connell

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