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{{Short description|Health and wellness issue}}
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'''Mental health in China''' is a growing issue. Experts have estimated that about 173 million people living in [[China]] are suffering from a [[mental disorder]].<ref name=":12"/> The desire to seek treatment is largely hindered by China's strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony.<ref name=":3" />
'''Mental health in China''' is a growing issue. Experts have estimated that about 130 million adults living in [[China]] are suffering from a [[mental disorder]].<ref name=":12">{{Cite journal|last1=Xiang|first1=Yu-Tao|last2=Yu|first2=Xin|last3=Sartorius|first3=Norman|last4=Ungvari|first4=Gabor S|last5=Chiu|first5=Helen FK|date=November 2012|title=Mental health in China: challenges and progress|journal=The Lancet|volume=380|issue=9855|pages=1715–1716|doi=10.1016/s0140-6736(11)60893-3|issn=0140-6736|pmid=23158236|s2cid=39124942}}</ref><ref name=":11" /> The desire to seek treatment is largely hindered by China's strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and [[Group cohesiveness|social harmony]].<ref name=":3" />


== History ==
== History ==
[[China]]'s first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor [[John Glasgow Kerr|John G. Kerr]] opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.<ref>{{Cite journal|title=The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications|volume=98|issue=9|pages=1593|journal=American Journal of Public Health|language=en|doi=10.2105/ajph.2008.134577|pmc=2509595|pmid=18633073|year=2008|last1=Blum|first1=N.|last2=Fee|first2=E.}}</ref>
[[China]]'s first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor [[John Glasgow Kerr|John G. Kerr]] opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.<ref>{{Cite journal|title=The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications|volume=98|issue=9|pages=1593|journal=American Journal of Public Health|language=en|doi=10.2105/ajph.2008.134577|pmc=2509595|pmid=18633073|year=2008|last1=Blum|first1=N.|last2=Fee|first2=E.}}</ref>


In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the [[Cultural Revolution]].<ref name=":2">{{Cite journal|last1=LIU|first1=JIN|last2=MA|first2=HONG|last3=HE|first3=YAN-LING|last4=XIE|first4=BIN|last5=XU|first5=YI-FENG|last6=TANG|first6=HONG-YU|last7=LI|first7=MING|last8=HAO|first8=WEI|last9=WANG|first9=XIANG-DONG|date=October 2011|title=Mental health system in China: history, recent service reform and future challenges|journal=World Psychiatry|volume=10|issue=3|pages=210–216|issn=1723-8617|pmc=3188776|pmid=21991281|doi=10.1002/j.2051-5545.2011.tb00059.x}}</ref>
In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the [[Cultural Revolution]].<ref name=":2">{{Cite journal|last1=Liu|first1=Jin|last2=Ma|first2=Hong|last3=He|first3=Yan-Ling|last4=Xie|first4=Bin|last5=Xu|first5=Yi-Feng|last6=Tang|first6=Hong-Yu|last7=Li|first7=Ming|last8=Hao|first8=Wei|last9=Wang|first9=Xiang-Dong|date=October 2011|title=Mental health system in China: history, recent service reform and future challenges|journal=World Psychiatry|volume=10|issue=3|pages=210–216|issn=1723-8617|pmc=3188776|pmid=21991281|doi=10.1002/j.2051-5545.2011.tb00059.x}}</ref>


In a meeting jointly held by Chinese ministries and the [[World Health Organization]] in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care.<ref name=":2" /> The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.
In a meeting jointly held by Chinese ministries and the [[World Health Organization]] in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care.<ref name=":2" /> The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.


In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.<ref>{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK44249/|title=Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health|last1=(us)|first1=Office of the Surgeon General|last2=(us)|first2=Center for Mental Health Services|last3=(us)|first3=National Institute of Mental Health|date=2001-08-01|publisher=Substance Abuse and Mental Health Services Administration (US)|language=en}}</ref>
In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.<ref>{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK44249/|title=Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health|last1=(us)|first1=Office of the Surgeon General|last2=(us)|first2=Center for Mental Health Services|last3=(us)|first3=National Institute of Mental Health|date=August 1, 2001|publisher=Substance Abuse and Mental Health Services Administration (US)|language=en}}</ref>


Since 2006, the government's 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses.<ref>{{Cite journal|last1=Good|first1=Byron J.|last2=Good|first2=Mary-Jo DelVecchio|date=June 2012|title=Significance of the 686 Program for China and for global mental health|journal=Shanghai Archives of Psychiatry|volume=24|issue=3|pages=175–177|doi=10.3969/j.issn.1002-0829.2012.03.008|issn=1002-0829|pmc=4198850|pmid=25324623}}</ref> These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.
Since 2006, the government's 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses.<ref>{{Cite journal|last1=Good|first1=Byron J.|last2=Good|first2=Mary-Jo DelVecchio|date=June 2012|title=Significance of the 686 Program for China and for global mental health|journal=Shanghai Archives of Psychiatry|volume=24|issue=3|pages=175–177|doi=10.3969/j.issn.1002-0829.2012.03.008|issn=1002-0829|pmc=4198850|pmid=25324623}}</ref> These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.


In 2011, the legal institution of China's State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalized against their will.<ref>[http://thinkingchinese.com/index.php?page_id=303 中国出台法律防止"被精神病"侵犯人权 – China published a law, guarding against the violation of human rights as mental patients are hospitalized by force] (bilingual), [http://thinkingchinese.com Thinking Chinese], June 13, 2011</ref> The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, stipulates that a qualified [[psychiatrist]] must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment.<ref>{{cite news|url=https://www.reuters.com/article/us-china-mentalhealth-idUSBRE89P0CS20121026|title=China adopts mental health law to curb forced treatment|date=2012-10-26|access-date=2012-10-27|work=Reuters}}</ref><ref>{{cite news|url=http://news.xinhuanet.com/english/china/2012-10/25/c_131930348.htm|archive-url=https://web.archive.org/web/20121029205038/http://news.xinhuanet.com/english/china/2012-10/25/c_131930348.htm|url-status=dead|archive-date=October 29, 2012|title=China Voice: Mental health law can better protect human rights|date=2012-10-25|access-date=2012-10-27|agency=Xinhua}}</ref> However, [[Human Rights Watch]] has criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a [[mental health tribunal]] and no guarantee of legal representation.<ref>[https://www.hrw.org/news/2013/05/03/china-end-arbitrary-detention-mental-health-institutions China: End Arbitrary Detention in Mental Health Institutions] Human Rights Watch, May 3, 2013</ref>
In 2011, the legal institution of China's State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalized against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, stipulates that a qualified [[psychiatrist]] must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment.<ref>{{cite news|url=https://www.reuters.com/article/us-china-mentalhealth-idUSBRE89P0CS20121026|title=China adopts mental health law to curb forced treatment|date=October 26, 2012|access-date=October 27, 2012|agency=Reuters}}</ref><ref>{{cite news|url=http://news.xinhuanet.com/english/china/2012-10/25/c_131930348.htm|archive-url=https://web.archive.org/web/20121029205038/http://news.xinhuanet.com/english/china/2012-10/25/c_131930348.htm|url-status=dead|archive-date=October 29, 2012|title=China Voice: Mental health law can better protect human rights|date=October 25, 2012|access-date=October 27, 2012|agency=Xinhua News Agency}}</ref> However, [[Human Rights Watch]] has criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a [[mental health tribunal]] and no guarantee of legal representation.<ref>[https://www.hrw.org/news/2013/05/03/china-end-arbitrary-detention-mental-health-institutions China: End Arbitrary Detention in Mental Health Institutions] Human Rights Watch, May 3, 2013</ref>


Since 1993, WHO has been [[WHO Collaborating Centres|collaborating]] with China in the development of a national mental [[health information system]].<ref>{{cite web|url=http://ssrd.rfmh.org/who/projects.html|title=World Health Organization Collaborating Center for Training and Research in Mental Health and the Prevention of Substance Abuse|publisher=WHO Collaborating Center at NKI|archive-url=https://web.archive.org/web/20120218153457/http://ssrd.rfmh.org/who/projects.html|archive-date=2012-02-18|access-date=2016-10-20}}</ref>
Since 1993, WHO has been [[WHO Collaborating Centres|collaborating]] with China in the development of a national mental [[health information system]].<ref>{{cite web|url=http://ssrd.rfmh.org/who/projects.html|title=World Health Organization Collaborating Center for Training and Research in Mental Health and the Prevention of Substance Abuse|publisher=WHO Collaborating Center at NKI|archive-url=https://web.archive.org/web/20120218153457/http://ssrd.rfmh.org/who/projects.html|archive-date=February 18, 2012|access-date=October 20, 2016}}</ref>


== Current situation ==
== Current situation ==
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=== Prevalence of mental disorders ===
=== Prevalence of mental disorders ===
Researchers estimate that roughly 173 million people in China have a mental disorder.<ref name=":12">{{Cite journal|last1=Xiang|first1=Yu-Tao|last2=Yu|first2=Xin|last3=Sartorius|first3=Norman|last4=Ungvari|first4=Gabor S|last5=Chiu|first5=Helen FK|date=November 2012|title=Mental health in China: challenges and progress|journal=The Lancet|volume=380|issue=9855|pages=1715–1716|doi=10.1016/s0140-6736(11)60893-3|pmid=23158236|s2cid=39124942|issn=0140-6736}}</ref> Over 90 percent of people with a mental disorder have never been treated.{{Citation needed|date=June 2020}}
Researchers estimate that roughly 130 million people in China over the age of 18 suffer from mental illness in any given year.<ref name=":11">{{Cite journal|last1=Huang|first1=Yueqin|last2=Wang|first2=Yu|last3=Wang|first3=Hong|last4=Liu|first4=Zhaorui|last5=Yu|first5=Xin|last6=Yan|first6=Jie|last7=Yu|first7=Yaqin|last8=Kou|first8=Changgui|last9=Xu|first9=Xiufeng |last10=Lu |first10=Jin|last11=Wang|first11=Zhizhong|last12=He|first12=Shulan|last13=Xu|first13=Yifeng|last14=He|first14=Yanling|last15=Li|first15=Tao|date=March 1, 2019|title=Prevalence of mental disorders in China: a cross-sectional epidemiological study|journal=The Lancet Psychiatry|volume=6|issue=3|pages=211–224|doi=10.1016/S2215-0366(18)30511-X|pmid=30792114|issn=2215-0366}}</ref>
[[File:Bipolar disorder world map - DALY - WHO2004.svg|thumb|right|300px|The map of [[disability-adjusted life years]] shows the disproportionate impact on the quality of life for persons with [[bipolar disorder]] in China and other [[East Asia]]n countries.]]
Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a [[mood disorder]], including 6 percent of people with [[major depressive disorder]].<ref>{{Cite journal|last1=Phillips|first1=Michael R|last2=Zhang|first2=Jingxuan|last3=Shi|first3=Qichang|last4=Song|first4=Zhiqiang|last5=Ding|first5=Zhijie|last6=Pang|first6=Shutao|last7=Li|first7=Xianyun|last8=Zhang|first8=Yali|last9=Wang|first9=Zhiqing|date=June 2009|title=Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey|journal=The Lancet|volume=373|issue=9680|pages=2041–2053|doi=10.1016/s0140-6736(09)60660-7|pmid=19524780|s2cid=5990225|issn=0140-6736}}</ref> Thirteen percent of the population had an [[anxiety disorder]] and 9 percent had an [[Alcoholism|alcohol use disorder]]. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.


In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.<ref>{{cite web|url=http://www.abc.net.au/worldtoday/content/2007/s2105125.htm|title=The World Today – China launches major reform of mental health services|publisher=Australian Broadcasting Corporation|access-date=October 3, 2018}}</ref>
A lack of government data on mental disorders makes it difficult to estimate the prevalence of specific mental disorders, as China has not conducted a national psychiatric survey since 1993.<ref name=":12"/>[[File:Bipolar disorder world map - DALY - WHO2004.svg|thumb|right|300px|The map of [[disability-adjusted life years]] shows the disproportionate impact on the quality of life for persons with [[bipolar disorder]] in China and other [[East Asia]]n countries.]]Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a [[mood disorder]], including 6 percent of people with [[major depressive disorder]].<ref>{{Cite journal|last1=Phillips|first1=Michael R|last2=Zhang|first2=Jingxuan|last3=Shi|first3=Qichang|last4=Song|first4=Zhiqiang|last5=Ding|first5=Zhijie|last6=Pang|first6=Shutao|last7=Li|first7=Xianyun|last8=Zhang|first8=Yali|last9=Wang|first9=Zhiqing|date=June 2009|title=Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey|journal=The Lancet|volume=373|issue=9680|pages=2041–2053|doi=10.1016/s0140-6736(09)60660-7|pmid=19524780|s2cid=5990225|issn=0140-6736}}</ref> Thirteen percent of the population had an [[anxiety disorder]] and 9 percent had an [[Alcoholism|alcohol use disorder]]. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.<ref>{{cite web|url=http://www.abc.net.au/worldtoday/content/2007/s2105125.htm|title=The World Today – China launches major reform of mental health services|website=abc.net.au|access-date=3 October 2018}}</ref>


There is a disproportionate impact on the quality of life for people with [[bipolar disorder]] in China and other [[East Asia]]n countries.
There is a disproportionate impact on the quality of life for people with [[bipolar disorder]] in China and other [[East Asia]]n countries.


The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999.<ref name=":12"/> Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62 percent of incidences.<ref name="who.int">{{cite web|url=https://www.who.int/mental_health/resources/suicide_prevention_asia.pdf|title=Archived copy|archive-url=https://web.archive.org/web/20110824021443/http://www.who.int/mental_health/resources/suicide_prevention_asia.pdf|archive-date=2011-08-24|url-status=dead|access-date=2011-07-30}}</ref>
The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999.<ref name=":12"/> Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62 percent of incidences.<ref name="who.int">{{cite web|url=https://www.who.int/mental_health/resources/suicide_prevention_asia.pdf|title=Archived copy|archive-url=https://web.archive.org/web/20110824021443/http://www.who.int/mental_health/resources/suicide_prevention_asia.pdf|archive-date=August 24, 2011|url-status=dead|access-date=July 30, 2011}}</ref>


=== Stigma related to cultural and folk beliefs ===
=== Stigma related to cultural and folk beliefs ===
It is estimated that 18 percent of the Chinese population, about 244 million people believe in Buddhism.<ref name=":0">{{Cite web|url=http://www.globalreligiousfutures.org/explorer/custom#/?subtopic=15&countries=China&chartType=pie&data_type=percentage&year=2010&religious_affiliation=all&gender=all|title=Religion Statistics and Information {{!}} GRF|website=globalreligiousfutures.org|language=en|access-date=2018-10-21}}</ref> Another 22 percent of the population, roughly 294 million people believe in folk religions<ref name=":0" /> which are a group of beliefs that share characteristics with [[Confucianism]], [[Buddhism]], [[Taoism]], and [[shamanism]].<ref name=":3">{{Cite web|url=http://hirr.hartsem.edu/ency/Asian.htm|title=Content Pages of the Encyclopedia of Religion and Social Science|website=hirr.hartsem.edu|access-date=2018-10-21}}</ref> Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honoring one's family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.
It is estimated that 18 percent of the Chinese population, about 244 million people, believe in Buddhism.<ref name=":0">{{Cite web|url=http://www.globalreligiousfutures.org/explorer/custom#/?subtopic=15&countries=China&chartType=pie&data_type=percentage&year=2010&religious_affiliation=all&gender=all|title=Religion Statistics and Information {{!}} GRF|website=globalreligiousfutures.org|language=en|access-date=October 21, 2018}}</ref> Another 22 percent of the population, roughly 294 million, people believe in folk religions<ref name=":0" /> which are a group of beliefs that share characteristics with [[Confucianism]], [[Buddhism]], [[Taoism]], and [[shamanism]].<ref name=":3">{{Cite web|url=http://hirr.hartsem.edu/ency/Asian.htm|title=Content Pages of the Encyclopedia of Religion and Social Science|website=hirr.hartsem.edu|access-date=October 21, 2018}}</ref> Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honoring one's family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience [[social isolation]].


Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations<ref>{{Cite journal|title=Factors that influence Asian communities' access to mental health care|journal = International Journal of Mental Health Nursing|volume = 14|issue = 2|pages = 88–95|last1=Wynaden|first1=Dianne|last2=Chapman|first2=Rose|date=2005-06-01|language=en|doi=10.1111/j.1440-0979.2005.00364.x|pmid = 15896255|last3=Orb|first3=Angelica|last4=McGowan|first4=Sunita|last5=Zeeman|first5=Zenith|last6=Yeak|first6=SiewHo}}</ref> are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family's reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family's overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalize their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.
Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations<ref>{{Cite journal|title=Factors that influence Asian communities' access to mental health care|journal=International Journal of Mental Health Nursing|volume=14|issue=2|pages=88–95|last1=Wynaden|first1=Dianne|last2=Chapman|first2=Rose|date=June 1, 2005|language=en|doi=10.1111/j.1440-0979.2005.00364.x|pmid=15896255|last3=Orb|first3=Angelica|last4=McGowan|first4=Sunita|last5=Zeeman|first5=Zenith|last6=Yeak|first6=SiewHo|doi-access=free}}</ref> are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family's reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family's overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalize their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.


In addition, many of these philosophies teach followers to accept one's fate.<ref name=":3" /> Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracized.
In addition, many of these philosophies teach followers to accept one's fate.<ref name=":3" /> Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracized.


=== Lack of qualified staff ===
=== Lack of qualified staff ===
China has 17,000 certified [[psychiatrist]]s, which is 10 percent of that of other developed countries per capita.<ref name="economist">{{cite news|url=http://www.economist.com/world/asia/displaystory.cfm?story_id=9657086|title=And now the 50-minute hour: Mental health in China|date=2007-08-18|access-date=2007-08-18|newspaper=[[The Economist]]|pages=35}}</ref> China averages one psychologist for every 83,000 people, and some of these psychologists are not board-licensed or certified to diagnose illnesses. Individuals without any academic background in mental health can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors.<ref>Huang, Hsuan-Ying. (2015). [http://internationalpsychoanalysis.net/wp-content/uploads/2015/08/mahistoricaloverviewofpsychotherapyinChina.pdf "From psychotherapy to psycho-boom: a historical overview of psychotherapy in China"]. ''Psychoanalysis & Psychotherapy in China''. 1: 1–30.</ref> Many psychiatrists or psychologists study psychology for personal use and do not intend to pursue a career in counseling.<ref>Hizi, Gil. (2017). "[https://muse.jhu.edu/article/661221/summary 'Developmental' Therapy for a 'Modernised' Society: The Sociopolitical Meanings of Psychology in Urban China"]. ''China: An International Journal''. 15(2): 98–119.</ref> Patients are likely to leave clinics with false diagnoses, and often do not return for follow-up treatments, which is detrimental to the degenerative nature of many psychiatric disorders.<ref>{{cite web|url=http://mentalhealthinchina.weebly.com|title=Abuse of Mentally Ill in China|last1=Chen|first1=Molly|website=Mental Health in China|publisher=Weebly|access-date=16 April 2016}}</ref>
By the end of 2019, there were 40,850 licensed [[psychiatrist]]s and psychiatric registrars, averaging 2.9 per 100,000 population, compared to the average in developed countries of 6.6 per 100,000.<ref>{{Cite journal|last1=Xu|first1=Ziyan|last2=Gahr|first2=Maximilian|last3=Xiang|first3=Yutao|last4=Kingdon|first4=David|last5=Rüsch|first5=Nicolas|last6=Wang|first6=Gang|date=March 1, 2022|title=The state of mental health care in China|journal=Asian Journal of Psychiatry|volume=69|pages=102975|doi=10.1016/j.ajp.2021.102975|pmid=34998231|issn=1876-2018}}</ref> Individuals without preliminary experience can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors.<ref>Huang, Hsuan-Ying. (2015). [http://internationalpsychoanalysis.net/wp-content/uploads/2015/08/mahistoricaloverviewofpsychotherapyinChina.pdf "From psychotherapy to psycho-boom: a historical overview of psychotherapy in China"]. ''Psychoanalysis & Psychotherapy in China''. 1: 1–30.</ref> Due to limited knowledge about psychiatry, low salary, high workload and stigma towards mental illness, very few medical graduates choose to specialize in psychiatry.<ref>Hizi, Gil. (2017). "[https://muse.jhu.edu/article/661221/summary 'Developmental' Therapy for a 'Modernised' Society: The Sociopolitical Meanings of Psychology in Urban China"]. ''China: An International Journal''. 15(2): 98–119.</ref>


A study in 2015 reported that two-thirds of counties in China lacked any psychiatrists.<ref>{{Cite journal|last1=Liang|first1=Di|last2=Mays|first2=Vickie M|last3=Hwang|first3=Wei-Chin|date=January 1, 2018|title=Integrated mental health services in China: challenges and planning for the future|url=https://academic.oup.com/heapol/article/33/1/107/4540646|journal=Health Policy and Planning|language=en|volume=33|issue=1|pages=107–122|doi=10.1093/heapol/czx137|issn=0268-1080|doi-access=free|pmid=29040516|pmc=5886187}}</ref>
The disparity between psychiatric services available between rural and urban areas<ref name="Abuse of Mentally Ill in China">{{cite web|url=http://mentalhealthinchina.weebly.com/|title=Abuse of Mentally Ill in China|last1=Chen|first1=Molly|website=Mental Health in China|publisher=Weebly|access-date=16 April 2016}}</ref> partially contributes to this statistic, as rural areas have traditionally relied on [[barefoot doctors]] since the 1970s for medical advice. These doctors are one of the few modes of healthcare able to reach isolated parts of rural China, and are unable to obtain modern medical equipment, and therefore, unable to reliably diagnose psychiatric illnesses. Furthermore, the nearest psychiatric clinic may be hundreds of kilometres away, and families may be unable to afford professional psychiatric treatment for the afflicted.


=== Physical symptoms ===
=== Physical symptoms ===
Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms.<ref>{{Cite journal|last=Lin|first=Tsung-Yi|date=December 1983|title=Psychiatry and Chinese Culture|journal=Western Journal of Medicine|volume=139|issue=6|pages=862–867|issn=0093-0415|pmc=1011017|pmid=6364576}}</ref> For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression.<ref>{{Cite journal|last1=Ryder|first1=Andrew|last2=Yang|first2=Jian|last3=Zhu|first3=Xiongzhao|last4=Yao|first4=Shuqiao|last5=Yi|first5=Jinyao|last6=Heine|first6=Steven|date=2008|title=The Cultural Shaping of Depression: Somatic Symptoms in China, Psychological Symptoms in North America?|journal=Journal of Abnormal Psychology|volume=117|issue=2|pages=300–13|citeseerx=10.1.1.329.7641|doi=10.1037/0021-843x.117.2.300|pmid=18489206}}</ref> However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.
Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms.<ref>{{Cite journal|last=Lin|first=Tsung-Yi|date=December 1983|title=Psychiatry and Chinese Culture|journal=Western Journal of Medicine|volume=139|issue=6|pages=862–867|issn=0093-0415|pmc=1011017|pmid=6364576}}</ref> For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression.<ref>{{Cite journal|last1=Ryder|first1=Andrew|last2=Yang|first2=Jian|last3=Zhu|first3=Xiongzhao|last4=Yao|first4=Shuqiao|last5=Yi|first5=Jinyao|last6=Heine|first6=Steven|date=2008|title=The Cultural Shaping of Depression: Somatic Symptoms in China, Psychological Symptoms in North America?|journal=Journal of Abnormal Psychology|volume=117|issue=2|pages=300–13|citeseerx=10.1.1.329.7641|doi=10.1037/0021-843x.117.2.300|pmid=18489206|s2cid=14281338}}</ref> However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.


=== Misuse ===
=== Misuse ===
According to various scholars, China's psychiatric facilities have been manipulated by government officials in order to silence political dissidents.<ref>{{Cite journal|last=Bonnie|first=Richard J.|date=2002|title=Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies|journal=The Journal of the American Academy of Psychiatry and the Law|volume=30|issue=1|pages=136–44|language=en|doi=10.2139/ssrn.1760001|pmid=11931362|issn=1556-5068|ssrn=1760001}}</ref><ref name=":1" /><ref>{{Cite journal|last=Munro|first=Robin J.|date=2002|title=Political psychiatry in post-Mao China and its origins in the cultural revolution|journal=The Journal of the American Academy of Psychiatry and the Law|volume=30|issue=1|pages=97–106; discussion 95–96|issn=1093-6793|pmid=11931373}}</ref> In addition to misuse by the state psychiatric facilities in China are also misused by powerful private individuals who use the system to advance their personal or business ends. China's legal system lacks an effective means of challenging involuntary detentions in psychiatric facilities.<ref name=":1">{{cite web |last1=Yin |first1=Chi |last2=Cohen |first2=Jerome A. |title=The Misuse of China's Mental Hospitals |url=https://thediplomat.com/2020/08/the-misuse-of-chinas-mental-hospitals/ |website=thediplomat.com |publisher=The Diplomat |access-date=14 August 2020}}</ref>
There have been multiple accusations that China's psychiatric facilities have been used by government officials to silence political dissidents.<ref>{{Cite journal|last=Bonnie|first=Richard J.|date=2002|title=Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies|journal=The Journal of the American Academy of Psychiatry and the Law|volume=30|issue=1|pages=136–44|language=en|doi=10.2139/ssrn.1760001|pmid=11931362|issn=1556-5068|ssrn=1760001}}</ref><ref name=":1">{{cite web|last1=Yin|first1=Chi|last2=Cohen|first2=Jerome A.|title=The Misuse of China's Mental Hospitals|url=https://thediplomat.com/2020/08/the-misuse-of-chinas-mental-hospitals/|access-date=August 14, 2020|website=thediplomat.com|publisher=The Diplomat}}</ref><ref>{{Cite journal|last=Munro|first=Robin J.|date=2002|title=Political psychiatry in post-Mao China and its origins in the cultural revolution|journal=The Journal of the American Academy of Psychiatry and the Law|volume=30|issue=1|pages=97–106; discussion 95–96|issn=1093-6793|pmid=11931373}}</ref> Prior to China's implementation to the National Mental Health Law in May 2013, involuntary admission was the most common type of admission for patients with psychotic disorders and required only informed consent signed by family members.<ref>{{Cite journal|last1=Shao|first1=Yang|last2=Xie|first2=Bin|last3=Good|first3=Mary-Jo DelVecchio|last4=Good|first4=Byron J.|date=January 2010|title=Current legislation on admission of mentally ill patients in China|journal=International Journal of Law and Psychiatry|volume=33|issue=1|pages=52–57|doi=10.1016/j.ijlp.2009.10.001|pmid=19913300|issn=0160-2527|pmc=2813951}}</ref> Involuntary admission under the reform is only allowed if patients to pose a clear threat to themselves or others, determined through initial assessment by a registered psychiatrist. Despite the law, a 2017 national survey showed that fewer than 50% of involuntarily admitted individuals met the criteria for involuntary admission, with the number of involuntary psychiatric admissions remaining high in China.<ref>{{Cite journal|last1=Jiang|first1=Feng|last2=Zhou|first2=Huixuan|last3=Hu|first3=Linlin|last4=Liu|first4=Tingfang|last5=Wu|first5=Shichao|last6=Zhao|first6=Pengyu|last7=Hu|first7=Guangyu|last8=Liu|first8=Huanzhong|last9=Tang|first9=Yilang |last10=Liu |first10=Yuanli|date=October 2018|title=Compliance with the criteria of involuntary admission in China's Mental Health Law: a national cross-sectional study of patients admitted to hospital involuntarily|journal=The Lancet|volume=392|pages=S9|doi=10.1016/s0140-6736(18)32638-2|issn=0140-6736}}</ref>


== Chinese military mental health ==
== Chinese military mental health ==
=== Overview ===
=== Overview ===
Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression.<ref>{{Cite journal|last1=Cox|first1=Kenneth L.|last2=Ursano|first2=Robert J.|last3=Stein|first3=Murray B.|last4=Heeringa|first4=Steven G.|last5=Colpe|first5=Lisa J.|last6=Gilman|first6=Stephen E.|last7=Kessler|first7=Ronald C.|last8=Schoenbaum|first8=Michael|date=2014-05-01|title=Predictors of Suicide and Accident Death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)|journal=JAMA Psychiatry|language=en|volume=71|issue=5|pages=493–503|doi=10.1001/jamapsychiatry.2013.4417|issn=2168-622X|pmc=4124912|pmid=24590048}}</ref> Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.<ref name="Wang Y. 2012 pp. 420-4">Wang Y., Zhang, L., Chen, C., Yao, G. (2012) Application of Chinese Military Health Scale in screening mental health of new recruits. ''Medical and Health Research Foundation of PLA.'' 37(5) pp. 420–4</ref>
Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression.<ref>{{Cite journal|last1=Cox|first1=Kenneth L.|last2=Ursano|first2=Robert J.|last3=Stein|first3=Murray B.|last4=Heeringa|first4=Steven G.|last5=Colpe|first5=Lisa J.|last6=Gilman|first6=Stephen E.|last7=Kessler|first7=Ronald C.|last8=Schoenbaum|first8=Michael|date=May 1, 2014|title=Predictors of Suicide and Accident Death in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS): Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)|journal=JAMA Psychiatry|language=en|volume=71|issue=5|pages=493–503|doi=10.1001/jamapsychiatry.2013.4417|issn=2168-622X|pmc=4124912|pmid=24590048}}</ref> Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.<ref name="Wang Y. 2012 pp. 420-4">Wang Y., Zhang, L., Chen, C., Yao, G. (2012) Application of Chinese Military Health Scale in screening mental health of new recruits. ''Medical and Health Research Foundation of PLA.'' 37(5) pp. 420–4</ref>


=== Background ===
=== Background ===
Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers' experiences in the plateaus.<ref name=":5">Zhao, M., Feng, Z., Wang, F., Lai, W., Hu, F…Xia, L. (2017). Chinese military mental health at high altitude, 1993–2013: A cross-temporal meta-analysis of SCL-90. ''Acta Psychologica Sinica. 49(5),'' pp. 653–662</ref> The change of emphasis from physical to mental health can be seen in China's four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops' ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.<ref>Wang, X., He. X. (2015) Progress of Chinese Military Mental Health. ''J Third Mil Med Univ'', ''37(22)'' pp. 2213–2217</ref>
Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers' experiences in the plateaus.<ref name=":5">Zhao, M., Feng, Z., Wang, F., Lai, W., Hu, F...Xia, L. (2017). Chinese military mental health at high altitude, 1993–2013: A cross-temporal meta-analysis of SCL-90. ''Acta Psychologica Sinica. 49(5),'' pp. 653–662</ref> The change of emphasis from physical to mental health can be seen in China's four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops' ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.<ref>Wang, X., He. X. (2015) Progress of Chinese Military Mental Health. ''J Third Mil Med Univ'', ''37(22)'' pp. 2213–2217</ref>


Mental health issue can impact active military members' effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation.<ref name=":6">Tan, Y., Li, Y., Wu, J., Chen, F., Lu, H., Lu, S., Yang, X., Ma, X. (2018). Mental health of Automobile Transportation Troop personnel stationed in the Western Sichuan Plateau of China. ''Medicine'', ''97''(12),</ref> It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.<ref name=":5" />
Mental health issue can impact active military members' effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation.<ref name=":6">Tan, Y., Li, Y., Wu, J., Chen, F., Lu, H., Lu, S., Yang, X., ... Ma, X. (2018). Mental health of Automobile Transportation Troop personnel stationed in the Western Sichuan Plateau of China. ''Medicine'', ''97''(12),</ref> It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.<ref name=":5" />


Comparatively, assessing the mental health status of the People's Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments.<ref>Sun, X., Zhao, L., Chen, C., Cui, X., Guo, J., Zhang, L. (2014). Mental Health of Chinese Peacekeepers in Liberia''. Eur J. Psychiat 28, pg 77–85''</ref> With such diverse military roles over an area of {{convert|3.25|e6sqmi|e6km2|order=flip|abbr=off}}, it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems.
Comparatively, assessing the mental health status of the People's Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments.<ref>Sun, X., Zhao, L., Chen, C., Cui, X., Guo, J., Zhang, L. (2014). Mental Health of Chinese Peacekeepers in Liberia''. Eur J. Psychiat 28, pg 77–85''</ref> With such diverse military roles over an area of {{convert|3.25|e6sqmi|e6km2|order=flip|abbr=off}}, it is difficult to gauge its impacts on soldiers' psyche and provide a single method to address mental health problems.


Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops;<ref name=":5" /> other researchers found that depressive symptoms can worsen.<ref>Feng Zhengzhi ,Qin, D.(2008) A Meta-Analysis Concerning the Mental Health Status of Members of the Chinese Army. ''Third Military Medical University. 40(03).'' pp. 358–367.</ref> These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.<ref name=":7">Chen H.H., Phillips, M.R., Cheng, H., Chen, Q.Q, Chen, X.D…Bueber, M. (2012) Mental Health Law of the People’s Republic of China''. Shanghai Arch Psychiatry 24(6)''pg. 305–321</ref>
Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops;<ref name=":5" /> other researchers found that depressive symptoms can worsen.<ref>Feng Zhengzhi ,Qin, D.(2008) A Meta-Analysis Concerning the Mental Health Status of Members of the Chinese Army. ''Third Military Medical University. 40(03).'' pp. 358–367.</ref> These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.<ref name=":7">Chen H.H., Phillips, M.R., Cheng, H., Chen, Q.Q, Chen, X.D...Bueber, M. (2012) Mental Health Law of the People’s Republic of China''. Shanghai Arch Psychiatry 24(6)''pg. 305–321</ref>


Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training,<ref name=":8">Yan J , Wang LJ , Cheng Q , Miao D.M., Zhang L.Y…Pan, Y. (2008) Estimated mental health and analysis of relative factors for new Chinese recruits. ''Mil Med 173(10)'' pp. 1031 – 4.</ref> or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves.<ref>Ge, Y., Ma, K., Cai, W., Zhang, S,. Wei, D. (2018) Relationship between anxiety sensitivity and psychological health''. Academic Journal of Second Military Medical University. (Vol. 39) pg. 92–96''</ref><ref name=":4">Xu, X., Li, X., Zhang, J., Wang, W., (2018) Mental Health-Related Stigma in China. ''Issues in Mental Health Nursing. 37(2)'' pp. 126–134</ref> Researchers also suggest to improve the mental health of the military members, programs should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.<ref name=":6" />
Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training,<ref name=":8">Yan J , Wang LJ , Cheng Q , Miao D.M., Zhang L.Y...Pan, Y. (2008) Estimated mental health and analysis of relative factors for new Chinese recruits. ''Mil Med 173(10)'' pp. 1031 – 4.</ref> or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves.<ref>Ge, Y., Ma, K., Cai, W., Zhang, S,. Wei, D. (2018) Relationship between anxiety sensitivity and psychological health''. Academic Journal of Second Military Medical University. (Vol. 39) pg. 92–96''</ref><ref name=":4">Xu, X., Li, X., Zhang, J., Wang, W., (2018) Mental Health-Related Stigma in China. ''Issues in Mental Health Nursing. 37(2)'' pp. 126–134</ref> Researchers also suggest to improve the mental health of the military members, programs should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.<ref name=":6" />


=== Implementation ===
=== Implementation ===
In 2006, the People's Republic Minister for National Defense began mental health vetting at the beginning of the military recruitment process.<ref name=":6" /> A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviors, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits.<ref name="Wang Y. 2012 pp. 420-4"/> Similar research has been conducted into the external factors that impact a person's mental fortitude, including single-child status, urban or rural environment, and education level.<ref name=":8" /> Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the [[Tibetan Centre for Human Rights and Democracy|Tibetan Center for Human Rights]] of a small portion of the [[People's Liberation Army]] training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should: <blockquote>“...close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.<ref>Moore, M. (2013, May). Chinese troops suffering post-traumatic stress disorder in Tibet. ''The Telegraph.'' Retrieved from <nowiki>https://www.telegraph.co.uk/news/worldnews/asia/tibet/10071121/Chinese-troops-suffering-post-traumatic-stress-disorder-in-Tibet.html</nowiki></ref></blockquote>In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People's Republic of China, it stated, “''The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.''"<ref name=":7" />
In 2006, the People's Republic Minister for National Defense began mental health vetting at the beginning of the military recruitment process.<ref name=":6" /> A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviors, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits.<ref name="Wang Y. 2012 pp. 420-4"/> Similar research has been conducted into the external factors that impact a person's mental fortitude, including single-child status, urban or rural environment, and education level.<ref name=":8" /> Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the [[Tibetan Centre for Human Rights and Democracy|Tibetan Center for Human Rights]] of a small portion of the [[People's Liberation Army]] training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should: <blockquote>“...close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone".<ref>{{Cite web|title=Chinese troops suffering post-traumatic stress disorder in Tibet|url=https://www.telegraph.co.uk/news/worldnews/asia/tibet/10071121/Chinese-troops-suffering-post-traumatic-stress-disorder-in-Tibet.html|access-date=2023-08-16|website=The Daily Telegraph|date=May 21, 2013}}</ref></blockquote>In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People's Republic of China, it stated, “''The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.''"<ref name=":7" />

Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People's Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood.<ref name=":9">Yang, Z., Cao, F., Lu, H., Zhu, X., Miao, D. (2014) Changes of anxiety in Chinese Military personnel over time: a cross-temporal meta-analysis. ''International Journal of Mental Health Systems. 8''</ref> This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China.<ref name=":10">{{Cite news|last=Buckley|first=Chris|date=June 25, 2018|title=Marching Across China, Army Veterans Join Ranks of Protesters|language=en-US|work=The New York Times|url=https://www.nytimes.com/2018/06/25/world/asia/china-veterans-protests.html|access-date=August 16, 2023|issn=0362-4331}}</ref> In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government.<ref name=":9" /> As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, [[General Secretary of the Chinese Communist Party]] [[Xi Jinping]] promised to enact laws that protect the welfare of veterans.<ref name=":10" />

== Mental health of women in China ==

=== Perinatal depression ===
[[Prenatal development|Perinatal]] depression, a mood disorder occurring during pregnancy and extending into the postpartum period, is linked with adverse health outcomes for both mothers and infants.<ref>{{Cite web|title=Perinatal Depression – National Institute of Mental Health (NIMH)|url=https://www.nimh.nih.gov/health/publications/perinatal-depression|access-date=March 31, 2024|website=nimh.nih.gov|language=en}}</ref> A meta-regression analysis showed that there has been a notable upward trend in the prevalence of perinatal depression, which affects approximately 16.3% of Chinese women, with 19.7% experiencing it during pregnancy and 14.8% after childbirth.<ref>{{Cite journal|last1=Nisar|first1=Anum|last2=Yin|first2=Juan|last3=Waqas|first3=Ahmed|last4=Bai|first4=Xue|last5=Wang|first5=Duolao|last6=Rahman|first6=Atif|last7=Li|first7=Xiaomei|date=December 2020|title=Prevalence of perinatal depression and its determinants in Mainland China: A systematic review and meta-analysis|journal=Journal of Affective Disorders|volume=277|pages=1022–1037|doi=10.1016/j.jad.2020.07.046|pmid=33065811|issn=0165-0327}}</ref> It indicated a significant inverse relationship between the provincial [[Gross domestic product|Gross Domestic Product]] (GDP) and depression rates among Chinese mothers.

Risk and protective factors for perinatal depression were studied systematically in three domains of mothers, infants, and sociocultural status. Studies shows that lower socioeconomic status, compromised physical well-being, pregnancy-related anxiety, challenges during childbirth and inadequate social support posed negative impact to mental health of Chinese mothers.<ref>{{Cite journal|last1=Chang|first1=Fang|last2=Fan|first2=Xin|last3=Zhang|first3=Yi|last4=Tang|first4=Bin|last5=Jia|first5=Xiyuan|date=January 16, 2022|title=Prevalence of depressive symptoms and correlated factors among pregnant women during their second and third trimesters in northwest rural China: a cross-sectional study|journal=BMC Pregnancy and Childbirth|volume=22|issue=1|pages=38|doi=10.1186/s12884-021-04340-0|doi-access=free|issn=1471-2393|pmc=8762974|pmid=35034637}}</ref> Conversely, enhanced living standards and increased educational support seemed to confer protective benefits.<ref>{{Cite journal|last1=Nisar|first1=Anum|last2=Yin|first2=Juan|last3=Waqas|first3=Ahmed|last4=Bai|first4=Xue|last5=Wang|first5=Duolao|last6=Rahman|first6=Atif|last7=Li|first7=Xiaomei|date=December 1, 2020|title=Prevalence of perinatal depression and its determinants in Mainland China: A systematic review and meta-analysis|journal=Journal of Affective Disorders|volume=277|pages=1022–1037|doi=10.1016/j.jad.2020.07.046|pmid=33065811|issn=0165-0327}}</ref>

After the implementation of the universal two-child policy, another review article indicates that the second-time mothers exhibited a higher likelihood of experiencing anxiety symptoms during pregnancy compared to both prenatal women overall and the entire sample.<ref>{{Cite journal|last1=Lu|first1=Li|last2=Duan|first2=Zhizhou|last3=Wang|first3=Yuanyuan|last4=Wilson|first4=Amanda|last5=Yang|first5=Yong|last6=Zhu|first6=Longjun|last7=Guo|first7=Yan|last8=Lv|first8=Yonglang|last9=Yang|first9=Xiaonan |last10=Yu |first10=Renjie|last11=Wang|first11=Shuilan|last12=Wu|first12=Zhengyan|last13=Jiang|first13=Ping|last14=Xia|first14=Mengqing|last15=Wang|first15=Guosheng|date=March 1, 2020|title=Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy|journal=Journal of Affective Disorders|volume=264|pages=187–192|doi=10.1016/j.jad.2019.12.011|pmid=32056749|issn=0165-0327}}</ref>


The COVID-19 pandemic also proved to affect the mental health and well-being of perinatal women in China.<ref>{{Cite journal|last1=Zeng|first1=Xiaoqin|last2=Li|first2=Wengao|last3=Sun|first3=Hengwen|last4=Luo|first4=Xian|last5=Garg|first5=Samradhvi|last6=Liu|first6=Ting|last7=Zhang|first7=Jingying|last8=Zhang|first8=Yongfu|date=2020|title=Mental Health Outcomes in Perinatal Women During the Remission Phase of COVID-19 in China|journal=Frontiers in Psychiatry|volume=11|doi=10.3389/fpsyt.2020.571876|doi-access=free|issn=1664-0640|pmc=7573142|pmid=33132935}}</ref> Several studies suggests that the prevalence rates of psychological distress, anxiety, depressive, and [[insomnia]] symptoms among of Chinese pregnant women were recorded at 70%, 37%, 31%, and 49%, respectively.<ref>{{Cite journal|last1=Dong|first1=Haoxu|last2=Hu|first2=Runan|last3=Lu|first3=Chao|last4=Huang|first4=Dajian|last5=Cui|first5=Dandan|last6=Huang|first6=Guangying|last7=Zhang|first7=Mingmin|date=February 1, 2021|title=Investigation on the mental health status of pregnant women in China during the Pandemic of COVID-19|journal=Archives of Gynecology and Obstetrics|language=en|volume=303|issue=2|pages=463–469|doi=10.1007/s00404-020-05805-x|issn=1432-0711|pmc=7532741|pmid=33009997}}</ref><ref>{{Cite journal|last1=Yan|first1=Haohao|last2=Ding|first2=Yudan|last3=Guo|first3=Wenbin|date=2020|title=Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis|journal=Frontiers in Psychology|volume=11|doi=10.3389/fpsyg.2020.617001|doi-access=free|issn=1664-1078|pmc=7723850|pmid=33324308}}</ref>
Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People's Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood.<ref name=":9">Yang, Z., Cao, F., Lu, H., Zhu, X., Miao, D. (2014) Changes of anxiety in Chinese Military personnel over time: a cross-temporal meta-analysis. ''International Journal of Mental Health Systems. 8''</ref> This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China.<ref name=":10">Buckley, C. (2018, June). Marching Across China, Army Veterans Join Ranks of Protesters. ''NY Times.'' Retrieved from <nowiki>https://www.nytimes.com/2018/06/25/world/asia/china-veterans-protests.html</nowiki></ref> In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government.<ref name=":9" /> As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, [[General Secretary of the Chinese Communist Party]] [[Xi Jinping]] promised to enact laws that protect the welfare of veterans.<ref name=":10" />


== See also ==
== See also ==
* [[Chinese Society of Psychiatry]]
* [[Chinese Society of Psychiatry]]
* [[Geriatric depression in China]]
* [[Geriatric depression in China]]
* [[Mental health in education]]
* [[Global mental health]]
* [[Global mental health]]
* [[Mental health in the Middle East]]
* [[Mental health in the Middle East]]
* [[Mental health in Southeast Africa]]
* [[Mental health in Southeast Africa]]
* {{section link|Political abuse of psychiatry|China}}
* {{section link|Political abuse of psychiatry|China}}
* [[Mental health of Chinese students]]


== References ==
== References ==
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{{Health in China}}
{{Health in China}}
{{Asia topic|Mental health in}}
{{World topic|Mental health in|title=Mental health by country|noredlinks=yes}}


[[Category:Mental health in China| ]]
[[Category:Mental health in China| ]]

Latest revision as of 05:14, 29 November 2024

Mental health in China is a growing issue. Experts have estimated that about 130 million adults living in China are suffering from a mental disorder.[1][2] The desire to seek treatment is largely hindered by China's strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony.[3]

History

[edit]

China's first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.[4]

In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.[5]

In a meeting jointly held by Chinese ministries and the World Health Organization in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care.[5] The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.

In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.[6]

Since 2006, the government's 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses.[7] These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.

In 2011, the legal institution of China's State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients to not to be hospitalized against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment.[8][9] However, Human Rights Watch has criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.[10]

Since 1993, WHO has been collaborating with China in the development of a national mental health information system.[11]

Current situation

[edit]

Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.

Prevalence of mental disorders

[edit]

Researchers estimate that roughly 130 million people in China over the age of 18 suffer from mental illness in any given year.[2]

The map of disability-adjusted life years shows the disproportionate impact on the quality of life for persons with bipolar disorder in China and other East Asian countries.

Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6 percent of people with major depressive disorder.[12] Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.[13]

There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.

The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999.[1] Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62 percent of incidences.[14]

[edit]

It is estimated that 18 percent of the Chinese population, about 244 million people, believe in Buddhism.[15] Another 22 percent of the population, roughly 294 million, people believe in folk religions[15] which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism.[3] Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honoring one's family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.

Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations[16] are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family's reputation. It is believed that mental health will hinder individuals from achieving the standards and goals- whether academic, social, career-based, or other- expected from parents. Without reaching the expectations, individuals are anticipated to bring shame to the family, which will affect the family's overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalize their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.

In addition, many of these philosophies teach followers to accept one's fate.[3] Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agreeing with others that they deserve to be ostracized.

Lack of qualified staff

[edit]

By the end of 2019, there were 40,850 licensed psychiatrists and psychiatric registrars, averaging 2.9 per 100,000 population, compared to the average in developed countries of 6.6 per 100,000.[17] Individuals without preliminary experience can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors.[18] Due to limited knowledge about psychiatry, low salary, high workload and stigma towards mental illness, very few medical graduates choose to specialize in psychiatry.[19]

A study in 2015 reported that two-thirds of counties in China lacked any psychiatrists.[20]

Physical symptoms

[edit]

Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms.[21] For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression.[22] However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.

Misuse

[edit]

There have been multiple accusations that China's psychiatric facilities have been used by government officials to silence political dissidents.[23][24][25] Prior to China's implementation to the National Mental Health Law in May 2013, involuntary admission was the most common type of admission for patients with psychotic disorders and required only informed consent signed by family members.[26] Involuntary admission under the reform is only allowed if patients to pose a clear threat to themselves or others, determined through initial assessment by a registered psychiatrist. Despite the law, a 2017 national survey showed that fewer than 50% of involuntarily admitted individuals met the criteria for involuntary admission, with the number of involuntary psychiatric admissions remaining high in China.[27]

Chinese military mental health

[edit]

Overview

[edit]

Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression.[28] Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.[29]

Background

[edit]

Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers' experiences in the plateaus.[30] The change of emphasis from physical to mental health can be seen in China's four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops' ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves.[31]

Mental health issue can impact active military members' effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation.[32] It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment.[30]

Comparatively, assessing the mental health status of the People's Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments.[33] With such diverse military roles over an area of 8.4 million square kilometres (3.25 million square miles), it is difficult to gauge its impacts on soldiers' psyche and provide a single method to address mental health problems.

Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops;[30] other researchers found that depressive symptoms can worsen.[34] These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.[35]

Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training,[36] or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves.[37][38] Researchers also suggest to improve the mental health of the military members, programs should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.[32]

Implementation

[edit]

In 2006, the People's Republic Minister for National Defense began mental health vetting at the beginning of the military recruitment process.[32] A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviors, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits.[29] Similar research has been conducted into the external factors that impact a person's mental fortitude, including single-child status, urban or rural environment, and education level.[36] Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Center for Human Rights of a small portion of the People's Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should:

“...close [their] eyes and imagine zooming in on the scene like a camera [when experiencing PTSD]. It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone".[39]

In 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People's Republic of China, it stated, “The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military."[35]

Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People's Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood.[40] This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China.[41] In both instances, veterans advocated for an increased focus on post-service benefits, resources to aid in post-service jobs, and justice for those who were treated poorly by the government.[40] As a way to combat the dissatisfaction of veterans and alleviate growing tension, the government established the Ministry of Veteran Affairs in 2018. At the same time, General Secretary of the Chinese Communist Party Xi Jinping promised to enact laws that protect the welfare of veterans.[41]

Mental health of women in China

[edit]

Perinatal depression

[edit]

Perinatal depression, a mood disorder occurring during pregnancy and extending into the postpartum period, is linked with adverse health outcomes for both mothers and infants.[42] A meta-regression analysis showed that there has been a notable upward trend in the prevalence of perinatal depression, which affects approximately 16.3% of Chinese women, with 19.7% experiencing it during pregnancy and 14.8% after childbirth.[43] It indicated a significant inverse relationship between the provincial Gross Domestic Product (GDP) and depression rates among Chinese mothers.

Risk and protective factors for perinatal depression were studied systematically in three domains of mothers, infants, and sociocultural status. Studies shows that lower socioeconomic status, compromised physical well-being, pregnancy-related anxiety, challenges during childbirth and inadequate social support posed negative impact to mental health of Chinese mothers.[44] Conversely, enhanced living standards and increased educational support seemed to confer protective benefits.[45]

After the implementation of the universal two-child policy, another review article indicates that the second-time mothers exhibited a higher likelihood of experiencing anxiety symptoms during pregnancy compared to both prenatal women overall and the entire sample.[46]

The COVID-19 pandemic also proved to affect the mental health and well-being of perinatal women in China.[47] Several studies suggests that the prevalence rates of psychological distress, anxiety, depressive, and insomnia symptoms among of Chinese pregnant women were recorded at 70%, 37%, 31%, and 49%, respectively.[48][49]

See also

[edit]

References

[edit]
  1. ^ a b Xiang, Yu-Tao; Yu, Xin; Sartorius, Norman; Ungvari, Gabor S; Chiu, Helen FK (November 2012). "Mental health in China: challenges and progress". The Lancet. 380 (9855): 1715–1716. doi:10.1016/s0140-6736(11)60893-3. ISSN 0140-6736. PMID 23158236. S2CID 39124942.
  2. ^ a b Huang, Yueqin; Wang, Yu; Wang, Hong; Liu, Zhaorui; Yu, Xin; Yan, Jie; Yu, Yaqin; Kou, Changgui; Xu, Xiufeng; Lu, Jin; Wang, Zhizhong; He, Shulan; Xu, Yifeng; He, Yanling; Li, Tao (March 1, 2019). "Prevalence of mental disorders in China: a cross-sectional epidemiological study". The Lancet Psychiatry. 6 (3): 211–224. doi:10.1016/S2215-0366(18)30511-X. ISSN 2215-0366. PMID 30792114.
  3. ^ a b c "Content Pages of the Encyclopedia of Religion and Social Science". hirr.hartsem.edu. Retrieved October 21, 2018.
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  6. ^ (us), Office of the Surgeon General; (us), Center for Mental Health Services; (us), National Institute of Mental Health (August 1, 2001). Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health. Substance Abuse and Mental Health Services Administration (US).
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  14. ^ "Archived copy" (PDF). Archived from the original (PDF) on August 24, 2011. Retrieved July 30, 2011.{{cite web}}: CS1 maint: archived copy as title (link)
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  16. ^ Wynaden, Dianne; Chapman, Rose; Orb, Angelica; McGowan, Sunita; Zeeman, Zenith; Yeak, SiewHo (June 1, 2005). "Factors that influence Asian communities' access to mental health care". International Journal of Mental Health Nursing. 14 (2): 88–95. doi:10.1111/j.1440-0979.2005.00364.x. PMID 15896255.
  17. ^ Xu, Ziyan; Gahr, Maximilian; Xiang, Yutao; Kingdon, David; Rüsch, Nicolas; Wang, Gang (March 1, 2022). "The state of mental health care in China". Asian Journal of Psychiatry. 69: 102975. doi:10.1016/j.ajp.2021.102975. ISSN 1876-2018. PMID 34998231.
  18. ^ Huang, Hsuan-Ying. (2015). "From psychotherapy to psycho-boom: a historical overview of psychotherapy in China". Psychoanalysis & Psychotherapy in China. 1: 1–30.
  19. ^ Hizi, Gil. (2017). "'Developmental' Therapy for a 'Modernised' Society: The Sociopolitical Meanings of Psychology in Urban China". China: An International Journal. 15(2): 98–119.
  20. ^ Liang, Di; Mays, Vickie M; Hwang, Wei-Chin (January 1, 2018). "Integrated mental health services in China: challenges and planning for the future". Health Policy and Planning. 33 (1): 107–122. doi:10.1093/heapol/czx137. ISSN 0268-1080. PMC 5886187. PMID 29040516.
  21. ^ Lin, Tsung-Yi (December 1983). "Psychiatry and Chinese Culture". Western Journal of Medicine. 139 (6): 862–867. ISSN 0093-0415. PMC 1011017. PMID 6364576.
  22. ^ Ryder, Andrew; Yang, Jian; Zhu, Xiongzhao; Yao, Shuqiao; Yi, Jinyao; Heine, Steven (2008). "The Cultural Shaping of Depression: Somatic Symptoms in China, Psychological Symptoms in North America?". Journal of Abnormal Psychology. 117 (2): 300–13. CiteSeerX 10.1.1.329.7641. doi:10.1037/0021-843x.117.2.300. PMID 18489206. S2CID 14281338.
  23. ^ Bonnie, Richard J. (2002). "Political Abuse of Psychiatry in the Soviet Union and in China: Complexities and Controversies". The Journal of the American Academy of Psychiatry and the Law. 30 (1): 136–44. doi:10.2139/ssrn.1760001. ISSN 1556-5068. PMID 11931362. SSRN 1760001.
  24. ^ Yin, Chi; Cohen, Jerome A. "The Misuse of China's Mental Hospitals". thediplomat.com. The Diplomat. Retrieved August 14, 2020.
  25. ^ Munro, Robin J. (2002). "Political psychiatry in post-Mao China and its origins in the cultural revolution". The Journal of the American Academy of Psychiatry and the Law. 30 (1): 97–106, discussion 95–96. ISSN 1093-6793. PMID 11931373.
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Further reading

[edit]
  • Normal and Abnormal Behavior in Chinese Culture (1981) edited by Arthur Kleinman and Tsung-yi Lin
  • Chinese Societies and Mental Health (1995) edited by Tsung-yi Lin, Wen-shing Tseng, and Eng-kung Yeh
  • Mental health care in China (1995) By Veronica Pearson
  • Narcotic Culture – A History of Drugs in China (2004) by Frank Dikötter, Lars Laamann and Zhou Xun