In China, depression goes untreated due to stigma and lack of psychiatrists

China has only 15 psychiatrists per million people

In China, long-standing social stigma around depression is a major obstacle. 
In rural areas in particular, people lack awareness and those with depression are often written off as being simply too lazy to do anything. Other times, people with mood disorders are considered insane and patients and their families are usually embarrassed or ashamed to do anything about it.
A lack of understanding is another factor. People mistakenly believe that they can simply get better through sheer willpower. An online survey by the World Psychiatry Association and sohu.com in July 2012 showed that about 45 percent of respondents said they wouldn't go to a hospital if they had depression. Over 75 percent of them believed that they would not need to see a doctor or be medicated.
Among those who do choose to seek help, most visit general hospitals, which highlights the importance for doctors in community hospitals to receive psychiatric training and learn how to recognize and diagnose depression.
The survey showed that of the patients who went to treat cardiovascular, gastrointestinal or other diseases in general hospitals, over 20 percent also had clinical depression or anxiety disorder, said He Yanling, director of clinical epidemiology at Shanghai Institute of Mental Health, the Xinhua News Agency reported in July last year. But the diagnostic rate in general hospitals remains abysmal.
There are about 20,000 registered psychiatrists in China, which translates to about 15 psychiatrists per million people, according to Xinhua. There are also around 40,000 certified counseling psychologists in the country, but they do not have the legal right to prescribe medication for depression but only offer counseling as a complement to treatment.
Not only is professional help limited by these numbers but the abilities of these professionals vary greatly. Many people who suffer from depression have been bounced around between several different doctors who all fail to give them the help they need.
Read the full article: Global Times

Depression a "time bomb" for China's wife-less young men

China's increasing numbers of unmarried men are prone to depression, suicidal feelings and aggression

by Michael Woodhead
China's sex ratio imbalance is producing an increasing number of unmarried men who have a high risk of depression, suicidal ideation, lower self-esteem and greater propensity to aggression, a Hangzhou study has shown.
Dr Zhou Xudong and researchers at the Institute of Social and Family Medicine of  Zhejiang University,  Hangzhou, studied psychiatric characteristics of 1,059 never-married men and 1,066 married men aged 30–40. They found that never-married men were poorer, less well educated and had lower self-esteem than married men. Never-married men were also much more likely to have depression symptoms, higher levels of aggression and were more likely to have suicidal thoughts or wishes  than married men.
The researchers say China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. They say their study is one of the first to show that this sex imbalance is having an impact on the psychological well-being of the large numbers of men who will never marry.
"The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services," they say.
"Our results present evidence for a potential mental health timebomb in rural large areas of rural China," they add.
They say the immediate question is what can be done to support the millions of men who, through no fault of their own, will be unable to marry and have children, and who, as a consequence have high rates of depression and suicidal tendencies.
"The challenge here is the virtual non-existence of mental health services in most of rural China. There are 1.3 psychiatrists and two psychiatric nurses per 100,000 people in China, but the overwhelming majority are in urban areas."
According to the researchers few men with depression are diagnosed or treated because of the lack of trained mental health professional in rural China.
"It would be straightforward and feasible to train rural doctors to identify key symptoms and signs of mental illness, or simply to administer a mental well-being check list as a screening tool for referral. The problem of depression is not of course confined to older unmarried men and such screening would identify vulnerable married men and women as well. This would of course require a major strengthening of mental health services at county level and above. But with mental health now rising on the health agenda and more resources available for health services as a result of the health reforms in China, there is a real opportunity now to address this," they conclude.
Source: Social Psychiatry

Sex imbalance gives Chinese men the blues

The skewed sex ratios in China contribute to depression, especially in unmarried men

by Michael Woodhead
The highly unbalanced sex ratios in parts of China are contributing to depression and suicidal tendencies in men, and women, but especially unmarried men, new research shows.
Dr Zhou Xudong and colleagues at the School of Public Health, Zhejiang University, Hangzhou, looked at depression rates in  7435 men and women aged 19–40 in Zhejiang, Yunnan and Guizhou. Depression was measured using the Chinese version of the Beck Depression Inventory (BDI).
They found depression in 17.6% of men and 17% of women, and suicidal thoughts and wishes in 18% and 20% of women respectively. The main factors associated with depression and suicidal thinking in men were high local sex ratio, rural residence, low education and poor economic status. Very high local sex ratio was the strongest independent determinant of depression in men.
The researchers conclude that "proactive measures need to be taken to identify and treat vulnerable individuals."
Read more: Journal of Affective Disorders

News in brief ...

Cholera becoming resistant to antibiotics in China

Antibiotic resistance is observed with increasing frequency among epidemic Vibrio cholerae strains in China, researchers from Beijing have warned.
Since the 1990s strains of V. cholerae have shown a rapid increase in the prevalence of resistance to antibiotics such as  nalidixic acid, tetracycline and trimethoprim/sulfamethoxazole.
This study serves as a warning of the rapid dissemination of resistance in the past 20 years," say researchers from the State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing.
Read more: International Journal of Antimicrobial Agents.

China's medical demand for helium creates world shortage

A shortage of helium caused by increasing demand for MRI machines in China is beginning to affect other countries - and even Disneyland balloons.
Tokyo Disney Resort has suspended sales of Disney-character balloons, and at least one hospital in the country has suspended use of MRI because of a lack of helium .
In hospitals, liquid helium is used to cool electromagnets inside MRI machines
However gas wholesalers say helium stock have run out as demand for helium for hospital use has increased mainly in emerging countries such as China. This has resulted in an at least threefold increase in helium prices in the last decade, greatly increasing the cost of semiconductor production, which relies heavily on helium.
Furthermore, due to an accident at a helium production facility in the United States, the supply-demand balance has been very tight since July, according to an Iwatani division chief. The situation may not improve until next spring at the earliest, observers say.
Read more: Daily Yomiuri

Elderly Chinese suffer from untreated depression

Depression is a common condition among older patients attending primary care clinics in Beijing, and most people do not receive treatment, a study. has found.
 A study of 1275 adults aged over 60 years at a primary care clinic in urban China found that 11% had major depression, with depression more likely to occur in older people, females and those with a  lower educational level or living alone.
Less than 1% of these patients received treatments and yet more than 60% of patients with depression initially remained depressed throughout the 12-month follow-up period.
Read more: Journal of Affective Disorders.

Rural areas urgently need newborn hearing screening

Urgent measures should be taken by the Chinese government to promote newborn hearing screening in the rural areas, researchers say.
Newborn hearing screening has been successfully implemented in Chinese cities , but not in rural areas, according to the authors of a new report.
Researchers screened for hearing problems in 11,568 babies born in five rural areas of Hubei. Overall, about 92%  newborns had normal hearing but 8% had a high-risk of hearing loss. While 71% newborns passed the initial screening test, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% .
Read more: International Journal of Pediatric Otolaryngology

Spinal fractures increasingly common in elderly Chinese

There has been a five fold increase in spinal fractures among older people over the let decade, new findings from Sichuan show.
Doctors from the Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing reviewed hospital records on all patients who was 60 years of age or older with spinal fracture at two university-affiliated hospitals between January 2001 and May 2011.  A total of 996 patients with spinal fractures were identified, of whom 35% were males. The annual incidence of spinal fractures among the elderly rose from 24 to 130 cases per 100,000 hospital admissions between 2001 and 2010.
The causes of spinal fractures include traumatic spinal fractures (72%), osteoporotic fracture with no specific cause (27%) and spinal fracture caused by tumour and tuberculosis (2%).
The lumbar region was the most common region of spinal fracture, followed by the thoracic and the cervical regions. Lumbar spinal fractures and thoracic spinal fractures were more commonly seen as a result of accidental falls from low heights and osteoporotic spinal fractures respectively. Spinal fractures usually occur outdoors causing by accidental falls from low heights, most frequently happen on the road.
Read more: Injury

Hospitals tricked into buying shoddy dentures

An unlicensed denture processing factory in Beijing has been ordered to suspend production for allegedly using recycled metal materials to make dentures.
The Beijing Jingjiayi Denture Processing Centre is also accused of using illegal cleansing cream to whiten the dentures to meet the requirement of hospitals and clinics.
The factory, in the city's Tongzhou District, has been ordered to suspend production after a local law enforcement team found it had no license following an undercover investigation by the newspaper.
The investigation found the factory melted recycled residue of metal materials to make dentures and used shoe polish and furniture cleansing products to whiten and brighten the dentures.
Since the purity of the metal was lower, the dentures would unavoidably have small holes on them. The poorly-made dentures were also likely to cause irritation in the mouth and other oral diseases if they were not disinfected under strict conditions, according to Shao Dongsheng, a former prosthodontist with Beijing Stomatological Hospital.
The unlicensed dentures and false teeth were sold to small- and medium-sized hospitals and dental clinics in Beijing at low prices.
Read more: Shanghai Daily

Vitamin B deficiency linked to depression in Chinese people

Thiamine deficiency linked to three-fold higher risk of depression

by Michael Woodhead 

People with low levels of the vitamin B component thiamine have a three-fold higher risk of depression, Shanghai researchers have shown.
According to researchers from the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences at the Shanghai Institutes for Biological Sciences, thiamine has been hypothesized to play an important role in mental health; however, few studies have investigated the association between thiamine nutritional status and depression in the Chinese population.
Therefore they conducted a trial to examine levels of thiamine and its phosphate esters [thiamine monophosphate (TMP) and thiamine diphosphate (TDP)] in erythrocytes of 1587 Chinese men and women.
They found that just over 11% of people had depressive symptoms, and that lower concentrations of all three thiamine biomarkers were associated with a higher prevalence of depressive symptoms.  People with the lowest thiamine levels had a 3-3.5 time higher risk of depressive symptoms compared to people with higher levels of thiamine.
"In conclusion, poorer thiamine nutritional status and higher odds of depressive symptoms were associated among older Chinese adults. This finding should be further investigated in prospective or interventional studies," the researchers say.
Read more: Journal of Nutrition

Almost one in three elderly Chinese have contemplated suicide

In a study of 263 people over 50 years of age in Mianyang, Sichuan, the lifetime prevalence of suicidal ideation was 28.9%, planning 11.4% and attempt 5.3%  respectively. The corresponding 12-month prevalence was 8.8% for ideation,  2.7% for planning and 0% for attempting suicide, respectively.

Correlates of suicidal thoughts/behaviors of this group are similar to findings from other community studies, such as female gender, unmarried status, major medical conditions, insomnia, financial difficulties and lower education, depressive symptoms, recent stressful life events, greater life dissatisfaction.

Read more: International Journal of Geriatric Psychiatry 27: 1124

Most bipolar patients in China are misdiagnosed and treated inappropriately with antidepressants

Study conclusion: The prescription of antidepressants for bipolar disorder patients misdiagnosed with major depressive disorder is very common, and only a very small proportion of patients received guideline-concordant treatment. Considering the potentially hazardous effects of inappropriate pharmacotherapy in this population, continuing education and training addressing the correct diagnosis of bipolar disorder and rational use of psychotropic medications are needed in China.

Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to examine prescribing patterns of antidepressants, antipsychotics and mood stabilizers in bipolar disorder patients misdiagnosed with major depressive disorder in China. A total of 1487 patients originally diagnosed with major depressive disorder were consecutively screened for diagnostic revision in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. Three hundred and nine of the 1487 patients (20.8%) fulfilled DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. Of the BD patients (n = 309), 227 (73.5%) received any use of antidepressants, 73 (23.6%) antipsychotics and 33 (10.7%) mood stabilizers.
In multiple logistic regression analyses, compared with those with MDD, patients with BD-I were more likely to receive antidepressants (OR 1.7, 95% CI 1.1–2.8, p = 0.02), antipsychotics (OR 1.6, 95% CI 1.04–2.5, p = 0.04) and mood stabilizers (OR 3.9, 95% CI 2.1–7.2, p < 0.001), whereas patients with BD-II were more likely to receive mood stabilizers (OR 2.4, 95% CI 1.3–4.4, p = 0.003).
There was no difference in the use of antidepressants (OR 1.1, 95% CI 0.8–1.5, p = 0.7) and antipsychotics (OR 1.3, 95% CI 0.9–1.9, p  = 0.2) between BD-II and MDD. In addition, there was no difference between BD-I and BD-II in any use of antidepressants, antipsychotics and mood stabilizers.

Read more: Human Psychopharmacology

China's health care system is failing to keep pace with rising tide of depression

China's second-most commonly diagnosed disease – depression – costs the nation an estimated 52 billion yuan every year in lost work days, medical tabs and, too often, funeral expenses.
Depression also takes a toll every day on Dr. Jiang Tao, who specializes in the disease as a resident at China's top mental health facility, Beijing Anding Hospital. He's regularly overwhelmed by patients who start lining up at 6 a.m. for his services. Daily before lunch, he diagnoses about 70 sufferers.
"Many more patients are coming to see us" than in the past, Jiang told Caixin. More than half the hospital's mental health cases involve depression, he said, which in recent years replaced schizophrenia as the most common ailment at Anding's six-year-old Depression Treatment Center.
Experts say it's a nationwide medical phenomenon. Liu Jinru, mental health center director at the Chinese Center for Disease Control and Prevention recently cited "a significant increase in depression and anxiety cases."
Across China "almost 50 percent of outpatient visitors complaining of mental problems are diagnosed with depression," Liu said. "And depression sufferers make up 40 percent of all being treated as patients in mental health wards."
Since 1998, depression has stood as the second-most commonly diagnosed illness in China after heart disease, according to Michael Phillips, a suicide researcher at Shanghai Mental Health Center. Health officials say about 260 million people were struggling with at least mild depression as of last year. And many think depression-related deaths such as suicides now exceed traffic fatalities, estimated at 250,000 every year. Moreover, a 2009 survey of depression patients in six cities across China by Shanghai Mental Health Center specialist Professor Michael Phillips, whose Chinese name is Fei Lipeng, found lifelong symptoms of the disease troubling 6 percent of all those surveyed. About 1 percent of mental health patients in China struggle with schizophrenia.
China's medical services cannot keep up with the growing demand. More than 88 percent of patients with mental disorders had never received professional help between 2001 and 2005, the Phillips survey found.
Due to a shortage of mental health facilities and health-care providers, according to the survey, only 45 percent of the nation's depression victims who saw mental health professionals had been treated in the previous six months. Others tried treatment programs at general hospitals or quasi-professional clinics, staffed by physicians who practice western or traditional Chinese medicine. And many get no help at all.
Clinics, some staffed by loosely trained caregivers, take advantage of those who can't find or afford professional services. Outside Anding Hospital, for example, representatives of storefront clinics advertise special "cures" in hopes of luring patients into expensive but often ineffective treatment programs.
Read more: Caixin