PITTSBURGH, Pennsylvania — According to the World Health Organization, an estimated 54 million Chinese citizens live with depression, and a further 41 million live with anxiety. One area of this phenomenon causing growing concern is the mental health of adolescents living in China. The fallout from the COVID-19 pandemic only exacerbates this ongoing trend. Efforts and initiatives are well underway to strengthen adolescent mental health in China, but multiple challenges still lie ahead.
Mental Health in Chinese Adolescents
One factor contributing to worsening mental health among Chinese adolescents is mounting pressures from the authoritative figures in their lives. Chinese culture upholds high standards and expectations for their youth both at home and at school.
The National Institute of Health finds that an estimated 28% of children in China live with a mental health condition as of 2021. Twenty-five percent of those children live with depression, and 22% live with anxiety. Previous findings show the overall prevalence of mental health conditions among Chinese adolescents in years prior at 17%. In addition, the prevalence of mental health conditions among Chinese adolescents increased during the COVID-19 pandemic, when nearly all schools in China were closed and students were confined to their homes, learning virtually, with no interaction with friends.
Furthermore, research from the Chinese Center for Disease Control and Prevention finds the number of children aged 5–14 who died by suicide has jumped by nearly 10% over the past decade. These findings contrast with research that found a suicide mortality rate decline of 5.3% among all age groups during the same time frame. According to China CDC Weekly, researchers attribute this to the implementation of nationwide mental health programs and initiatives.
China also faces a shortage of licensed mental health professionals to properly accommodate the needs of its population. About 5,000 clinical psychologists practice in China, compared to 200,000 in the United States, despite the United States’ population being one-quarter the size of China’s.
On this topic, The Borgen Project spoke with Xiaojie Qin, a psychotherapist and the director of CandleX, a China-based nonprofit organization working to promote the mental health of people in local and international communities.
“We are still at the stage to fill the huge gap of mental health needs, and service providers,” Qin said. “There are improvements in the last ten years, talking about mental health in school, doing screening (although controversial, and I doubt the effectiveness of such monitoring). I think we have to start somewhere, and then we have a huge learning curve.”
Impact of Societal, Familial and Educational Expectations
According to ParentingScience, some researchers have labeled traditional Chinese parenting methods as authoritarian in nature. Common practices include an emphasis on high standards and controlling behaviors through punishments such as shaming or the withdrawal of love and support.
One aspect of this is an idea known as filial piety, a Confucian concept derived from Chinese culture, which is deeply rooted in modern Chinese society. According to ScienceDirect, the concept “is demonstrated, in part, through service to one’s parents. It has shaped family caregiving, intergenerational equity, old age income support, living arrangements, and other aspects of individual, family, social, political, and legal relations in China, Japan, and South Korea for millennia.” It has also been criticized by researchers and mental health professionals.
If not upheld, children may face ostracism from their friends and family, guilt, shame and limited support from the family.
Familial relations are commonly related to a child’s academic performance. Chinese culture greatly values academic excellence and expects students to perform at their highest level, and teachers are highly respected in Chinese culture. The National College Entrance Examination (NCEE), commonly known as the Gaokao, is a standard college admittance exam, and a student’s score carries significant weight regarding potential educational and career opportunities. A student’s future could be determined based on the Gaokao score they receive.
Efforts To Strengthen Adolescent Mental Health in China
There are multiple governmental and nonprofit organizations working to promote the overall well-being of adolescents in China living with mental health issues. The “Opinions on Strengthening Mental Health Care Services,” issued in 2016, clarifies the responsibilities of government stakeholders and other relevant sectors. It also requires educational institutions to strengthen their mental health education to promote positivity and wellness to students.
The China Children and Teenagers’ Fund (CCTF) is a nonprofit working to promote mental health and overall well-being for adolescents living in China. The organization provides professional psychological support, counseling services and educational programs and materials for adolescents who are struggling with their mental health.
Throughout its duration, the Adolescent Health and Development Project, co-initiated by the United Nations Children’s Fund (UNICEF) and the National Health Commission of China, aided hundreds of thousands of adolescents struggling with their mental health. The project provided packages to counselors and teachers to better equip them to address the needs and promote the overall well-being of their respective students or clients.
With these existing initiatives, Xiaojie Qin of CandleX still expresses concern over what the future holds for adolescents who struggle with their mental health.
“This era creates tremendous challenges for young people these days, and will increase the gap that I’ve seen in teens’ mental health (may I even call it mental health inequality).” While efforts and initiatives are in place, strengthening adolescent mental health in China remains a significant challenge for the nation as the population grows and the care system struggles to accommodate the needs of patients.
– Nicholas DeLuca