-Interview with Xu, a Chinese-American psychiatrist.
China is a country with a high suicide rate, and many suicides are depression patients.
Reporter: You pointed out that depression is now a worldwide public health problem. Please talk about the occurrence, diagnosis and treatment of depression, and talk about depression among students and teachers with specific cases.
Xu: When it comes to the prevalence or prevalence of depression, every country has different statistics. Earlier data, for example, according to the statistics of the International Health Organization in 2002, in western society, the incidence rate of adults is 5% to 10%. In China and Japan, only 2%. Generally, people in the industry believe that this low data does not mean that China people and Japanese people are particularly good in mental health and are not prone to depression, but because orientals love face and refuse to admit that they have depression. This situation is also evident in the Chinese communities in Hong Kong and Los Angeles. In previous years, the prevalence of depression in Hong Kong and Los Angeles was low. The situation has changed in recent years. In 2009, two surveys in Hongkong and Chinese mainland both found that the prevalence of depression in China was about 8%.
Of the 1 10,000 people who commit suicide every year in the world, more than14 is in China. There is a shocking figure in academic circles: every year, more than 287,000 people in China die of suicide, 2 million people attempt suicide, and 23 people out of 65,438+10,000 commit suicide, which is a country with a high suicide rate.
Among the patients I have treated abroad, there are many educators, namely students and teachers. For example, a middle school student who immigrated with his parents has a good family. Studying in China is very good, but I can't adapt to changing schools in the United States. I said I was depressed, unable to concentrate, and inexplicably depressed. There is also a 30-year-old middle school female teacher with a good family relationship. I was pregnant unexpectedly six months ago, and I was very unhappy. Later, she had a miscarriage and began to suffer from insomnia and loss of appetite. And she can't sleep when she wakes up at three or four in the morning every day, and her mind is full of distractions and thoughts. It's difficult to get up in the morning. What I have to do all day makes me feel at a loss and I can't concentrate during the day. I often cry alone, and I can't say why. Sometimes I can't help thinking of my dead parents. This situation has been going on for three months without improvement.
They all meet the diagnostic criteria of American Psychiatric Association for depression ... The prominent problem of China students is stress. There were many exams in previous years, and employment pressure has become a big problem in recent years.
At present, people in China generally lack knowledge about depression, and only a few patients have received treatment.
Reporter: In your lectures and writings, you mentioned that at present, China people generally lack sufficient knowledge about depression, and most patients have not been diagnosed and treated. What do you think is the reason for this situation?
Just like hypertension, diabetes, cancer or some infectious diseases, depression is a disease that everyone may suffer from. When people in China suffer from depression, they tend to be somatic. However, these symptoms are relatively rare in western patients with depression. I have a pamphlet called "Out of Depression". I wrote this book for two main reasons. First, China people generally don't understand depression and don't pay attention to mental health. Depression has become the second largest public health problem in the world, but in China, more than 95% of patients with depression have not been found, and of course they have not been treated. These findings do not mean that people with depression in China are willing to receive treatment. Recent studies have found that China people suffer from depression, and only a few patients (study abroad).
Wwww.liuxue86.com) received treatment. Depression not only affects health and quality of life, but also causes 10% patients to commit suicide. People in China usually use physical symptoms to express their depression, and spend a lot of time and money on various tests, trying to find a way to treat symptoms such as heartbeat, headache, bloating, dizziness and insomnia. When doctors told them that they could not find any physical problems to explain these symptoms, people in China still refused to accept that these symptoms were actually caused by anxiety and depression, and resolutely refused psychiatric treatment.
Experts believe that China people are particularly prone to somatization of depression. There may be two reasons: first, it is a matter of face, and it is shameful to admit that there is a mental problem. It is even more humiliating to express depression with somatization symptoms. The second is the concept that there is no mental or emotional problem, and that depression cannot be pathological, so it is basically a physical symptom of depression. Mental illness is a very complicated problem, which is usually the result of the interaction of physiological, psychological and social factors.
Modern medical research shows that depression is a problem caused by brain nerve dysfunction. Personally, I attribute depression to the interaction between environment and genes, which mainly affects one's mood, mentality, will and expectation. People with depression feel depressed, unhappy, lack of motivation, depressed, bored, pessimistic, confident, at a loss, and even have suicidal and world-weary thoughts.
In a word, the tradition of moral evaluation of mental illness has always existed in China, which makes many patients and their families unwilling to openly admit their illness and delays treatment. The common concept of "three drugs are toxic" also makes many people unable to choose drug treatment.
Depression is caused by the bad interaction between genes and environment, and the prevention of depression should start with reducing the incentives.
Reporter: Can depression be prevented? What are the effective treatments at present?
Xu: In order to prevent depression, we need to reduce the causes of depression, that is, we need to reduce the adverse interaction between genes and the environment. Since genes cannot be changed, can we reduce environmental incentives? Theoretically, the factors that lead to a happy life, such as mutual love, justice and peace, the meaning of life, physical and mental health and sufficient economic income, should reduce the environmental incentives that induce depression. Of course, this still needs empirical research. So far, I haven't seen any research report on the prevention of depression.
Depression is the result of the interaction between genes and environment, so treatment needs to focus on these two reasons. On the one hand, drugs are used to alleviate the symptoms of brain dysfunction caused by genes; On the other hand, psychological counseling can reduce the pressure of the environment and increase patients' ability to cope with the pressure, thus helping patients live a healthy and normal life.
Counseling generally starts from several aspects: discussing symptoms to let patients know more about depression; Discuss the inducement and let patients know the cause of depression; Discuss how to reduce incentives. Ways to reduce incentives include changing negative mentality and taking appropriate measures to improve living conditions; Review your family and growth experience and understand the factors that shape your mentality and character; Start practicing how to live a healthy and normal life, such as going to bed early and getting up early, exercising regularly and eating normally.
Before deciding on medication, doctors need to discuss the above-mentioned targeted consultation projects with patients and their families. It is impossible for patients to prescribe without saying a few words as soon as they enter the door. The purpose of drug therapy is to alleviate or eliminate the symptoms of depression, help patients improve their sleep quality, and improve their self-conscious symptoms such as loss of appetite, depression, lack of interest and motivation, and lack of motivation. It usually takes a week or two for the therapeutic effect of drugs to appear, so patients need to continue taking drugs, because the therapeutic effect of drugs can not be achieved in a day or two. Also know that sometimes drugs have side effects, which may be particularly obvious in the first few days. If you keep taking the medicine for a few days, the side effects should be gradually reduced. Western medicine usually prescribes according to the recognized standard procedures in the discipline, such as first-line drugs, that is, drugs with obvious curative effect, small side effects and lower price. If the effect is still not obvious after a few weeks, switch to second-line drugs. Patients need to communicate with doctors in time.
To stay away from depression and establish mental health, we need to change our understanding and transform our social culture.
Reporter: Do you think finding happiness can keep you away from depression? What can the World Happiness Report give us? How to build mental health?
Are westerners happier after so many years of self-pursuit? Recently, the United Nations published a "World Happiness Report" and found that western countries are indeed happier. In the global 150 countries, the ten happiest countries all come from western society. Only five Central and South American countries and three Middle Eastern countries are in the top 25, and the rest are western countries. Of course, we should not ignore the fact that western countries may be happier than other countries, but the prevalence of depression in western countries does not seem to have decreased, and the suicide rate in western countries has not decreased in the past decade or so.
In the happiness report of the United Nations, Chinese mainland ranks 93rd, 64th, 43rd and 30th. Judging from the ranking of the report, it seems that China people and overseas Chinese are not very happy. What is the reason? Without exact data, we can only speculate. I think the possible reasons include the following: First, China people pay too much attention to face, which may lead to opaque interpersonal relationships, hinder sincere and frank interpersonal communication, care too much about other people's opinions, pay attention to appearance, neglect to cultivate the growth of inner life, and give up fighting for things that are beneficial to them for face. Second, I am not good at frank and open communication. China people seem to be used to "tacit understanding", "When you say nothing" and "Silence speaks louder than words". It seems to be a virtue to bury things in your heart and hide the truth, especially bad news or things. It's hard to feel comfortable living in such an environment. Third, when striving for achievements, the definition of achievements is too narrow. As long as the method is correct, it is good to strive for success. However, if the definition of achievement is limited to utilitarianism, the cost of success will be too great for many people. Fourth, "everyone sweeps the snow in front of his own door, regardless of others' frost." Foreigners who are famous for their profits often donate a lot of money to some institutions, such as universities, hospitals, libraries or other welfare institutions. In the happiness report of the United Nations, donations to charities are regarded as one of the indicators to measure the quality of life.
In other words, even regardless of religion and belief, happiness can not be achieved only by satisfying one's own desires, but also by living a meaningful, loving, free and fair life, and of course, having enough economic income, healthy body and mind, good family and interpersonal relationships, etc.
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