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China's rapid changes are bringing stress—and high suicide rates

BEIJING—Suicide hot lines can't handle all the desperate calls in China, and it's little wonder. Some 2 million people try to kill themselves each year in China, and about 250,000 of them succeed.

During peak hours, the telephones just ring and ring at the Beijing Suicide Research and Prevention Hotline. Social workers and nurses are too busy to respond.

"We get over 20,000 calls a month, of which we can answer maybe 15 percent," said Dr. Michael R. Phillips, the center's Canadian-born executive director.

Incoming calls funnel through a computer system, and those working the hot lines view screens that display the telephone numbers of callers waiting for counselors.

"We can see the numbers disappear if we don't get to them in time," said Wang Yaxing, the staff director at the center. "We feel very sad about that. The callers get frustrated, and they might kill themselves."

Many Chinese may feel disoriented—even acutely anxious—over the topsy-turvy changes in their country, which has gone from cradle-to-grave communism to a rather savage style of capitalism in little over a generation.

"The last 20 years, we've developed so fast," Dr. Liu Fuyuan, the vice chair of the China Mental Health Association. He cited a study of 10,000 Chinese that showed 79 percent feel pressure, including schoolchildren stressed over grades and workers scared they may lose their jobs. "The pressure is very fierce. You can be fired at any time."

Suicide in China isn't entirely like in the West. Far more women than men commit suicide, the majority of them in rural areas. Suicide is also prevalent among the elderly, some of whom don't want to burden their children with their financial or health woes. Guns are largely unavailable, so those wanting to kill themselves leap from tall buildings in cities or reach for pesticide or rat poison in the countryside.

Chinese generally don't seek professional help for temporary psychological distress. Many Chinese shun those with mental illnesses or severe depression.

"The stigma of getting psychological treatment is such that many people prefer to be desperately unhappy," said Phillips, a Harvard-trained psychiatrist who's been in China for nearly two decades.

Until 2000, China published no tallies on suicide. Since then, it says that about 250,000 people kill themselves annually.

China's suicide rate is 23 per 100,000 people, far greater than the world's average of 10 per 100,000 people and more than double the rate in the United States (11 per 100,000 people). It's slightly less than Japan's rate of 27 per 100,000 people, but China's far greater population makes the absolute numbers of suicides staggeringly higher.

Phillips set up the suicide hot line center in August 2003 at the Huilongguan psychiatric hospital in northern Beijing, China's largest. Twenty people staff the center, offering 24-hour service. All phone calls are taped, and new operators are given six months of training, surpassing international standards.

With barely any advertising, the calls began to pour in—and not only from the Beijing metropolitan area. Some 81 percent of the calls come from elsewhere in China.

Two-thirds of the callers are between 20 and 39 years old and have never sought psychological help before, Phillips said.

Some 10 suicide hot lines have now sprung up around China, some of them regional rather than national. The hope is to eventually link them together in a phone network, so that if responders at one hot line are busy, the call could be rerouted to another center. But Chinese officials have yet to offer sufficient funding, so Phillips is soliciting help from abroad.

About a third of those who call the Beijing hot line are seriously depressed. Most are first-time callers, viewing the hot line as their only alternative.

"It's free, and there's no loss of face in using a hot line," Phillips said.

While older Chinese use the hot line less often, they make up a significant portion of the suicides in the nation.

"One-third of all suicides in the country are of people 55 years or older," said Cheng Yong, director of the National Association for the Elderly.

Invariably, as seniors confront health problems, loneliness and financial hardship, they do so in isolation.

"Ninety percent of elderly people who attempt suicide or who die by suicide never seek help," said Cao Lianyuan, head of the Huilongguan Psychiatric Hospital.

Many suicides—perhaps a third—are impulsive responses to stressful situations. That's especially true among poorly educated women in rural areas, where some are forced into loveless marriages. Suicides are seen almost as normal. Such disempowered rural women rarely call hot lines, partly because they may not know of their existence.

In rural hamlets, a conflict with a husband or a mother-in-law can quickly become an intolerable burden, especially if the question of divorce arises, Liu said.

"In some rural areas, it is shameful to be divorced," Liu said.

A container of pesticide or rat poison is ever present, making suicide a quick and easy choice for a peasant woman in the thralls of sudden depression.

"It's like a loaded gun, because they are very lethal and it's quite hard to resuscitate people," said Phillips, noting that studies show 58 percent of all suicides in China involve pesticides. Many rural clinics are without the atropine and respirators needed to revive those who ingest pesticide or poison, he added.

"If we improved resuscitation at the local level by just 50 percent, we'd save at least 50,000 lives a year," Phillips said.

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(c) 2005, Knight Ridder/Tribune Information Services.

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