It is a given that when people experience a lot of change in a short period of time, they get stressed out. But just imagine the impact in a place like China, where in less than a generation, economic development has drastically changed people’s standards of living and led millions of people to leave rural homes for jobs in the cities. The disruptions have put many people’s mental health to the test. Research by Dr Ran Maosheng of the Department of Social Work and Social Administration and his collaborators has been showing the extent of the impact.

Dr Ran, a psychiatrist by training, set up the Chengdu Mental Health Project (CMHP) in 1994 to provide a platform for research and interventions on mental illness and mental health services. Ever since, the project has been tracking more than 150,000 people in six townships in Chengdu through China’s household registration system, which keeps people registered in their home towns even after they leave.

“My aim is to understand the impact of social development on mental illness and mental health services, so we can advise the government on what policies would be meaningful to improve people’s lives,” he said.

“This project is unique in the world because it is longitudinal and the population is large. To do this in a Western country would be too expensive and the refusal rate would also be very high.”

​ This project is unique in the world because it is longitudinal and the population is large. To do this in a Western country would be too expensive and the refusal rate would also be very high.

Dr Ran Maosheng

Prevalence up nearly 50 per cent

Surveys conducted with the help of doctors, nurses and psychologists trained by the CMHP show that the prevalence of mental illness has increased with China’s economic development.

Between 1994 and 2015, the prevalence of all mental illnesses increased by 48.2 per cent. Economic change is one reason why. More industrial jobs and more motorcycles have resulted in more brain traumas from accidents, and so the proportion of mental illness cases linked with brain trauma has increased by 388 per cent.

Increasing wealth has also meant people have more money to buy alcohol and drugs, coinciding with a 373.8 per cent increase in mental illness from alcoholism and alcohol dependence and a whopping 1,808.7 per cent increase in mental illness from drug and substance abuse.

Other societal changes are also having an impact. An ageing society has led to a 214.8 per cent increase in mental illness associated with cerebovascular disease, and a 126.4 per cent in senile dementia.

Even the one-child policy has had an impact. Apart from surveys, CMHP has conducted interventions, in particular on schizophrenia. One finding is that gender differences in schizophrenia have been exacerbated by the one-child policy.

While it is known that women have better long-term outcomes than men, possibly due to the protective effects of oestrogen, and they are less aggressive than men, Dr Ran and his team showed that gender imbalances may be aggravating the problem by making it that much less likely for men to marry, especially in rural China.

“The gender ratio in rural China means there are more males than females. Even males who are mentally healthy cannot marry. Females with schizophrenia have relatively less severe aggressive symptoms. So all that together means they are more likely to marry, and they are more likely to have a family caregiver,” he said.

Focus on interventions

The importance of family in supporting patients has been another major focus of Dr Ran’s work, given that in 1994 a CMHP survey found nearly one-third of schizophrenic patients did not receive medication due to poverty, ignorance, lack of a caregiver or other reasons. Since most patients are cared for by their families in the community rather than the State, it was felt they should be targeted, too.

A psycho-educational family intervention was devised for patients with schizophrenia and their families and subjected to a cluster randomised control trial. “We trained family members, not only patients, in many different skills such as how to understand the illness, how to take care of patients, how to prevent relapse and how to handle their relationship with the patient,” he said.

The results of a 14-year follow-up study were recently published and showed the intervention group did better in such things as the patient continuing to see a doctor and the family having a better understanding of the importance of medication compliance. More work might be needed to strengthen other outcomes in the long term, though, which this study is helping to highlight.

The CMHP also works with collaborators such as Harvard University, Yale University, King’s College London, University of British Columbia, Peking University, Tsinghua University and Sichuan University, and recently started a new project with the University of Pennsylvania on reducing the stigma for patients with mental illness. “I hope the CMHP can develop as a platform, not just for mental health, but for issues related to the elderly and others as well, so we contribute to improving services for people in need,” Dr Ran said.

Mental Health In
Modern China

China’s rapid economic growth and societal changes are having a tremendous impact on mental health, as revealed in a long-term project by Dr Ran Maosheng.

The investigation team of the Chengdu Mental Health Project in 2015.

Over 80 papers and one book have been published from the series studies of the Chengdu Mental Health Project. Family-Based Mental Health Care in Rural China was published by the Hong Kong University Press in 2005.

The Chengdu Mental Health Project provides training to primary health professionals in the Xinjin county, Chengdu City.

The Chengdu Mental Health Project was set up to provide a platform for research and interventions on mental illness and mental health services in China.