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a few days ago, i saw cctv news reporter zhuang shengchun’s in-depth investigation of a child psychiatric clinic, and the opening chapter deeply touched me.

the first epidemiological survey report on the prevalence of mental illness among chinese children was published in the journal child psychology and psychiatry. the study was led by zheng yi and other scholars from beijing anding hospital and started at the end of 2012. about 74,000 children and adolescents from five provinces (cities) including beijing, liaoning, jiangsu, hunan and sichuan were selected as samples.

the survey results show that among school students aged 6 to 16, the total prevalence of mental disorders among chinese children and adolescents is 17.5%. among them, the most prevalent mental disorders include attention deficit hyperactivity disorder (6.4%), anxiety disorders (4.7%), oppositional defiant disorder (3.6%), depressive disorders (3.0%), and tic disorders (2.5%).

this ratio is terribly high. and this data is up to 2021. students who have studied the covid-19 pandemic in recent years should understand that the impact of the pandemic on mental illnesses has been very large.

lu lin, an academician of the chinese academy of sciences, said that the impact of the epidemic on mental health will last for at least 20 years. during the epidemic, "more than 70 million new depression patients, 90 million anxiety patients, and hundreds of millions of people developed sleep disorders and other problems."

at present, the prevalence of depressive disorders among adults in my country is 6.8%, of which depression is 3.4%, and the number of patients is about 95 million. the trauma caused by the new crown epidemic cannot be ignored and needs our attention.

in february this year, a research team led by ziyad al-aly published the results of a study on the long-term effects of covid-19 on mental health in the british medical journal. the study used data from the u.s. department of veterans affairs.

the study showed that the risk of diagnosis or prescription of mental health events in the covid-19 group increased by 60% compared with the control group. specifically, the risk of anxiety disorders in the covid-19 group increased by 35%, the risk of depression increased by 39%, the risk of stress and adjustment disorders increased by 38%, and the risk of using antidepressants increased by 55%. in addition, the risk of cognitive impairment in the covid-19 group increased by 80%, and the risk of sleep disorders increased by 41%.

in lu lin's view, the impact of the epidemic on the mental health of teenagers is more direct. during the epidemic, as a doctor, lu lin saw a large number of teenagers in his medical clinic. they were isolated at home because of the epidemic, and because they were addicted to games, their biological rhythms were reversed. when the epidemic was over, they became depressed, afraid to see people, and unwilling to go out, so they could not return to school normally.

in other words, the total prevalence of mental disorders among chinese children and adolescents in 2021 was 17.5%. if we can see this figure in 2023, it will definitely be higher!

what are the reasons for the high incidence of depression among teenagers in recent years?

is it that the disease rate has increased or the rate of doctor visits has increased?

there is no clear answer at the moment, and it is more likely that it is a combination of these two factors.

let's not talk about the issue of the rate of medical treatment. from the perspective of the increase in the prevalence rate, what is the reason for the increase in the prevalence rate?

a professor i work with happens to be studying the genetics of mental illness. from her research, we can see a number that shows that only less than 20% of mental illnesses can be truly hereditary. in other words, most new patients are affected by environmental factors.

for example, a child may have some unconscious small movements due to external pressure, such as clearing his throat and twisting his mouth. if the pressure is not successfully eliminated, it will develop into tics.

if this pressure continues to exist, tics can develop into depression or even schizophrenia.

so what are these external pressures?

studies have shown that five types of adolescents are most likely to have psychological problems, and these five types of people are basically caused by the external pressure we just mentioned. these five types of people include those who are bullied in school, left-behind children in rural areas, abused children and adolescents, internet addicts, and only children or neglected children and adolescents with multiple siblings.

however, facing the grim reality of the surge in the number of children and adolescents suffering from mental illnesses is the extreme shortage of child psychiatrists.

or to put it another way, let alone child psychiatrists, even ordinary pediatricians are in a serious shortage. many children's mental illnesses are mixed in with adult psychiatric departments for treatment, but there is a big difference between the two. childhood mental illnesses are closely related to the developmental characteristics, growth stages, hormone levels and adolescent psychology of children and adolescents. many children are unable to express their illnesses, and it is difficult to make a correct judgment based on the description of their parents alone.

some more direct factors are that many mental illnesses appear in childhood. for example, most of the autism spectrum disorders we often talk about appear in childhood.

the national level has also discovered the problem of shortage of child psychiatrists, and has formulated many plans. for example, the "healthy china action - children and adolescents mental health action plan" proposes that from 2019 to 2022, 60% of second-level and above psychiatric hospitals will set up child and adolescent psychological clinics, 30% of children's specialty hospitals, maternal and child health hospitals, and second-level and above general hospitals will open mental (psychological) clinics, and the awareness rate of core knowledge of children and adolescents' mental health will reach 80%.

but the question is, where do doctors come from? can they grow out of the ground just by sending documents?

now it has been two years since the time node of 2022. looking back, have the goals set at the beginning been really achieved?

in addition to the shortage of doctors, stigma is also one of the main culprits for the current serious situation.

the word stigma comes from the greek word "stigma", which refers to a certain physical characteristic of a person. later, in the medical field, it refers to an inner shame experience caused by a patient's illness.

disease stigma is very serious in china, especially among people with certain diseases, such as mental illness and sexually transmitted diseases.

in the chinese context, even insulting someone means you are a psychopath.

in this environment, it is even more difficult for patients with mental illnesses to seek medical treatment, causing many families and patients to refuse medical treatment, or even if they go reluctantly, they will not cooperate with treatment.

especially some parents, when their children have a fever, they rush to the hospital as soon as the fever is not very high, but even when the children show many obviously abnormal mental manifestations, they still refuse to go to the hospital for treatment.

only by doing more popular science work can we eliminate the sense of shame about illness and make everyone realize that there is no essential difference between mental illness and colds and fevers. it is just that if the brain is sick, it still needs to see a doctor and care.

in some cases, people think their children have mental problems, but instead of seeing a psychiatrist, they go to a psychologist. not to mention the problem that there are a lot of psychologists in china, and there are a lot of makeshift teams. how many people have delayed their treatment because of misdiagnosis by seeing a psychologist?

here comes another more troublesome problem of mental illness. there is no clear molecular marker indicator. for example, for colds and fevers, we can do a lot of tests in the hospital and judge the condition based on the indicators. but many mental illnesses do not have such indicators. most of them rely on the doctor's subjective judgment and scale, which is prone to misdiagnosis.

yes, even professional psychiatrists cannot necessarily make a clear diagnosis of the condition. there have been cases where children were diagnosed with autism by several hospitals, but were eventually found to have schizophrenia by other doctors. do parents of these children dare to trust those makeshift psychological counseling teams?

finally, i want to say something to everyone. it is not our children who are sick now, but this society.

when we over-push our children, deprive them of their time to play, and prevent them from experiencing setbacks, we cultivate children who are only good at taking exams and studying. these children really become flowers in a greenhouse, unable to resist the slightest wind or rain.

children raised in this way, even if they do not have mental illnesses, their personalities are not sound. i have discussed this with many college teachers. now many students regard their freshman year as their senior year of high school because they cannot adapt to college life. the core reason is that they only have one goal in the first ten years of their lives, which is to enter college. after entering college, their lives are confused. so some people set a new goal for themselves, which is to get into graduate school. what about after getting into graduate school? take a doctorate? take the civil service exam?

so what should you do when no one sets life goals for you? this brings up another question: why is the incidence of mental illness so high among phds? the pressure on phds is one factor, but isn’t it also an important factor that the environment they live in since childhood does not cultivate a good personality and the ability to relieve stress?

from this perspective, even if we add more child psychiatrists and do more popular science work so that all children can receive treatment in a timely manner, it is still a process of treating the symptoms rather than the root cause.

this sick society will still push a large number of children into the abyss.

ultimately, it is our parents and our society that need to cure the disease. only by solving this problem at its root can we prevent more children from entering the child psychiatric ward.