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Is there a depression crisis in Asia’s cities?
How much of a problem is depression in Asia’s metropolises and how can it be identified and prevented?
Despite the stigma associated with mental health problems in Southeast Asia, depression is becoming a topic that is hard to ignore and even more difficult to discuss.
Depression is generally defined as an intense feeling of despair that goes beyond any normal degree of sadness encountered in everyday life.
The symptoms can be mild, moderate or severe. It can greatly disrupt a person’s life, work, relationships, eating and sleeping patterns, as well as the passions we enjoy in our spare time.
The condition, which can also be recurring or chronic, is said to affect a staggering 86 million people across Southeast Asia, with the World Health Organization (WHO) pointing to suicide as the second biggest cause of death among 15-29 year-olds in the region.
Women of childbearing age (particularly following childbirth) and adults over the age of 60 are also said to be at higher risk of depression.
Many believe the region is rapidly turning into a pressure cooker, with the stresses of modern living and cultural attitudes towards expressing such feelings leading to record numbers of suicide.
This was highlighted in 2016, when the South China Morning Post reported that education chiefs in Hong Kong were taking urgent measures to try and reverse a sharp increase in suicide among young people.
It followed the news that 22 students had taken their own lives since the start of the academic year alone – with four such deaths taking place in the space of just five days.
With almost 60% of the world’s population concentrated in Southeast Asia – mainly within Asian metropolises, many put the blame squarely on modern living.
For example, Delhi in India contains 25 million people, while Bangkok and Hong Kong boast a population density of 9.3 million and 7.3 million respectively, with hefty visitor numbers swelling this further each year.
A study conducted by the Central Institute of Mental Health in Mannheim, Germany, suggests that city-dwellers suffer more stress, fear and anxiety than their bucolic rural counterparts, thanks to more hyperactivity in the amygdala region of their brain, which is linked to depression and anxiety.
Regional commentators are also quick to point to cultural attitudes also play a large part in the suppression of such feelings.
The tendency across the Southeast Asian population is to try to conceal any depression, for fear that any such admission would be viewed as weakness or a taint on their family’s honour. In some cases, health professionals are also said not to view the symptoms of depression as ‘real’ or pathological.
Governments appear to be waking up to the problem. In March, India passed a Mental Healthcare Bill – which decriminalises the act of suicide and aims to provider better care in terms of prevention and ongoing support.
Praising India for these steps, WHO is now calling on other nations in the region to make similar efforts to ramp up the quality of their services.
In 2017, it made mental wellbeing the focus of its annual World Health Day, putting the message out loud and clear that no one should have to suffer in silence.
“People experiencing depression often find a range of evidence-based coping mechanisms useful,” comments Dr Poonam Khetrapal Singh, Regional Director, WHO Southeast Asia.
“From talking to someone they trust to exercising regularly or staying connected with loved ones. Avoiding or restricting alcohol intake and refraining from using illicit drugs helps keep depression at bay. But many people also find professional help an important part of managing the condition, particularly in terms of exploring treatment options.”
WHO’s Mental Health Gap Action Programme (mhGAP) aims to help countries, particularly those with low to middle-incomes increase services for people with mental, neurological and substance use disorders.
There’s little doubt that being an expat brings its own set of challenges – where feelings of trying to fit in, the need to succeed and coping with a sense of isolation from loved ones back home may all contribute to depression, which the WHO says now affects more than 300 million people globally.
Stay-at-home parents, in particular, can face a difficult task in juggling their own needs with the demands of their family.
Worries about accessing local services or knowing who to trust can make it difficult for people to open up. This can make online forums another good way to connect with others experiencing the same feelings.
Remote counselling is widely available for those looking to access more tailored support, with the International Therapy Directory offering detailed information on services. Local embassies should also be able to provide a list of accredited experts based in the area.
Take care of you
The UK-based Mental Health Foundation offers its 10 top recommendations for preserving your wellbeing:
1 Talk about your feelings
2 Keep active
3 Eat well
4 Drink sensibly
5 Stay in touch
6 Ask for help
7 Take a break
8 Do something you’re good at
9 Accept who you are
10 Take care of others