DOWN AND OUT
IT'S MORE THAN a year since singer-actor Leslie Cheung Kwok-wing scribbled the Chinese character for 'depression' on a piece of paper, then jumped to his death.
His intent was to escape, rather than publicise, the illness that dogged him. But in taking that last step, Cheung helped change perceptions in Hong Kong. It's made people understand that depression is more than feeling a bit sad and sorry for yourself. Depression is a disease that can ruin the lives of even the most talented, wealthy and admired people.
'People are aware of depression,' says Professor Wing Yuen-kwok of the Chinese University of Hong Kong's department of psychiatry.
In the 1980s, studies suggested Hong Kong Chinese suffered significantly lower levels of depression than westerners. But in recent years, depression levels have surged - along with the rate of suicide. 'Nowadays, suicide is recognised as the end stage to mental illness,' says Wing. 'We may have a lot of problems, but we don't kill ourselves. A lot of people have marital or financial problems, but they don't kill themselves.'
Wing says the rise in depression levels in Hong Kong may reflect changes in populations around the world. According to the World Health Organisation, global depression levels are rising so rapidly that it predicts that by 2020 it will be second only to heart disease as a cause of death and major disability.
However, that's not the whole story, says Wing. In the 80s, when the studies were conducted, admitting to such a condition wasn't acceptable to most traditional Chinese.
'Maybe Chinese didn't report it,' he says. 'But it's also possibly because the family support system was stronger. There was more support, therefore less anxiety. Or it may simply have been that depression was not diagnosed properly then.'
Wing says traditional Chinese are more likely to describe physical symptoms than emotions.
Accepting that the problem may be psychiatric first requires careful physical examination, testing and detailed questioning - something many busy family doctors lack the time to do. Many patients may have simply been sent home with antibiotics. And, given the tendency of Hongkongers to shop around when unsatisfied with their treatment, doctors who missed depression cases would probably never know about it.
Hong Kong, which until recently had a low overall suicide rate, has long had a high rate of suicide among the elderly. This was often dismissed as a result of elderly people no longer wishing to live in poverty or with chronic or terminal illness. But psychiatrists say it may also be due to a high rate of undiagnosed depression among the elderly because they're least likely to admit to symptoms of mental illness or emotional distress.
As well, there's now more drug and alcohol use among the Chinese population, Wing says. Wherever drugs and alcohol are involved, depression levels go up. Once it was a disease of middle age. Now, it's increasingly a problem for the young.
Why this shift? Wing says the increasing divorce rate, greater family problems and more drug abuse all make children more vulnerable to depression. 'Given that depression is a disease with a high death rate - but one that's difficult to detect - what symptoms should warn friends and relatives of a depressed person that they need help?
There are four major areas.
Mood: The person's mood changes significantly. They may be tearful, miserable or not reacting to anything. Or they may be irritable and overreacting to everything.
Thinking: A depressed person is unable to think clearly or concentrate. They may suffer memory loss and when asked about their views tend to take a pessimistic stance. 'They feel useless and worthless,' says Wing. 'They see everything as dark grey - and this is out of all proportion.'
Function: Depressed people lose the ability to function normally in daily life. They become inattentive, and their poor concentration and memory impairment mean they make mistakes at work. They get into more quarrels with colleagues and family. 'Their family, work and marital functioning is all affected,' Wing says.
Behaviour: A depressed person may be unable to do anything at a normal pace. Everything takes longer and is harder. Some may not have the energy to get out of bed. But others with the form known as 'agitated depression' may become irritable, even violent.
What should you do if you suspect someone is suffering from depression? The first step is to go to a psychiatrist or clinic for assessment. Someone deeply depressed is unlikely to go by themselves, so they'll need a relative or friend to take them.
Recovering from depression and staying healthy are also big challenges. Fortunately, in the past few years a number of support groups have been set up to deal with the problem.