The old peasant woman spoke in a hushed voice as her grandson cowered behind her back: "My daughter-in-law killed herself with rat poison. Nobody knows why. It was one of those things."
The scene, in a small, poor village in Anhui Province last week, is common in China, where suicide rates are almost as high as ignorance about depression.
For years, psychological disorders were ignored or treated as the product of decadent foreign societies, but a flood of studies has revealed that China has some of the biggest mental health problems in the world, particularly among rural women and urban school children.
Last week the Beijing Suicide Research and Prevention Center reported that China had 22 suicides for every 100,000 people, almost 50 percent higher than the global average.
The rate in the countryside was three times higher than in urban centers, reflecting a growing gap between poor inland farms and rich coastal cities. With more men leaving villages to work as migrant laborers, women have less support in dealing with the pressures of motherhood, farming and moving out of their home villages to marry.
In rural areas, 30 women in every 100,000 take their own lives. More than half use pesticides. Those that want revenge on their communities throw themselves down the village well, polluting the water supply.
More women attempt suicide than men in every country in the world -- but only in China do they succeed more often. That is because rural doctors and nurses are not adequately trained or equipped to save them. More than 60 percent of suicide victims die after failed attempts to resuscitate them.
The social and financial impact is only starting to be understood. Last month researchers estimated the annual cost of depression at US$4 billion, the highest in the world after the US. The study was undertaken by Chinese health officials and the Social and Economic Burden of Depression Initiative -- an organization partly funded by multinational firm Wyeth Pharmaceuticals, which sees China as a huge potential market for its anti-depressant drugs.
There are not likely to be many buyers among the 800 million rural population, more than a quarter of whom live on less than US$4 a day. The government has acknowledged that more than half the country's peasants cannot afford to visit a hospital, even with a physical illness or injury. Mental health is less of a priority -- often a source of shame and harder to diagnose. Foreign researchers say 60 percent of farmers had never heard of the Chinese word for depression.
But in the cities there is a growing awareness of mental health issues, particularly among a "one-child" generation brought up without the support of siblings but under extra pressure to satisfy expectations of parents and grandparents.
Nationwide, there has been an 80 percent rise in reports of emotional and behavioral problems, such as truancy and theft, among pupils, say researchers at Pekjing University. Most of the 30 to 50 million children affected are from families with absent parents.
"There is a change in patterns of social stress," said Michael Phillips, director of the Beijing Suicide Research and Prevention Center.
"There is more divorce, more villagers are leaving to work in the cities and there is more competition in school," he said.
"Yet there has been a decrease in poverty, which should decrease depression and suicide. One seems to have cancelled out the gains of the other," he added.
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