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Multiple measures to fight depression

ZHU CHUANLIN et al. | 2021-06-17 | Hits:
(Chinese Social Sciences Today)

A group of 9th graders participate in a mental health training game to boost mutual trust and team spirit in Huainan City, Anhui Province, on April 9. Photo: CFP

At this year’s NPC and CPPCC sessions, mental health related proposals were on the agenda for many deputies and members. According to incomplete statistics, approximately 30 deputies discussed this topic. For example, Zhao Guoxiang, a NPC deputy and president-elect of the Chinese Psychological Society, pointed out that the establishment of a “one-stop” community mental health service station would help meet the people’s growing demand for psychological services in light of increasingly prominent psychological and behavioral problems caused by negative mental health experiences such as depression and anxiety.

Mental health
The China National Mental Health Development Report (2019-2020), released by the Institute of Psychology at the Chinese Academy of Sciences in March, found that in 2020, the detection rate for depression among adolescents in China was 24.6%, with the depression rate among girls higher than that of boys. It should be noted that a survey of more than 10,000 researchers found that nearly 25% of the respondents showed varying degrees of depression, while more than 50% showed varying degrees of anxiety. This suggests that depression is not just a problem for teenagers, but for researchers as well.
Depression is one of the most common and treatable mental disorders. Patients usually exhibit a loss of interest, feelings of guilt, low self-esteem, sleep and appetite disorders, physical fatigue, and difficulty concentrating. The disease is characterized by a significant and persistent low mood, which is not commensurate with the situation the patients are in. They often feel grief, or pessimism, and in severe cases, this might result in suicide attempts or suicidal behaviors.
According to the World Health Organization (WHO), in 2017, more than 300 million people worldwide were living with depression, an increase of more than 18% from 2005 to 2015. As of 2019, more than 95 million people in China were suffering from depression, posing a threat to people’s mental health. 
Studies have pointed out that two-thirds of the patients with depression in China are women, among which 10%-15% of the patients may eventually choose to commit suicide, and the suicide rate of patients with depression is 20 times higher than the general public. 
In addition, the WHO 2020 survey showed that in developing countries, the probability of women experiencing mental disorders during pregnancy and postpartum is 15.6% and 19.8%, respectively, in these cases depression is the most common disorder. Studies have shown that nearly 43% of pregnant and postpartum women in China suffer from depression. As we can see, it is particularly necessary to take note of mental health problems for depressed individuals.
Current solutions
Though the experience of depression can be damaging to mental health, a series of theoretical and practical attempts have been carried out to alleviate the adverse effects of depression on physical and mental health. Lessons learned from past experiences can be summarized as follows.
Improving mental health is time consuming, there is no quick fix, so we should establish and improve national mental health testing systems to screen abnormal mental health cases as soon as possible. In the context of normalizing prevention and control, public mental health efforts are essential, especially for groups such as teenagers living with grandparents, students, college teachers, and car-hailing drivers. It is suggested that mental health education should be incorporated into primary and secondary schools’ curriculum systems. Courses related to mental health should be compulsory for students, and top-level design for mental health education should be strengthened. 
At the same time, we should increase investment in training for professional mental health counselors and teachers. Public accounts on WeChat for mental health education can also be established, to inform a wider audience. The government should take the lead in establishing a mental health examination and file management system for the public, and install long-term mechanisms to detect and help those struggling with depression. 
Academic research
Since the main clinical symptom for depressed individuals is a significant and persistent low mood, it is necessary to regulate this unhealthy experience. Researchers have carried out a large number of studies on the emotional regulation of depressed individuals. 
For example, Chinese scholar Zhang Shaohua found that adolescents with different depressive symptoms had different preferences in the use of emotional regulation strategies. Individuals with more depressive symptoms had a lower frequency of using cognitive reappraisal strategies for emotional regulation, and higher frequency of using expressive suppression strategies. 
In the meantime, researcher Cheng Mengyin found when older adults used cognitive reappraisal less often, they were at higher risk of experiencing depressive emotions. 
Cognitive reappraisal and expressive suppression are the two most representative emotion regulation strategies in James Gross’s emotion regulation process model, and are also the two most studied emotion regulation strategies in the academic world at present. 
Cognitive reappraisal is about thinking outside the box, disrupting unhealthy thought patterns, and looking at things from a different perspective. For example, when one sees the scene of a car accident, the observer can contemplate how fortunate it is that only cars collided and no one was injured. Expressive suppression refers to the inhibition of one’s emotional experiences as much as possible, neither expressing emotions through words, nor showing emotions through facial expressions. For example, when one fails an important exam, the student may feel so sad that they want to cry, but manage to keep a neutral expression and pretend nothing has happened. 
A large number of studies have shown that cognitive reappraisal falls under the purview of an adaptive emotion regulation strategy, whereas expressive suppression is a non-adaptive emotion regulation strategy, which is more likely to induce psychological disorders. The effects of cognitive reappraisal and expressive suppression on individuals’ emotional regulation are mainly reflected in their cognitive, affective, and social functions.
On a cognitive level, emotional regulation using expressive suppression strategies will consume more cognitive resources, and this approach will negatively impact simple and complex memory tasks. However, the cognitive reappraisal strategy doesn’t consume as many cognitive resources and does not adversely affect the completion of memory tasks. 
From an emotional perspective, the frequent use of expressive suppression strategies for emotional regulation will weaken individuals’ positive emotional experiences, and increase negative emotional experiences. The cognitive reappraisal strategy, on the other hand, is helpful to enhance positive emotional experiences and weaken negative emotional experiences. 
Moreover, an expressive suppression strategy would weaken an individual’s ability to express emotions, but a cognitive reappraisal strategy would not. Therefore, the habitual use of non-adaptive expressive suppression strategies for emotion regulation is an important cause of significant and lasting depression. 
In terms of social function, frequent expressive suppression will not allow individuals to obtain social support, and will reduce an individual’s depth of interpersonal communications, while limiting the establishment of intimate relationships, and thus reducing one’s sense of happiness. The cognitive reappraisal strategy will do the opposite.
Going forward
The emotional and social functional deficits of depressed individuals are closely related to behaviors, and using expressive suppression strategies to regulate emotions is particularly harmful. In order to help depressed individuals avoid depression, we can start with the following recommendations. 
First, the government’s leading role should be highlighted. Given the importance of mental health, a national center for mental health and mental health prevention and control was established in March 2021, aiming to screen and evaluate depression, schizophrenia, and other mental illnesses, which provides a strong support for the promotion of mental health. 
Second, since the use of expressive suppression strategies can harm depressed individuals’ emotional and social functions, we can help people develop healthy habits such as using cognitive reappraisal strategies to regulate emotions by means of education and training. 
Third, studies have shown that appropriate physical exercise helps to improve physical health and alleviate negative emotional experiences. Individuals who engage in regular physical activity experience more positive emotions and have fewer depressive symptoms than those who are sedentary. 
In addition, China’s National Mental Health Development Report (2019-2020) found that interpersonal relationships and living habits are important factors which affect an individual’s mental health. Specifically, when people have better interpersonal relationships, healthy eating habits, and exercise frequently, then they have lower levels of depression. This attests to the feasibility and effectiveness of taking part in physical exercise to alleviate depression. 
In summary, in the process of clinical treatment, we can start with correcting emotional regulation strategies for depressed individuals, and flexibly adopt a variety of other means to help people establish healthy emotional experiences and emotional expression systems, so as to improve their mental health.
Zhu Chuanlin and Jiang Yuhan are from the School of Education Science at Yangzhou University; Li Ping is from the Brain and Cognitive Neuroscience Research Center at Liaoning Normal University.
Edited by YANG XUE