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China’s elderly exposed to suicide risk

Wednesday 17 April 2013

By Cameron Frecklington

BEIJING - The voice down the other end of the phone quivers and cracks. It is an old voice, rich in experience but tinged with sadness. He talks of a wife lost to pancreatic cancer, lamenting what might have been had he done more. He tells tales of her virtues before breaking down in tears.

"People live to have a meaningful life. Without her, my life is meaningless," he sobs.

Listening is Xu Kun, director of the Love Delivery Hotline, a suicide prevention hotline that targets the elderly in China. That is all many of the hotline’s callers really want. They are representative of discontented elderly population where suicidal thoughts and tendencies are common.

The past and present

China’s suicide rate received considerable media attention in 2002 when an article was published in The Lancet, a British medical journal. The article’s research estimated that from 1995 to 1999, 287,000 people committed suicide in China each year, a rate of 23 per 100,000, more than double the rate in the US at the same time.

Since then, China’s suicide rate has fallen considerably. A study looking into suicide trends from 1990 to 2010 in Shandong, one of China’s most populated provinces, showed that suicide rates have decreased in the province each year by an average of 8%. The overall age-adjusted suicide rate dropped from 36 per 100,000 to 11 over that same period.

The research states that the overall reduction in the suicide rate from the late 1990s to the late 2000s in Shandong, a decrease of 46%, is similar to the decrease in suicide nationwide.

Professor Jing Jun, a professor of sociology at Tsinghua University, believes that China’s decrease in suicide rate can ultimately be tied to the rural-to-urban migration of at-risk rural women during China’s economic miracle.

Jing believes that urban migration takes the women away from "family-based conflicts to which there are no resolutions". By moving away from these hopeless situations, often where the women have no say in who they marry and where they live, they can gain a sense of control over their own lives.

Dr Hansen Sun, a researcher involved with the Shandong study and epidemiologist at Queensland University of Technology in Australia, also contends that economic development brings with it improved health care, advanced emergency services, better roads, and greater access to vehicles. These factors, combined with government efforts to lessen the availability of highly toxic pesticides, may have greatly reduced the fatality rates of suicide in rural areas, thus reducing the suicide rate of the entire country.

However, Sun’s research also discovered that the suicide rate among the elderly, those aged 65 years and over, decreased at a pace disproportionate to the drop in the national suicide rate. The research showed the risk of suicide among people aged 65 or over was five times that of the general population.

Fifteen minutes of sunshine

The headquarters for the Love Delivery Hotline are in a single office of an unassuming building in the Fengtai district of Beijing, south-west of the tourists snapping pictures of Chairman Mao in central Tiananmen Square. The stairwell is dark and dank and the hallway towards the call center hauntingly sterile, with identical doors leading off the cold, tiled corridor. When the doors opens, however, warmth flows out.

Xu Kun greets all at the door with a gentle smile and demeanor. Today is the organization’s afternoon tea event, held twice a month. Fruit, sunflower seeds, and hibiscus tea await on the quadrangle of tables as volunteers scurry about in preparation.

"This event is to help those who have lost their spouse, to help them recover, and also for those who have experienced a late divorce. It is to help them come out of the shadows," says Xu.

Elderly men and women enter in dribs and drabs, collecting a yellow ticket from one of the volunteers as they come in. This ticket assigns them a seat number so that each participant sits next to someone new, their partner for the day. They write their name, age, gender, and what they are looking for from a new friend on a registration form. The atmosphere is full of nerves. An old man, wiry and stern, fidgets while scanning the room. Two women make polite small talk and laugh timidly.

Xu Kun is retired now, and dedicated to the hotline she founded in 2006. She speaks with a mix of equal parts pragmatism and ideology, still influenced by her old life as a professor of ancient philosophy at Beijing’s Capital University of Economics and Business. She was inspired to start the Love Delivery Hotline organization when one of her colleagues lost his wife and fell into deep depression.

"For people who have lost their spouse, there is an 18-month period when the emotions are not stable." According to Xu, these are the people who are most at risk. Aside from those who have lost a partner, those who suffer from chronic health problems and the accompanying worries about the future are also the most susceptible to suicidal thoughts.

During a normal day, Xu Kun works the phones, calling to check in on 8-10 elderly citizens. The phone numbers come from people who have called the hotline before, from various promotional activities, or from a database of neighborhoods in Beijing.

Once the crowd has settled, the networking begins. Pairs are encouraged to talk among themselves and after five minutes, each "couple" needs to introduce their partner to the group. In time, nerves dissipate, jokes are made, and smiles become more unreserved. The two women who were chattering nervously just 15 minutes ago now have arms around each other and seem as though they have been friends all their lives.

Xu Kun says that just talking to the elderly is often enough, that "15 minutes of conversation is like 15 minutes of sunshine" and may stop them from committing suicide.

Elderly at risk

One factor that Sun believes is a problem is the lack of social, mental, and emotional support available to the elderly.

Sun says that traditionally, Chinese children are expected to look after their parents in old age. He says that economic development and improved standards of living have made this easier, but at the same time, the pressure on children to provide for their elders is daunting.

"Many elderly people are experiencing improved financial and physical support from their children but less emotional support because everyone is getting busier. I think this is particularly an issue in China because of the fast pace of economic development."

Professor Jing has found similar trends in his work. Jing’s research found that from 2002 to 2008, the suicide rate among China’s rural elderly aged 70-74 years old averaged around 47 per 100,000 people. In addition, the same age group in urban areas increased from an average rate of 13 per 100,000 in the 1990s to 34 per 100,000 from 2002 to 2008.

In comparison, the suicide rate among the elderly aged 65 and over in the US was 14.9 per 100,000 people in 2010, according to the American Association of Suicidology. This was only a slight increase on the national suicide rate of 12.4.

Jing believes that China’s rapid urban development is partly to blame. Urbanization, according to Jing, brings with it the disappearance of the traditional neighborhoods and communities where the elderly can maintain a familiar environment that they trust.

"If you talk about old neighbors who have a relationship over 10 years, that is very surprising. For life, forget about it. There is not that kind of neighborhood anymore. No community. People do not know each other", says Jing.

A lack of community

Xie Zhaohui, a doctor of epidemiology at Beijing Electric Power Health Management Center, believes that over time the sense of family, of community, in many Chinese households has disappeared.

"Parents and children don’t live together anymore. Now, they live separately. In the past, there may have been three generations living together", says Xie. Due to the expensive nature of housing in Beijing, she says, some parents gift their houses to their children and choose to live in lesser dwellings.

Xie also blames the loss of traditional housing that accompanies urbanization. Siheyuan houses, also known as Chinese quadrangles, consist of a courtyard surrounded by four buildings. These houses are pervasive throughout northern China and are emblematic of the old way of life in Beijing. Many neighborhoods of such housing, known as hutongs, have been torn down in recent years to make way for apartment buildings.

"In the old days, many families would meet together every day in the courtyard," Xie says. "The elderly would meet and talk. Now, people live in apartments. Some do not go out. They just stay in their apartments. Many who live in such apartments leave early and return late. There are no neighbors around. No one to talk to. There is little opportunity or reason to go out, especially in winter".

Jing says that since 1949, more than 2,000 hutongs in Beijing have been destroyed, drastically changing the cityscape, with many residents uprooted and relocated elsewhere.

Smiles and support

The MC of the afternoon tea is now forced to shout in an attempt to get the attention of the group. Banter is flying across the table and phone numbers are exchanged by like-minded individuals. The emcee addresses the crowd and announces the game is about to begin.

For the game, each pair will be asked an obscure question which can result in the awarding of tickets that contain recipe ingredients. The first team to make a full meal with five ingredients will win.

After a few rounds and some gentle ribbing for wrong answers, Zhu Chunming, 67, and her partner are trying to concoct gastronomic delights with ginger, salt, eggs, and peanuts. They are not deterred by their somewhat incompatible ingredients and throw themselves into every question, regardless of whether the question is aimed at them or not.

Zhu lives alone but is lucky enough to still have family that visits and classmates from her old school days in Beijing. She learned of the afternoon tea event from her neighbor and has come to make friends and help others.

"When I encounter sadness, I think of my father and my upbringing. He stressed how important it is to be independent when I was young. I need to be tough," says Zhu. "I know people may think that I am old-fashioned, but I also take strength from the words of Chairman Mao. His words inspire me and get me through difficult times."

After the game, a more somber atmosphere permeates as all are invited to talk about loved ones who have passed away. Zhu, the genial lady forced into culinary conflict, volunteers to go first. She tells of her husband and their time in Xinjiang as meteorologists. Her hands tremble and tissues are offered as she recounts a workplace accident that she believes led to his stroke and death a week later.

After Zhu is finished and the respectful applause ends, a slight gentleman named Wei stands with resolve etched upon his face. He explains that his wife died only three months ago, three days after being diagnosed with leukemia. He reads a poem that he wrote for her, saying that he thought they would always be together, how his world has collapsed since she left him; he cannot eat, he cannot sleep, he cannot talk to anyone. Tears roll down his cheeks, and the room is filled with a thoughtful silence and reflective nods as he wishes her well wherever she may be and tells her how they will be together in the next life.

This is who the Love Hotline, and all that they represent, is for. The support offered by those who have experienced similar tragedy is invaluable. After the event, when participants are free to mingle and talk amongst themselves, a widower heads straight for Wei, and the two chat while a strong handshake is shared and words of solace are passed.

Addressing the problem There is a common belief among scholars of suicide that mental illness does not present itself in suicide victims in China to the degree that it does in Western victims. According to Professor Jing, the percentages are around 50% in China compared to 90% in the West.

However, with a 2009 study suggesting that impulsive suicidal emotions may be not a primary cause of suicide among the elderly in China, it would appear that the mental well-being of the elderly plays a major roll. Loneliness, depression, anxiety, and boredom all undoubtedly factor into how the elderly view their life.

According to Xu Kun, there are three pillars that contribute to suicide among the elderly. These pillars are the love of a spouse, their own physical health, and the role that they have, in comparison to the role they once had, in society.

It is when a person’s pillars crumble, says Xu, that they become more vulnerable. They start to question their meaning, their role, in society. They have no responsibilities, no duties, left to perform in many cases.

Through her daily phone conversations, a radio program she runs weekly through the Beijing People’s Radio, the bi-weekly afternoon tea events, and the Love Bus, an activity that transports participants to a different location in Beijing each month, Xu Kun is trying to raise the spirits of those who may need it most of all, yet who society tends to forget about.

Xie believes that while the government has begun to focus on the mental well-being of society in recent years, more needs to be done. Psychologists need to be present in every community hospital, while exercise programs and social gatherings for the elderly need to be organized by the government through social workers. However, Xie also feels that education on the importance of mental well-being is the primary concern.

"In the past, people did not know much about mental health. In the US, visiting a psychiatrist is common. In China, attitudes are changing. Famous people, rich people, educated people visit psychiatrists now. However, old people still do not think it is okay. We have a duty to tell them, to educate them, it is okay. It is no different than a physical problem."

Cameron Frecklington is a master’s candidate in global business journalism at Tsinghua University, Beijing.

(Copyright 2013 Cameron Frecklington)

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