Health | Study finds high prevalence of depression among locals

Brian Hall

A recent study has shown that the estimated number of the Chinese population in Macau that suffer from depression is between 23,556 and 36,625; 8 percent of the MSAR’s population.

In a report titled “The epidemiology of current depression in Macau, China: Towards a plan for mental health action,” a research group from the University of Macau (UM) noted that the number of residents suffering from depression corresponded to a larger share of the population than in Hong Kong or the mainland.

Led by Brian Hall, a scholar and an associate professor at UM, the study surveyed 1,068 Chinese individuals over the age of 18. Telephone surveys and respondent recruitment were carried out in January 2015 using a Computer-Assisted Telephone Interview (CATI) system.

According to the report, a higher proportion of women (9.3 percent) were reported to suffer from depression than men (6.6 percent). In addition, older women reported a higher prevalence (13.4 percent) of depression than other demographics.

The groups at risk of developing depression were those residents that were unemployed, separated or divorced, reported poor self-rated health, low quality of life, and lower social standing.

The study showed that a person’s perceptions of fairness and their own social integration are also among the factors that increase the likelihood of experiencing depression.

So far, no study has attempted to estimate the prevalence of depression in Macau specifically.

Thus the research team argued that there are key differences in population and living conditions, suggesting that a separate psychiatric epidemiologic program is needed in Macau, citing the MSAR’s rapid economic development in the past ten years.

A prior population-representative study showed that 10.4 percent of 1,881 older adults of 60 and above; and 15 percent of 380 urban-dwelling older adults living in public housing showed depression.

With the aim of correlating depression within local residents and estimating the prevalence of current depression in the Macau populace, the study is said to be the first step to determining the overall picture of mental health in Macau.

“Overall, we know little about the level of depression and general mental health of the Macau population, which limits public health planning and action towards establishing appropriate care models of mental health,” the study notes.

After over two years of conducting the research, the team concluded 46.1 percent of the participants reported fair or poor health. Some 52 percent reported low relative social class, and 55.8 percent reported low quality of life. A total of 35.8 percent reported low trust, 20.4 percent reported low perceived fairness, 21.8 percent reported low integration, and 16.8 percent reported low social cohesion. The mean depressive symptom severity in the population was 3.54 (the standard being = 4.7).

As the overall population estimate of depression stood at 8 percent, scholars concluded between 23,556 and 36,625 Macau Chinese adults are likely to meet the criteria for major depression, when applying the estimates of the total population.

Researchers hinted that since results are higher than those reported in previous studies in Hong Kong and China, mental health care should be a priority in the region.

Government registration figures show that there is a mismatch between the numbers of depression cases found in the study and the number of registered psychotherapists in Macau.

According to figures, there are only 21 registered psychotherapists in Macau, yet the current professional accreditation law does not specify the qualification requirements of psychotherapists.

“So far as we are aware, in Macau, there are only four doctoral-level clinical psychologists, but only one among them can conduct treatment in the Chinese language,” the researchers stated. “There are currently no specialist programs for postgraduate training in clinical psychology, so it is unlikely that Macau can train an adequate workforce and other models should be considered,” it added.

Speaking to the Times, Brian Hall, assistant professor of Psychology at the University of Macau, expressed his concern that the treatment gap presented a challenge in terms of seeking healthcare in the territory and suggested a public consultation and discussion on mental health that is coordinated with the government.

“In any place in the world that is developing a comprehensive action plan for mental health, they engage community stakeholders, NGOs, government offices and academics, and work together to try to solve the problem,” he said.

However, research shows that mental illnesses are still considered a taboo to Asians in general, making it more difficult for people with mental disorders to reach out to their families.

Yet Hall expressed the belief that mental health is a key and important factor to consider for overall comprehensive public health initiative for Macau.

“I think that the issue of stigma would make it more difficult to establish a more comprehensive mental health system in Macau,” Hall lamented.

“Depression is a mental illness that tends to be more invisible and more difficult to see, and is coupled with stigma, I think it makes [the community] less likely to take action on these issues,” the academic added.

The research also suggested that “mental healthcare should shift to community-based outpatient centers,” noting that it could increase access to care and reduce the stigma associated with seeking psychiatric care.

Although there are two hospitals in the territory that provide inpatient hospitalization for patients with severe mental illness there are no outpatient care services.

“This leads to medication and hospitalization as frontline treatments rather than preventative or psychosocial interventions,” the study noted.

Researchers lamented that despite the rapid growth in the Macau’s economic development, the health system has not necessarily kept up.

Hall hoped that the recent study would open dialogues in a more public discourse about mental health, and would have an impact on treating depression.

According to Hall, the team is looking at other potential contributing factors to  the prevalence of depression and other mental disorders in Macau, as they aim to examine more specific indicators and risk factors of depression that might be relevant to the region.

“We plan on making an even more context specific, even more appropriate for Macau context. […] We want to measure things that might be more relevant to the local population in terms of how themselves think about mental health,” the scientist concluded.