Zhou Song (pseudonym), a 23-year-old depression patient, was busy with a very important thing during the "Eleventh" holiday.
654381October 2, came to Xishan Island, Taihu Lake, Suzhou. Two days later, he welcomed 87 campers here-students with depression and their parents-to participate in a five-day parent-child camp, which was "spent" by the depressed community to help them heal. And this is also a process of his own healing.
Zhou Song is thin and hunched, and speaks quickly. If he had not suffered from depression, he should have graduated from university in July this year and started a new stage of his life, just like other students. Now, he is facing a completely different life path and challenges.
From the second day of junior high school, Zhou Song found that his physical condition was abnormal, but it was not until 2022 that he was diagnosed with serious psychological problems in the general psychological test of the college entrance examination that he knew what was going on. Later, he was diagnosed with depression in a mental hospital.
This screening changed his life to some extent. Looking back now, "if there is no screening, there are two possibilities. One is to graduate smoothly, but in my state at that time, this may be slim. The second is that there is no diagnosis and no outside help. I may end my life alone at some point. "
At this level, Zhou Song thinks he is the beneficiary of psychological screening. However, after he was diagnosed with depression, he spent a hard time in college, without more support, and failed to change the fate of dropping out of school or even dropping out of school.
Tomorrow (10, 10) is World Mental Health Day. A month ago (1 1, September), the Health and Health Commission issued the Work Plan for Exploring the Special Services for Depression Prevention and Treatment (hereinafter referred to as the Work Plan), proposing that depression screening should be included in the physical examination items of college and middle school students, pregnant women and the elderly. Many depression experts believe that this is a good thing, but if it is not done well, it may also bring secondary harm.
Zhou Song's story is like a footnote to this work plan.
Neglected adolescent depression
"I don't know why, I'm so sad ..." A poem by Heine, a German poet, describes the feelings of patients with depression before diagnosis.
In the TV series Little Joy, the heroine Joe, a senior three student, cried in front of her parents and said, "I don't know what happened to me" before jumping into the sea. After being rescued, she seemed to suddenly realize: "Dad, am I sick?"
△ Screenshot of TV series "Little Joy".
Like Joe, he experienced helplessness and ignorance.
He was born in an institutional family in the west and is working.
Zhou Song lived in his own family building and grew up in the educational atmosphere of "other people's children". "The people around him are too good to compare with others."
Since elementary school, Zhou Song's brain can't stop. "I always think about some unnecessary problems that I can't solve, which has caused excessive psychological burden." He recalled that at the worst time in junior high school, he was full of absolute hatred for the world. "I don't know what I hate, but I think the world is all black."
In the second day of junior high school, Zhou Song observed some of her symptoms: heartache, bad stomach, bone headache and repeated pain, but she couldn't find anything wrong when she went to the hospital for examination. Later, he read that psychological problems can lead to physical symptoms, but he didn't realize that he might have mental illness.
In senior three, because of anxiety, Zhou Song once asked his mother to find a psychologist for himself, but at that time, the family didn't pay attention to it, didn't want to go to the hospital, and didn't know where to find a doctor. The matter went away.
It was not until 2022 that Zhou Song went to a university in the coastal area to learn about his illness. Shortly after the start of school, the whole class was called to the school computer room and filled out a questionnaire called Cattell Sixteen Personality Factors Test on the Internet. There are hundreds of questions in the questionnaire, including some secret questions to evaluate mental health such as depression and anxiety.
Two weeks after the exam, the teacher handed him an envelope containing the exam results. At that time, three students in the class received envelopes, and he revealed the most serious problem.
After the results came out, the school psychologist called Zhou Song's mother, but it didn't attract attention. In June of that year 1 1 I went to a specialized hospital, accompanied by a high school classmate.
During a visit, Song Zhao was diagnosed with mild depression. "My parents still can't understand why I am sick. In their eyes, I am a little grumpy, I don't like to talk, I am a little withdrawn, and other children are no different from normal children. " Going home in the winter vacation for one semester, Zhou Song's life is very irregular. She played games all day, didn't want to go out and didn't go to the class reunion, but her mother still didn't realize the seriousness of the problem.
This situation is very common. A mother and daughter once attended a parent-child camp together until their daughter dropped out of school. The mother thought it was a "rebellious mentality of youth" until one day, she saw her daughter with 10 knife wounds. She said, "I tried to draw a line on my hand with a knife, but I couldn't ... I really realized that the child was not rebellious, but sick."
After returning to school in the second semester, Zhou Song's situation got worse. He lives a life of sleeping at three o'clock in the middle of the night, getting up at three o'clock in the afternoon and eating only one meal a day. At the beginning of April 2022, Zhou Song's parents finally arrived at the weekend and accompanied him to the specialized hospital again. This time, he was diagnosed with severe depression.
PHQ-9 scale, is the screening accurate?
Zhou Song's diagnosis experience epitomizes the low awareness rate and the low rate of seeing a doctor about depression in China. Although I came from a noble family, it took me five years from physical symptoms in junior high school to psychological problems in college. No one realized that Zhou Song's unusual performance was due to mental illness.
In the work plan released by the Health and Wellness Committee on September 1 1, the working objectives of the pilot areas by 2022 were determined, including the awareness rate of public depression prevention and treatment reaching 80%, the treatment rate of depression increasing by 50% and the treatment rate increasing by 30%.
Experts in the field of psychiatry believe that screening, as a starting point, shows that medical care will be biased towards depressed people, which is a good thing for depressed patients like Zhou Song, who can get early diagnosis and treatment.
"If the work plan is started, it can be said that it is a larger-scale depression screening in the country, and the three people selected are also people with a higher incidence of depression." The vice president of Kangning Hospital affiliated to Wenzhou Medical University told 8: 00 news.
Zhang Jin, the founder of "Crossing" and a rehabilitation patient with depression, supports this plan. But he also pointed out that to do this good thing well, we need to consider more factors and determine the corresponding plan.
The first is how to ensure the accuracy of screening.
PHQ-9, also known as Patient Health Questionnaire -9, which is used for depression screening in the work plan, is nine self-assessment tools based on depression in the Diagnostic and Statistical Manual of Mental Disorders (4th edition), and its length is only half that of other depression screening tools.
△PHQ-9 scale, scoring rules: 0-4 points without depression; 5-9 points mild depression; 10- 14 points of moderate depression; 15- 19 points for moderate and severe depression; 20-27 points, severe depression. : Huashan Hospital affiliated to Fudan University WeChat
"Screening is different from diagnosis, with high requirements and low specificity. The reliability and validity of PHQ-9 scale have been confirmed by some studies." Yao said, "The most important thing is that PHO-9 can meet the requirements of fast, convenient and easy landing."
Zhang Jin, on the other hand, put forward that "the emotional state of the tester is unstable, and the answers will be very different if you do the same scale at different times;" Even to the extreme, if the tester has studied the scale in advance and mastered the scoring law, it is entirely possible to manipulate the results of the scale test. "
Yao, the former vice president of the Sixth Hospital of the University (Institute of Mental Health of the University) and a famous psychologist, explained to Eight Points Wen Jian: "Depression is a disease with a heavy sense of shame. If it is a compulsory entrance examination, using the self-test scale PHQ-9 cannot avoid exaggeration or deliberate concealment. "
"I can't take the initiative to disclose my illness to the school. How will my classmates and teachers treat me when they know about this? Similar psychological assessment schools have done it many times, and every time I filled in extremely healthy sunshine. If it's blood drawing and EEG examination, there's nothing I can do If it was a scale, I would never tell the truth. The conditions are still backward and parents still don't understand. What can we do? " A student patient in the "Crossing" group wrote.
Screening for depression, and then what?
Zhou Song is also worried that "it's no use finding out", which is one of his reactions after seeing the news of the work plan.
From June 5438 to October 2022 10, after the screening results were handed over to Zhou Song, the school staff repeatedly urged him to talk to the school psychological center. After talking with the teachers in the school psychological center, the evaluation results show that Zhou Song's potential psychological problems are very serious. The school asked him to go to a specialized hospital and issue a diagnosis certificate.
Because of the high rate, people with depression are in school, which is a risk factor that the elderly have to consider. "The work pressure of the teacher group is also great." Lv Wei said that he had clinically met depressed students who resumed their studies after dropping out of school. The school required that they must issue a certificate of "guarantee that they have been cured and there is no problem", but the hospital could not give such a certificate.
Looking back now, Zhou Song thinks that the diagnosis of depression in a specialized hospital has a great influence on his psychology. "I finally have an excuse to sleep in the dormitory and not go to class." Zhou Song said that before he was diagnosed, he had to deal with all aspects of college life, and even forced himself to make changes, run for the league secretary of his class and be active in various societies. After the diagnosis, he felt that he finally had an excuse to escape completely. "If you don't want to take the exam, take it slowly, or drop out of school."
The teacher and the teacher in the psychological center are the few people in the school who know his illness. Although most students have related psychology courses, Zhou Song thinks they don't really understand depression. Every other month, the clerk will talk to him, "How are you recently?" "Have you had a good class?" These problems make Zhou Song feel at a loss. "Come to me regularly once a month. This is very routine and useless. "
At the end of the term, once Zhou Song didn't go to the exam, the teacher called, and his attitude was very bad. "I almost made it clear that you should drop out of school quickly. I can feel that the school gave him some pressure. "
The psychological center of the school is the only place in Zhou Song where you can feel a little comfort. One semester, Zhou Song went there once a week. Although I didn't talk to the teacher very deeply, I fell asleep several times in the middle chair. In the second semester, when he was in a bad state, he even took the initiative to ask the psychological teacher for help.
But then the teacher in the center changed, and the second teacher paid insufficient attention to his situation. He goes once a week and once every two weeks. Later, he gave up directly.
Shame has been with me for a long time after the diagnosis. After the first school year in 2022, Zhou Song dropped out of school. However, the reason for dropping out of school is not depression. His mother believes that dropping out of school on the grounds of depression will be written into the file, which is not conducive to future studies and employment.
At school, Zhou Song guessed that some teachers knew about their illness. Among the students, except for the antidepressants that his roommate saw in his dormitory, others only knew that Zhou Song had some physical problems, but didn't know the specific reasons. The close classmates asked about it, and Zhou Song made fun of them. In the campus environment at that time, he could not truthfully disclose his illness.
In the autumn of 2022, after a year's suspension from school, Zhou Song returned to the university, but faced with the pressure from study, exams and interpersonal relationships, he felt more anxious.
After reading the work plan, Yao Zui is worried about students like this. "Who will be given the screening results, who will intervene in the follow-up schools, and how to protect the student groups are not known at present." Yao believes that this is hard to avoid. Students are screened for depression and treated differently at school.
The Work Plan only mentions "giving priority to students with abnormal evaluation results."
But what is a "point"? Zhang Jin analyzed that if it refers to measures such as privacy protection, acceptance, care and treatment, it is of course a blessing. "However, will some schools label students as' abnormal assessment results' and start a new stove in terms of group activities, examination qualifications and score statistics? Even, will there be extreme situations in which some' key' objects are discouraged and excluded from the campus? "
Zhang Jin believes that if this is the case, it will be extremely unfair to this "key" group, and it is likely to cause them secondary harm.
△ 65438+1On October 4th, the opening ceremony of Suzhou Camp was "Crossing".
Adolescent depression is more difficult to cure.
From June 5438 to October 2022, Zhou Song came into contact with depressed communities. After that, I will participate in the Shanghai camp, Chengdu camp and Xiamen camp.
Looking back now, it was his worst time. Zou Feng, a psychologist and one of the founders of Crossing, remembers that at that time, Zhou Song often walked more than ten miles alone. 165438+ 10 In June, he still wore short-sleeved shorts, because the cold could make him "clear-headed".
Xiamen camp is held by the sea. Several psychology teachers were very nervous at that time. He will jump into the sea and let Zou Feng follow him. When Zhou Song was in a daze on the rocks by the sea, Zou Feng sat next to him and said nothing. That's enough. They went back together.
After many contacts with Zhou Song, Zou Feng judged that his illness was "because of anxiety, and depression was only a by-product". After 2022, Zhou Song visited many hospitals in Shanghai and his hometown, but failed to really find the cause. In three years, he took more than 30 kinds of antidepressants, and all of them had no obvious effect.
Zou Feng has always held a view that adolescent depression and mania are often not serious, mainly manifested in anxiety. "I am anxious about success. I am young. What should I do if I can't catch up with others because I am sick? "
After dropping out of school, he deviated from the normal life track and his anxiety became more serious. At first, all my classmates graduated, but Zhou Song only got more than 20 credits. Not long ago, because school started, he received a member. According to the regulations of the school, he can only keep his student status for six years. He must leave school in 2022. "It's up to you whether to quit school or not."
Therefore, Zou Feng believes that adolescent depression is often more difficult to cure than adults. "Teenagers lack the conditions for a soft landing. As long as adults pull up their state through drugs, their working ability, experience and relationships are ready-made, and they can immediately put themselves into their work, and their self-confidence will come back. However, teenagers just lack these. Even if they recover their relevant abilities, go back to school and face the new environment, real problems can't be solved and anxiety is still there. "
"I am so timid that I can't face the pressure, I didn't study hard, and I didn't become what I should be or can be. I hate myself, I can't accept myself, I feel incompetent. " Until recently, Zhou Song believed from beginning to end that besides the influence of environment and family, his personality was the main cause of illness.
In the past year, some positive changes have taken place quietly. During the Spring Festival this year, Zhou Song spent more than 40 days in her psychologist Xiaomei's home. Teacher Xiaomei went out to work after graduating from junior high school and later became a registered psychologist. Zou Feng felt that Zhou Song's thinking suddenly changed. He doesn't have to get a bachelor's degree, but he can realize his value and do what he wants to do in the future.
Now, Zhou Song is an informal worker, and also provides technical support for some live broadcast projects related to Zou Feng's psychological problems. He also found his own direction of efforts-to establish a depression community for college students, and this plan was also supported by Zhang Jin.
Previously, Zou Feng found that no matter which psychology teacher he talked to, Zhou Song would only shed two tears, and when he dried it, there would be no more. This is his performance of controlling himself. On September 16, Zhou Song finally shed tears when he talked about his growing experience at a round table meeting of "Crossing" Qiandao Lake Camp.
Afterwards, he sent a circle of friends. "Once, in front of everyone, I stated my experience that I had been unwilling to talk about, re-tore the scars that I didn't want to touch, and forced me to face it. I finally burst into tears."
/kloc-when he was 0/9 years old, Zhou Song got his driver's license, but he was afraid to get into the driver's seat, fearing that he would lose control and his car would be destroyed if he stepped on the accelerator. In Qiandao Lake, once in Zhou Song, I volunteered to drive. This time from Hangzhou to Suzhou, Zou Feng gave him the car keys directly.
A few months ago, Zhou Song asked his parents to buy him a house in Jiaxing. In addition to hoping to give himself a little sense of security, at the round table, he revealed another small idea of buying a house. "I may leave this world at any time. Houses in Zhejiang will only go up, not down. I think I have to go and leave some legacy for my parents. "
Hearing this, the parents present wiped their tears, but Zou Feng was moved and amused by what he said. "I didn't expect him to think so much. I am also very happy that he can say so. "
note:
Although there is no data on the awareness rate, treatment rate and treatment rate of depression in China at present, there are documents showing that the treatment rate of depression is less than 10%.
In contrast to the low medical rate, the prevalence rate is increasing year by year. Previously, academic circles predicted that by 2022, depression would become the second largest disease burden in China after cardiovascular diseases (economic losses caused by diseases and premature deaths to patients, families and medical care consumed for disease prevention and treatment).
According to the results of the first epidemiological survey of mental disorders published in The Lancet-Psychiatry by Professor Huang Yueqin from the Sixth Hospital of University in 2022, the lifetime prevalence rate of mental disorders (excluding senile dementia) in China is 16.57%. Among them, the prevalence rate of anxiety disorder is high, and the lifetime prevalence rate is 7.57%. The lifetime prevalence rate of depression is 7.37%, ranking second.
This survey was initiated on 20 12 and funded by the Health and Wellness Commission and the Ministry of Science and Technology.
For college and middle school students, although there is no authoritative epidemiological survey data, the industry knows that the prevalence rate is increasing year by year. The Health and Health Commission once quoted a data that there are about 30 million children under the age of 0/7 in China suffering from various emotional disorders and behavioral problems.
Zhu Xueqi | Author
Wang | Editor
This article first appeared on WeChat "Eight Tips", ID: Health Insight.
The above is the standard score of phq9 scale, which is about the sharing of depressive symptoms. I saw the online test of phq9 scale, I hope this will help everyone!