Psychologists reach out on social media to address Chinese youth’s high suicide rate

Due to a lack of professional therapists, the country's collectivist mindset and culture of moderation, many depressed Chinese find it hard to talk to psychologists in the real world.

Professor Zhu Tingshao and his team of volunteers are trying to help those showing suicidal signs on social media platforms.

Zhu Tingshao analyzes users' Weibo posts to identify whether they have suicidal tendencies and need help. [Photo: Global Times]

"It will all be worth it if we are able to save a single life." 

That's the motto of Professor Zhu Tingshao and his team of academic volunteers from the Institute of Psychology under the Chinese Academy of Sciences, who are reaching out online to strangers they think are suffering from depression to offer them someone to talk to, in the hope that they can do their part to solve China's suicide problem.

Carefully going through Sina Weibo posts that show signs of being authored by depressed people, Zhu and the other volunteers, sitting in silence behind screens, are ready to give a hand to anyone who hints they may want to end their lives. 

"People send signals if they write about killing themselves, looking for guns or hazardous pills, or regularly post content related to death and suicide," Zhu said.

A total of 6,000 Weibo posts and comments are analyzed by Zhu and his team every week, about 400 of which are identified as showing clear signs of suicidal intent.

The team, the first of its kind in the world, is in many ways a response to China's specific mental health problems: the growth in the number of people suffering from mental problems, the lack of qualified mental health professionals and people's lack of understanding about mental health issues.

Gathering place

Inspired by stories of people who committed suicide after posting about the topic repeatedly on their social media accounts, the team set out to develop a new counseling format. 

The project enables psychologists to find and connect with people showing signs of being suicidal and offer them help, while traditionally patients or those around them have to seek help from psychologists.

The team's diagnoses are based on Weibo users' posts, which they say can tell them more about what is going on in a person's head than a traditional psychological survey. In such surveys, people are asked questions such as how regularly they feel depressed, contemplate suicide or self-harm.

"Chinese people tend to fill in the survey with middling responses because of China's collectivist mindset and culture of moderation. This means they rarely choose extreme options," Li Tonggui, a professor at Peking University's School of Psychological and Cognitive Sciences said. "But their posts on Weibo are usually written without conscious intent."

A user, named "fan" was one of many people on Weibo who expressed their despair and suicidal thoughts on their account before ending their lives. 

"I have depression, so I've decided to go. It's not a big deal. You shall not be concerned about my leaving. Bye." 

This is the last post that "fan" wrote before she committed suicide on March 9, 2012. 

She had long been suffering from depression, which can be seen in posts dating back to 2010.

Many other users suffering from depression have congregated around fan's last post, expressing their own thoughts and troubles, even pretending to chat with fan.

The post has become a place for people to share their sadness, receiving more than 693,000 comments so far.

According to Zhu, a large proportion of the comments under these posts show the signs of suicidal tendencies. These comments offer a way for the team to identify people and offer help to them through social media. 

People who have similar experiences tend to want to gather together to alleviate their depression and anxiety by pouring their hearts out to people who understand. However in self-centered modern society it's difficult to find people who will lend you their ear, he said. 

Caring messages

"We saw your posts … How are you doing? How's your emotional state? You might think your situation is tough but there are still many who care about you, you still have way out."

Those identified as suicidal by the team's volunteer psychologists will receive a carefully designed private message from the team, which was written over months of careful editing.

"We were trying to make the private messages sound like they come from a real person and acceptable for those users who might wish to hear a caring and loving message rather than being abruptly bothered by strangers," Zhu said.

The team then offers the people advice, asks them to chat on the phone with the Beijing Suicide Research and Prevention Center and fill in online surveys which are used to further help them understand their mental health problems.

However despite the team's best efforts, many simply reject mental health advice from a group of strangers.

These people do not expect to be contacted by strangers offering help, as they are used to hiding themselves away and do not usually ask friends for help, Li says. 

An anonymous 26-year-old volunteer psychologist with the project revealed to the Global Times, that some users even said "'I know I'm talking to a computer… there is no one that cares…'"

Moreover, some are pleased to receive the message, but struggle to express themselves.

What the team is doing might not help these people in the long run but can prevent them from killing themselves in the short-term, Zhu argued. 

People with psychological difficulties need to go through a slow rehabilitation process, which usually requires multiple sessions of professional psychological treatment.

However, Li cast some doubt on the effectiveness of the project, as he argues that the most depressed users are unlikely to reply to messages at all. 

Artificial intelligence 

Because they send hundreds of private messages each day, the team has been warned by Sina and labeled by the company as a commercial advertisement company. 

Sina has placed limits on the team's Weibo account, Psychological Map, which means it can only send 200 private messages each day. The team has reached out to Sina to tell them about their project and its non-profit goals, but the limits remain.

Zhu admitted that arranging deeper cooperation with Sina would allow them to help more people, but worries that Sina would try to earn money from the project.  "If the project becomes profitable, it would lose its meaning and the original goal." Zhu said.

"A profitable project would definitely become profit-oriented and by making profits it would take advantage of those victims, which runs counter to our desire of helping them."

Starting in May, the team will use artificial intelligence (AI) to diagnose people through automatic textual analysis, which will allow greater quantities of data to be analyzed and users to be rapidly ranked by the degree of suicidal intent displayed.

This will massively reduce volunteers' workload and more accurately identify those in need. Volunteers will then double check the AI's analysis and reach out to the needy.

"The project will be semi-automatic. Computers, after all, are machines that have no humanity." Zhu said. "We cannot tolerate it wrongly identifying one single person when they are already vulnerable in face of a high possibility of suicide attempts. And no one likes to interact with machines." 

Gloomy reality

A total of 5.4 million Chinese people have been diagnosed as suffering from major depressive disorder, National Health and Family Planning Commission (NHFPC) data released in April shows. 

About 250,000 Chinese citizens commit suicide each year. Suicide has become the primary cause of death among Chinese aged between 15 and 35, the People's Daily quoted the WHO as saying in 2013.

China's suicide rate is relatively high at 20 per 100,000 people, the NHFPC data shows. The US suicide rate is around 13 per 100,000, and the United Kingdom is under 10, the Asian Weekly reported in April.

Numerous bulletins, advertisements, platforms and forums pop up if one types the phrase "psychological counseling" into Chinese search engines. However patients who wish to find a good psychologist may be frustrated by the chaotic market.

The chaos is largely the result of unqualified professionals swarming into the market as demand has exploded in recent years, said Zhang Kan, a professor at the Institute of Psychology at Chinese Academy of Sciences.

Only 10 percent of the 100,000 trained psychologists in China are actually able to independently offer professional psychological counseling services, Zhang told the Global Times.