China and India Burdened by Untreated Mental Disorders
The growing burden of untreated mental disorders in the world’s two most populous countries, India and China, cannot be adequately addressed without changes to their health care systems and by training folk healers to become collaborators, a new report has found.
The analysis, published as a part of a series in the journals The Lancet and The Lancet Psychiatry, draws on years of medical surveys in those countries. It represents the latest effort by an international coalition of researchers to put mental health care at the center of the global health agenda; last month, the World Bank and the World Health Organization convened hundreds of public officials, doctors and other specialists in a landmark meeting in Washington to focus attention on global mental health.
这项分析基于对这两国的多年医学调查，是发表在《柳叶刀》(The Lancet)和《柳叶刀精神病学》(The Lancet Psychiatry)上的一系列论文的一部分。它代表着一个国际研究者联合行动的最新努力，想把心理卫生推向全球医疗服务日程的核心位置。上个月，世界银行(World Bank)和世界卫生组织(World Health Organization)召集数百名官员、医生和其他专家在华盛顿举行了一次具有重要意义的会议，集中讨论全球精神健康问题。
The new research, presented in three papers, found that less than 10 percent of people in India and China with a mental disorder received effective treatment, and that the resulting burden of disability from those two countries was higher than in all Western countries combined.
“India and China together represent more than a third of world’s population, and both countries are at a remarkable stage of epidemiologic and demographic transition,” said a co-author of one of the papers, Dr. Vikram Patel, a professor of international mental health and co-founder of a community-based mental health center, Sangath, in Goa State in India, in a recorded interview accompanying the articles.
One lesson, experts not involved in the research said, is that investment is still lagging well behind spending on other medical conditions. Both countries spend less than 1 percent of their total medical budget on mental health.
“I think politicians and service planners will find this research valuable,” said Dr. Alex Cohen, the course director of the global mental health program at the London School of Hygiene & Tropical Medicine. “But if you don’t have the resources to treat more than 2 percent of the people who need it,” then the overall burden can seem overwhelming.
伦敦卫生与热带医学学院(London School of Hygiene & Tropical Medicine)的全球精神健康科目课程主管亚历克斯·科恩博士(Alex Cohen)说，“我认为，政治家和公共服务规划者会发现这项调查很有价值。但是，如果不调动足够的资源去治疗超过2%的需要治疗的人”，那么总体负担就可能显得难以应付。
In the past decade, both India and China have taken steps to expand access to mental health care. In China, a government program started in 2004 reportedly has trained 10,000 psychiatrists and built hundreds of community mental health centers, in what some consider a historic investment in better psychiatric care. An Indian government program to increase care in communities has effectively reduced hospital costs, in some areas, though implementation has been spotty at best, experts said.
But particularly in rural areas, the majority of people in both countries still have little means or access to psychiatrists or therapists.
“Very few Chinese with common mental illnesses such as depression and anxiety ever seek treatment,” Dr. Michael Phillips, of Shanghai Jiao Tong University and Emory University, said in a statement. “ And the country as a whole is ill prepared for the coming epidemic of dementia as the population ages rapidly.”
“患有抑郁症或焦虑症等常见精神疾病的中国人极少寻求治疗，”上海交通大学和埃默里大学(Emory University)的迈克尔·菲利普斯博士(Michael Phillips)在一项声明中说，“随着人口快速老化，这个国家总体来说没有准备好迎接即将到来的认知障碍症大面积发作问题。”
One group of practitioners that is very accessible — and one the researchers said policy makers should consider potential allies — include traditional healers, herbalists and spiritual guides. In China, many doctors get some training in traditional healing arts, like herbal treatments, acupuncture and qigong. In India, likewise, many doctors incorporate yoga, and Ayurveda medicine.
A collaboration makes good sense for another reason, the researchers wrote: “In view of the popularity of traditional, complementary and alternative medicine, it is likely that even if sufficient biomedical mental health services were available, people would continue to access other therapeutic systems.”
Yet the evidence that medical doctors and folk healers can work together to provide effective mental health care is scarce, experts said. A recent review of the role of traditional healing for mental disorders, led by Dr. Oye Gureje of the University of Ibadan in Nigeria, found that healers “have more readily adopted conventional psychiatric diagnoses such as depression or anxiety” than disorders like schizophrenia or bipolar disorder, which are thought to be spiritual in nature by the healers. And in some developing countries, traditional healers routinely use shackles, isolation and fasting — methods that “might fail to meet widespread understandings of human rights and humane care,” the paper concluded.
但是专家们说，西方医师和民间治疗师携手合作有效治疗精神疾病的案例很少。前不久，尼日利亚伊巴丹大学(University of Ibadan)的奥耶·居雷耶博士(Oye Gureje)领导了一项研究，评估传统疗法对精神疾病治疗的作用。研究发现，治疗师们“更容易接受抑郁症或焦虑症之类的传统的精神病诊断”，而不容易接受精神分裂症或躁郁症，他们认为这些疾病从本质上讲是有关性灵的。论文还指出，在有些发展中国家，传统治疗师经常使用手铐脚镣、隔离和禁食等方法，这些方法“可能违背人们对人权和人道关怀的普遍理解”。
The growing burden detailed in the new papers was due largely to aging and population growth. Some diagnoses, like attention deficit disorder in China, declined between 1990 and 2013; others, like dementia and abuse of drugs and alcohol have risen. For reasons no one understands, suicide rates have fallen sharply in China in that time, and risen steadily in India.