You're listening to Roundtable.
I'm Steve Hatherly today with Yushan and Feifei.
Coming up, a startling fact.
Reported rates of youth depression in China range from 4% to 41%.
Now, you're probably thinking that doesn't make any sense.
And you're right.
It doesn't.
It's a huge gap.
And new research points to a fundamental flaw in the diagnostic tools themselves.
It has major implications for treatment and policy, and we're going to learn all about it.
After that, a bit of a lighter topic, or is it?
Picture this.
A tiny civilization is thriving.
In your socks, and when you wear them again, you're not just putting on laundry, you're declaring a bacterial war.
We'll cover exactly what's going on down there and why your washing machine may not be doing its job when washing your socks.
Our podcast listeners, that's you, can find us at Roundtable China on Apple Podcasts.
And don't forget, we love hearing your voice as well.
So here's what you do.
You send your voice notes with your thoughts on any of the things that we discuss here on the program to roundtablepodcast at qqcom.
Once again, Roundtable Podcasts.
And now, Despite growing attention to the mental health of children and adolescents in China, data on depression prevalence is remarkably inconsistent.
Rates from different studies range from as low as 4% to as high as 41%.
New collaborative research from Nanjing Normal University and a national tertiary hospital reveal a critical overlooked problem.
We may be using the wrong tools to diagnose depression in Chinese youth.
Many existing screening scales were designed for Western adults and differ drastically in their content, their cultural relevance and also their suitability for young people.
Consequently, the same child could be classified as depressed by one scale and not depressed by another.
This research synthesizes these insights and also discusses their profound implications and there are a lot for public health, clinical practice and future policy as well.
Let's start with the problem as well.
I mean, 4% to 41%.
Why are the charts not helping us here to clearly understand kids' mental health states?
Well, first of all, I think we need to look at the methods that most of the clinics and hospitals in China are using to diagnose depression.
Most large-scale surveys rely on self-reporting questionnaires.
They have different tools.
For example, some of them using a nine-item shorter version of the CESD, a very internationally widely used screening tool.
Some of them rely on a questionnaire.
They are internationally standard screening tools, but they do not measure the same thing.
That's what the study by the Nanjing Normal University and that hospital found.
They found, for example, not two depression scales measure the same set of symptoms.
So the researchers.
They looked at over 440 relevant studies and they checked 33 unique depression scales and 27 of them can.
They can have a complete view of their skills and they found that not one single skill can cover all 84 symptoms under depression and no single symptom appear in all scales, So it's like every scale is capturing only a fraction of depressions.
So that is one issue.
Another issue is that most scales share very little in common, despite all claiming to measure depression, the same problem.
Yeah.
So they're looking at the sky, kind of.
And these scales and these measurement tools are looking at.
You know, one scale, one measurement tool is looking at one piece of the sky.
And the other measurement tools are looking at a totally different piece of the sky.
There's very little overlap.
Yeah.
And that's the reason that you have this 4% to 41% difference.
It's challenging.
It's really, really challenging because depression is a very complex it's an invisible kind of constellation, to use the sky metaphor again.
And every diagnostic tool is looking at.
If every diagnostic tool is looking at it through a different lens, this is not good news for the patients, no matter how old they are.
Yeah.
So that's why, as Steve said, that in practice somebody, a child, can be classified as depression by, for example, scale A, But under scale B that child is perfectly fine.
Same kid.
Yeah.
So that's an issue.
Here's another one.
Why are we using Western adult tools on Chinese children?
That's what I found really curious too, because a study shows that across cultural psychology has long shown that depressive symptoms vary across different societies.
For example, in South Asia worrying too much tends to be more common, while in Africa and Southeast Asia the thinking too much is more common, and age differences also shows quite significant difference.
For example, the youth depression shows more sleep problems and appetite changes, energy loss, while among adults, depression shows quite differently among what's called the anhedonia, which is the inability to experience pleasure from outside.
It's just the losing of interest in things.
So yeah, among all of these variations and also the 27 scales you mentioned earlier, Fei-Fei used in the Chinese studies, Only eight, according to the results, included age-specific symptoms, while only four included cultural-specific symptoms.
So the most frequent used scales were the SDS.
That's developed by a professor from Duke University all the way back in 1970s.
That's the self-rating depression scale where people or patients answer a short, 20-item questionnaire.
So that means that we're using all of these skills, but we're often applying tools designed for another society, for American adults in the 1960s to 70s to today's Chinese kids.
And that's something that's also creating mismatch. here as well.
And I believe by the sound of how I was pronouncing the scales, you can tell that I'm really a newbie in this.
And as I was doing the research, I found something really interesting too.
Nowadays, when parents take their kids to do screenings for depression, they believe in the result.
But based on which test or which screening tool they're using, Different things are being detected, but they just simply believe that's the result for depression level.
But that's not always the case.
There's another one in use here as well.
You mentioned the SDS.
There's also the SCL-90.
That's the name of that one.
That's a system checklist, SL or SCL, system checklist.
That's a longer questionnaire.
It's 90 questions.
It asks about things like obsessive compulsive disorder and interpersonal sensitivity and depression, but also anxiety and hostility and phobic anxiety.
That's a general screen for overall psychiatric distress.
It's not a specific depression tool.
It's depression subscale within it is just one piece of it.
So what that means then is that we're applying the tools and these are old.
So not only are they from a different part of the world, but they're older measurements as well.
Exactly.
And also that's why in the study they find that over 800 children that were labeled depressed by one scale targeting children well, the same group of children were considered not depressed by three other different scales.
So it's very difficult, I think, especially for parents and schools, to determine the amount of trust you can put on these questionnaires.
Well, let's talk about that.
I mean, for parents and for schools and just for society in general, what does this mean now?
What do we do with this information?
I think for parents in schools it's more like in their face, it's more direct that a single depression questionnaire cannot define the kid's mental health status.
And you can't just look at one parameter and see the outcome and make decision out of it.
It measures only one part of the picture.
So clinical diagnosis should rely on professional evaluation, not a single score, and a more comprehensive result should be there instead of just doing one test after another.
Okay.
And also, I think, for researchers, because these studies look at a lot of the papers that's been published, a lot of studies also done by other researchers, And I think for researchers they need to beware that do not get too reliable on these measurement tools.
And they also need to come up with ways to standardize these tools.
Yeah, for policymakers.
Yeah, because you can just imagine the problems here, right?
So if you have, you know your child may think oh, something's wrong.
Or the parents might think, you know, I want to have my child checked.
They don't seem particularly happy.
Something seems off.
And they go and they're measured by these measurement tools from the West, from the 1960s and 70s.
And they happen to take the test that says, you're fine.
Well, then what happens after that?
Then the kid comes home and the parent says, well, you're fine, I guess.
And the kid starts to think, oh, well, I don't feel fine anymore.
But I guess, you know, what happens to their feelings?
Their feelings are suddenly unjustified.
And then that's just going to snowball.
And it's going to create more problems with the child and then with the family at home and within school.
I would think
Yeah, exactly.
So that's, I think, for this in the end of this study the calls for policymakers to develop a policy appropriate, culturally grounded and scientifically validated assessment tool for Chinese people and Chinese youth.
So how do you do that then?
How do you create something that's specifically for Chinese kids? well i think first of all as yushan mentioned when it comes to some symptoms for example it can vary among societies and cultures but what about what's the most prevalent symptoms symptoms in the chinese society for example people in south africa the the southeast asian countries they are worrying too much is one of the symptoms showing depression but what about chinese on the Chinese side.
And another thing is that I think it sort of relies on the data that you collected.
It puts a bigger question.
If the tools we've been using to diagnose, to measure the mental health states among the population for years is wrong, what does that say about the current data that you have?
When it comes to this problem, you kind of have to start over again a little bit, i think.
If you want to create something that's specifically for chinese kids, well then it has to be at least grounded in chinese culture somehow, or even within, even within, chinese language.
Exactly exactly.
Things don't translate from english to chinese very well sometimes, and back back and forth.
Yeah, because they also found a translation error in one of the scales.
It says in an early chinese translation of a very widely used scale, the phrase i could not get going was incorrectly translated i walk slowly in chinese.
That doesn't make sense at all.
Well, it also doesn't signify that there's something wrong.
Yeah, exactly.
And previously I think we mentioned, on the show of how China has been actively using AI in treating mental illness.
We didn't really particularly mention about how kids react to that, but that shows a sign of how this society here in China is trying to adapt to this new phenomena.
That Yes.
Mental health matters.
And yes, we need our own local mechanism in combating that.
Yeah.
And that's, I mean, the silver lining here is quite obvious, I think because yep, you've got a system in place that isn't the best system to be used.
But how?
But we are looking at the problems it does pose give us and we're trying to figure out how to fix it rather than just ignoring mental health for Chinese kids altogether.
So that's moving up and that's also snowballing into something that's more major here in China too, and I believe for parents it lies.
I've been watching like podcast videos on discussions among Chinese parents and also doctors in the hospitals saying how they've been receiving many kids and what are the symptoms, what are the reactions from the parents, etc.
And according to those talks, I just tend to realize that parents are the first screening barrier for any of the depression symptoms.
Any health-related system.
Yeah, true.
And in this very topic that we're bringing onto the table today, I think yes parents, moms and dads.
It's perhaps up to you then, these scales on really measuring what's going on with the kids.
One of my favorite expressions is see the problem, fix the problem.
And that seems like what is happening here.
You're listening to Roundtable.
I'm Steve today with Fei-Fei and Yuxia.
And coming up next, your socks are gross.
I'll tell you why.
Looking for passion?
How about fiery debate?
Want to hear about current events in China from different perspectives?
Then tune in to Roundtable, where East meets West and understanding is the goal.
This is Roundtable.
I'm Steve with you, Sean and Feifei.
All right, here's your scenario.
You're running late and your laundry basket is a thriving ecosystem.
But you spot a pair of socks.
Clean-ish.
You wore them just yesterday.
But hey, it's okay because you're just going to run to the corner store and straight back.
Your brain goes into the internal debate.
I can do this, right?
Well, you know that's not the right answer, but we all know that it's something that we do sometimes.
Scientifically, though, is re-wearing socks a bad idea?
Yeah, I think we know that it is.
But here's what I want to share with you today, and we'll get to it in a little bit.
When you do finally wash your socks, are you actually washing them in a way that gets all that bacteria out of there?
Let's start with this one.
I'm leading this story, by the way, because I chose it.
Here's how it went at the group meeting when I suggested this topic.
I said, hey, let's talk socks.
And if you're washing them correctly in the group went, i gave.
I literally gave a roll of my eyes.
I was not expecting.
Listen, dear listener.
Whenever you hear a weird story pop up on roundtable, you can trust that it was me who suggested it.
Awesome, now everybody thinks nobody wears the same socks twice in a row.
Right, let me share this with you.
First, there was a survey a total of three thousand men and women in six european countries, And it was a representative survey conducted by a market research institute, very reputable institute that showed that a large percentage of people actually re-wear their socks for a second day in a row.
It's not a surprise.
It's not surprising to you.
I saw a lot of people do that because, you know, it smells nothing.
It looks perfectly fine.
The sniff test.
I like to call that the sniff test.
Yeah, I have a friend who, her standards.
Oh, you have a friend.
Who designed whether it's time.
I have a friend.
Her standards of doing laundry is to sniff them.
And if it smells, it means it needs a laundry.
If not, it means a second or a third wear.
A third wear.
Yeah, sometimes.
Wow.
Okay, so I was asking around the office.
I did my own little survey.
Okay.
Do you wear your socks second day in a row?
Everybody said no, ew, no.
And every person I asked said exactly the same thing.
But that survey result and Feifei's quote friend suggests that the answer is no.
Are otherwise.
But OK, here's what I wanted to share the most.
So people think when you wash your socks with an antibacterial detergent, that you are actually killing all of the bacteria in the socks.
Therefore, no problem.
Is this also your belief?
Yeah, yeah.
That's why we put the sometimes I even include more sort of the antibacteria thing liquid inside atop of the detergent.
Okay.
Yeah, I kind of soak my socks before I throw them into the washing machine.
Ooh, let's come back to that.
One more layer to ensure that the fungi and the bacteria are killed.
Let's come back to that.
Okay, question.
Do you wash your clothes or your socks or whatever in cold water or hot water?
Cold water.
Absolutely.
And here is the hook of my story today.
Cold water doesn't cut it.
Scientific studies show that cold water washing around 30 degrees...
Celsius is designed to clean clothes, not eliminate microorganisms.
Research has demonstrated that after washing contaminated socks I think that's just socks that you just wore
In cold water with detergent, over 50% of the athlete's foot fungus remain.
You know what athlete's foot fungus is?
Yeah.
That fungus then contaminates the water and can transfer spores to other clothes that you've put in your washing machine if you put the laundry or put the water at a cold temperature.
So at what temperature then should we be washing our socks to make sure it's not contaminated?
60 degrees Celsius is the proven threshold for killing the resilient fungal spores.
But that would shrink a lot of clothes.
That is not my problem.
That's why.
I'm here to kill your foot fungus today, Feifei.
That's why you need to wash your socks separately.
Yeah, exactly.
So cold water does nothing.
Basically they call that if you wash your socks in cold water, that's basically a germ relocation program.
A germ relocation program.
It doesn't kill bacteria.
So you're going to ask next, okay, well, what about warm water?
Yep, warm water, like 40 to 60 degrees Celsius.
It provides inconsistent germ killing.
It's going to reduce germs, but it's not a reliable sanitizer.
And so that's why the hot water, it's non-negotiable, they say.
It has to be hot water.
And just quickly.
Your next question is well, what if?
And that's why I asked you before antibacterial detergent.
If I put that in cold water, it's working, right?
Well, the disinfecting chemicals in antibacterial detergents, or most of them, are significantly less active and effective at lower temperatures.
They are formulated to work best in hot or warm water.
Cold washes are often quicker and it reduces the contact time between the chemical and any bacteria.
So some antibacterial agents can be partially deactivated or rendered insoluble in cold water, making them even less effective.
They should include that on the label.
Doesn't work.
Sometimes work better in warmer temperature, exactly.
Yeah, wash in hot water.
So what do you think?
Are you surprised by this?
I found this to be very interesting information.
Yes i, like i mentioned, i only soak them, but that's also done in cold water.
And tell us, tell us your method, though.
That sounds effective, because it's an extra step before you put them in the washing.
Yeah, so what i do is I gather my socks in a unique basket that's just for socks.
And then, after they pile up to an amount that doesn't waste water and it's a certain amount that's doable for a laundry then you soak them into a basin that has the detergent of killing fungi and bacteria and let it stay.
Just sit in there for like half an hour to an hour and then throw all that into the washing machine to have the normal.
What I did is the cold water washing process.
So it's like adding a screen of killing before the actual laundry.
That's very responsible.
I think most people don't do that, though, Feifei.
Yeah, I just wash them with my pants, you know, clothes that I wear outdoors.
Yeah, I kind of do that with my gym socks too.
Yeah, me too.
And gyms, I think, are another layer of bacteria on top there.
So when Fei Fei said, my friend rewears their socks, I was wondering if she was talking about me.
I'm guilty of this, but it requires a little explanation.
So when I go to the gym, I have multiple socks, pairs of socks in my gym bag.
And sometimes they're exactly the same socks.
So I can't tell.
Sometimes I forget to take them out when I come home.
So I'll go back to the gym and go to put on my socks.
And I'm like, which ones were the one I wore last time?
And then the sniff test.
I hope these are right.
So I think I'm guilty of it sometimes as well.
But there you go.
60 degrees, people.
60 degrees.
You heard it here first on Roundtable.
Yes.
And that'll do it for today's show.
Thank you very much for sharing your time with us today.
I'm Steve for Feifei and for you, Sean.
Have a good one.
And please do come back again next time.
