A round 20 mourning family members and former classmates gathered on Saturday for a memorial service at the University of International Business and Economics in Chaoyang district to bid farewell to Sienna (pseudonym), a young female alumnus who committed suicide following her bout with depression.

Moments before midnight on February 17, Sienna left a haunting suicide note on her Sina Weibo account under the username "siennasaina" before plunging to her death from a building. She stated she would take her life because she could no longer cope with her depression, which was only diagnosed before Spring Festival this year.

"Depression is too painful and my world has become dark and twisted. I can no longer feel any happiness, no matter how hard I try," Sienna, who was born in 1987, wrote in her farewell post. 

Growing epidemic

Sienna's suicide shocked her family and close friends, who remembered her as an intelligent woman interested in fashion, finance and travel. However, her microblog posts also revealed she battled insomnia and fear of discrimination over her depression. Sienna, who was originally from the Inner Mongolia Autonomous Region, worried that seeking treatment for her condition would place a psychological and financial burden on her family.

Sienna's final post, which was forwarded more than 18,000 times by press time, was met by universal sorrow from her friends, medical professionals and microbloggers who sympathized with her private anguish.

China has one of the highest suicide rates in the world – more than 22 out of every 100,000 deaths – with those aged between 15 and 34 most at risk, according to 2011 figures from the Chinese Center for Disease Control and Prevention. In 2005, 26 million people nationwide were diagnosed as clinically depressed, according to the China Mental Health Association.

However, today this number likely exceeds 60 million, based on estimates by He Rihui, director of the psychological department at the Guangdong General Hospital of Armed Police.

Dr He has called for more understanding and help for people suffering depression in the wake of Sienna's death.

"There are no concrete statistics about how many people suffer depression [in China] now. From my own observations, the number has soared over the past two years," Dr He told Metro Beijing, citing the growing trend of suicides publicized on social media.

On March 17, 2012, a finance senior at a Nanjing university committed suicide in her campus dormitory after posting a suicide note that automatically uploaded to her Sina Weibo account the following day.

Six months earlier, Beijing police successfully prevented the suicide of a model who uploaded a farewell post accompanied by a photo of pills she planned to overdose on. 

Wang Weimin, a psychiatrist at the Beijing Sunshine Journey Psychological Counseling Center in Haidian district, said he was devastated though hardly shocked by Sienna's suicide, noting pressure from work, studies and relationships can sometimes push youths over the brink.

"A major source of pressure for young people, especially new college graduates, is finding a job," said Dr Wang, 34, who has been in his profession since 2005.

"Anxiety and nervousness, which can lead to depression, often arise during job-hunting, and such symptoms are more prominent among females."

Suffering in silence

For sufferers unwilling or unable to access professional counseling or be prescribed anti-depressants, hot lines offering free counseling can be a lifeline.

The Beijing Psychology Help Hotline, funded by the city's municipal government, and the Beijing Anding Hospital Hotline, which is staffed by mental health experts, both lend a helping ear to those eager to talk about their depression.

"The problem is that people who know they are depressed will go to hospitals, yet those who don't know they are living with depression are far less likely to seek help," said Wang Gang, director of the Beijing Anding Hospital Depression Center.

Around 60 percent of people suffering depression do not seek help, the China Mental Health Association found in a 2005 study.

The social stigma attached to depression and family pressure are major obstacles preventing sufferers from seeking help, said Dr He, noting this persuades many youths in particular to vent their anguish on social media.

"A lot of people equate depression with suicide or a mental disorder. People think once you are diagnosed as depressed you are likely to commit suicide, which leads others to dread being around people with depression," he said.

For parents who know little about depression, the worst advice they can give their depressed child is to cheer up or snap out of their glum mood.

"This can cause [depressed youths] to manifest negative feelings towards their family and dare not tell others about their problem," Dr He explained.

People battling depression often feel they have little alternative other than suffering in silence, said Yuan Yipeng, a patient of Dr He's who has attempted suicide several times.

Yuan, a former employee at IBM, made national headlines when he filed an unfair dismissal lawsuit against the company, which terminated his employment in 2007 after learning of Yuan's depression.

"Some doctors recommend patients diagnosed as depressed to make public their condition to receive effective help from their company, family and friends, but many are afraid they might lose their jobs, much like I did," Yuan told Metro Beijing.

"I once was told by the medical supervisor at IBM that my biggest mistake was making my illness known to the company."

More professional help

The biggest problem in China regarding the treatment of depression is the extremely low diagnosis rate, said Wang Gang.

"According to a survey in 2005, 90 percent of people with depression in Beijing weren't diagnosed or didn't receive treatment for their depression. The situation is dire in Beijing, the capital with the country's best medical resources, let alone smaller cities," he said.

In recent years, the government has gradually come to grips with the scale of the epidemic and major hospitals nationwide have opened psychological clinics, said Wang Gang.

However, he noted the biggest problem was that these clinics are mainly staffed by neurologists, rather than psychologists. Another key barrier that needs to be addressed is the cost to patients for counseling and professionalism of counselors, said Wang Weimin.

An hour-long counseling session in Beijing costs at least 300 yuan ($48), although qualifications for counselors in China are relatively easy to attain compared to many other countries.

Among the 300,000 qualified counselors in Beijing, few meet the high standards demanded by the industry, said Wang Weimin. "Instead of providing professional aids that can help patients overcome their depression, many [counselors] just spend their time chatting," he said.

Readers seeking support and information about suicide prevention can contact the Beijing Psychology Help Hotline on 800-810-1117 or the Beijing Anding Hospital Hotline on 5830-3063.