In the photo Zhou’s family used for her missing person’s notice, the sixty-something-year-old was wearing her best smile; her permed hair escaped from underneath a smart cap and cascaded down her shoulders.

Her husband, Wu, and their daughter ultimately found her on the footage of a riverside surveillance camera. Wu recalls that, in the video, she appeared to be in a hurry: “She got there by taxi and, upon getting out, ran toward the water at full speed without looking back for a moment.”

In an interview with Sixth Tone’s sister publication The Paper, Wu repeatedly uttered one phrase: “I can’t make sense of it.” Like other people in this article, Wu wanted to use only his family name.

Having suffered from severe depression for nearly a decade, Zhou ended her life by leaping into a river. Though accompanied in old age by a supporting family and a beloved grandson, she spent much of the winter of her life proclaiming that it was just too hard for her to go on any longer.

Elderly people like Zhou are the age group in China who most often show symptoms of depression. Among 50 to 64-year-olds, the prevalence of symptoms was 4.1%, according to a nationwide epidemiology report from 2019. The second-highest group was people aged 65 and up, at 3.8%.

Wu, who is nearly 80 years old, says that, when they were young, Zhou was already prone to bouts of anxiety. A homemaker, she kept a watchful eye on him; later in life, when babysitting her grandson, she’d be seized with fear that letting him out of her sight for more than a few seconds would spell disaster. In her fifties, Zhou became a paranoid hypochondriac.

At first, she believed she was suffering from a UTI, though doctors could find nothing to suggest that was the case; later, she would often complain that she hurt all over. They made numerous visits to the hospital and finally, at someone’s suggestion, decided to take her to a psychiatrist, who determined that the hypochondria was in fact a manifestation of depression.

They prescribed her some medicine, which for a while “got things under control,” Wu says. In the following decade or so, she’d go for routine checkups, during one of which a benign tumor was found. But even then, “it was no big deal,” Wu remembers — Zhou’s depression didn’t flare up either in the lead-up to or immediately after the surgery. It was only in recent years that Zhou said her medication was “clouding her mind” with suicidal thoughts.

Though Wu knew his wife was sick, he still couldn’t help but feel that she was being dramatic. Then, a few days before she went missing, they finally switched her medication as she’d been demanding. This sudden change only destabilized her further, resulting in her running away. The first time, the family was able to bring her back and get her to sit down for a meal. Racked with guilt and worried sick, Wu owned up to his error of judgement and told his wife how he felt. He recalls that, at the time, Zhou seemed to respond positively to what he was saying. But on the surveillance footage from the next morning, she ran so fast toward the water, it was as if her mind was made up for good.

Ge has also been through the ordeal of searching for a loved one gone missing: In his case, it was his mother, Cheng. The woman was similarly resolute in her decision to end her life. She locked herself in one of the utility rooms of their building’s underground parking lot, and by the time her friends in the building discovered her, it was already too late.

Ge’s father passed away of cancer when his mother was in her fifties. Having spent a whole year at her husband’s bedside, tending to his every need, she was devastated when he died. Like Zhou, Cheng had also shown signs of hypochondria: She frequently complained of pains, bloating, and dizziness. Signs of depression first appeared after she fell in the courtyard downstairs. During her subsequent recovery confined at home, she slowly turned into a different person; once boisterous and extraverted, she became avoidant and fearful. Not only did she shut herself inside, she also began to ignore communication from others.

Her depression was cyclical, usually flaring up in the spring and lasting for two to three months. At the worst, Cheng would stay awake all night and pace around the living room with the lights off. The only pretext that could get her out of the apartment was going to the hospital. A once forceful personality, Cheng would now beg the doctor to help her, as though clutching at straws.

The doctor exhorted Ge to find someone to keep his mother company lest she try to take her life. The best he could do was ask a few relatives from back in his hometown to come.

Also on the doctor’s advice, Ge tried to jolly things up around home whenever an episode looked imminent, laughing loudly while playing with his toddler. But these efforts made little difference. He would try to make her see that she was still needed. “Mom, our child needs you. I need you — I can’t live without you,” he would say. But it was like talking to a brick wall.

She would only repeat to herself: “It’s like my brain is transparent. The voices outside feel like they’re coming to me from far, far away.”

Ge says that, after one suicide attempt, relatives mostly asked him: Did something happen at home? Did your wife argue with her? In the weeks that followed, Ge got several group photos featuring his mother at the ready so that, if need be, he could prove to his relatives that familial disharmony was not the reason.

Jiang Nan, an associate professor at the National University of Singapore, has researched geriatric mental health issues for over a decade and also provides senior citizens with psychological counseling. Jiang says that old people’s inner worlds often prove elusive; younger social workers have difficulty communicating with them, and they often shun “scientific opinions.”

To organize activities that keep their minds and bodies active, “you generally need to find someone in-group whose voice carries weight to set things up,” Jiang says. All social workers can do is coordinate.

Communication barriers are not just generational; they also exist between one elderly person and another — even married couples. Wu remembers that his wife would sometimes complain that she hadn’t slept all night, and yet he had seen her sleeping for hours. He would even take photos and show them to her as proof. But upon seeing them, Zhou would merely squeeze out a smile without saying a word.

Triggers for depression include important life events, or physiological changes such as the menopause, a chronic illness taking a turn for the worse, or the side effects of medication, Jiang says.

Giving elderly people someone to confide in isn’t always enough to solve their problems. Jiang recommends reminiscence therapy, during which the elderly are encouraged to recount their life stories. It can help them redefine themselves, rebuild their self-esteem, and heal old wounds.

In Shanghai, a Chinese city with relatively advanced elderly care, reminiscence therapy can be innovative.

Li Xia, head of the Shanghai Mental Health Center’s Geriatric Department, has one patient who is a retired official and loves discussing the news. She decided to apply reminiscence therapy and make him relive his younger self. While talking about global affairs, she asked him, “How do you think it got this way? Could you write down your point of view for me?” The patient conscientiously set about completing this assignment, analyzing and comparing foreign leaders in the news.

In Li’s opinion, doctor-patient equality means they shouldn’t be treated like children. When they say that their lives are hopeless — that they’ll never get better — these are real feelings and therefore deserve listening to.

In addition to lending a sympathetic ear, doctors sometimes find themselves navigating their patients’ familial conflicts. Li says that one elderly patient bought a pile of expensive electronics, stood on the side of the road, and handed them out to passersby, as though staging some performance art. It was to show that he was willing to do anything with his money — even give it to strangers — so long as none of it went to his son. He would also lean out the windows of his home to declare to the world that his son and daughter-in-law had no respect for him and that life was not worth living. Once, he locked all the doors and began smashing and throwing things about. His son called the police to break down the door. He then sent his father to see Li.

After a while on medication, the man calmed down enough to talk. “We organized therapy sessions with his family,” Li says. He didn’t want to leave his home; but, given how difficult it had become to look after him, his son wanted to put him in a retirement facility with professional care. Though this is a common predicament in China, the man’s depression made his son feel as though he was under an additional layer of pressure — he was worried that the neighbors would say he’d abandoned his father.

Ultimately, after a few sessions, this patient agreed to move. Li has since heard that he is now doing fine. “There, he earned the role as a kind of group leader,” she says.

In patients with deeply-seated unresolved issues, the road to recovery can be longer. Now almost 80 years old, Ren was diagnosed with depression more than 20 years ago. In the ’90s, Ren quit his job as a state-employed engineer and joined the masses of government workers who wanted to take advantage of the newly created and booming private sector. It wasn’t long before his efforts failed. When things were most dire, he made ends meet by selling goods from a roadside stall.

Today, he can’t help but imagine the pension he would have gotten if he had stayed in his cushy state job.

His ties with old friends are also fraught. He says that, in a WeChat group of former middle school classmates, there are a few members who like to humble-brag about their successful careers. Others have gradually drifted into silence. Classmates from university are a bit more cultivated; whether online or offline, they incessantly debate current affairs. Over time, he’s grown distant from all of them. He feels as though he hasn’t done right by his family, and that the world hasn’t done right by him.

Sometimes, he envies young people, because they still have the chance to make use of life’s lessons, whereas he’s learned “too little, too late.”

When his depression flares up, other than taking his medication, Ren won’t do a single thing from dawn till dusk; he lets the TV blare in the living room without watching it. After a few months, he gradually recovers.

Li says it is hard to win the trust of elderly people who present a high risk for suicide — even those who have been admitted to geriatric wards. A few years ago, an old woman waited for the other patients in the room to fall asleep before swallowing a plastic component used in intravenous infusions and tearing her bedsheets into ribbons. When the doctor asked her why, she merely replied, “For fun.”

“No matter how we try to help her, she refuses to trust us,” Li says. “Nothing she says is real; all she thinks about is death, and she won’t tell you a word about it.”

She adds that there are also many patients who don’t want to leave the hospital: They have everything they need there, and it’s all paid for by state-sponsored medical insurance. In some places, elderly psychiatric institutes have gradually come to be operated like retirement homes — resources mostly go to keeping patients fed and bathed, and staff have little time left to address their mental illnesses.

Family members sometimes find hospital treatment practices, such as forcible physical restraint or electroconvulsive therapy, difficult to accept. Such measures are taken in the interest of calming down the patient so that constructive dialogue can take place.

Wu doesn’t know all that much about treatments. He vaguely remembers having heard about “shock therapy” and finds the concept terrifying. Since his wife died, he sometimes thinks to himself that, if he could go back in time, he’d “have her committed to a hospital, even if it would have caused her pain.”

In his 80 years on earth, he has organized funerals for a number of people, including people much younger than himself, and for a while thought that he’d become accustomed to such matters — that they were just the way of the world. But the death of a spouse is different, and he still hasn’t processed the grief:

“I loved her — very deeply, you could say.”

In China, the Beijing Suicide Research and Prevention Center can be reached for free at 800-810-1117 or 010-82951332. In the United States, the Suicide & Crisis Lifeline can be reached for free by dialing 988. A fuller list of prevention services by country can be found here.

Reporter: Ge Mingning.

A version of this article originally appeared in The Paper. It has been translated and edited for brevity and clarity, and is published here with permission.

Translator: Lewis Wright; editors: Zhi Yu and Kevin Schoenmakers.

(Header image: Westend61/VCG)