China Mental Wellness Report

Fifi Kao reports on the current mental health situation and trends in China

To discuss the mental health trends in China, we first need to consider the three basic generation groups in China today and their upbringing trajectories. Over the past 40 years, China has developed so rapidly that the social contexts – political, economic, educational, and more – for these three groups are entirely different. This makes it difficult for me to simply generalize a “mental health trend” for China as a whole. I have categorized them into the 18+, 40+, and 60+ age groups.

Additionally, I have noticed significant economic disparities among China’s provinces and cities, which also lead to distinct differences in mental health needs.

China’s first-tier cities such as Shanghai, Beijing, Guangzhou, and Shenzhen have large populations, each exceeding 20 million people. These cities feature high population density, a large proportion of migrant populations, high urbanization levels, numerous high-paying jobs, and developed industries like finance, technology, and the internet. They boast high GDP, diversified industries, and internationalization. Their infrastructure, including transportation and communication, is advanced, with well-established public services, top-tier schools, and medical institutions. However, housing prices and living costs are high.

Second-tier cities have permanent populations ranging from 10 to 20 million, such as Chengdu, Chongqing, Hangzhou, and Wuhan. These cities experience rapid population growth and economic development, attracting large numbers of people from within the province and surrounding areas. However, the concentration of high-paying jobs and industries is not as strong as in first-tier cities. The cost of living is approximately 30-50% lower than in first-tier cities.

Third-tier and below cities have smaller populations, typically between 1 and 5 million. Population growth is slow, and these cities face issues of population outflow. Their economic structures are less diversified, income levels are lower, and the cost of living is about 10-20% of that in first-tier cities.

For the purposes of this discussion, I will focus on first- and second-tier cities as representatives.

60+ Population
Addressing Loneliness, Cognitive Decline,
and Late-Life Adaptation

In China’s first- and second-tier cities, individuals aged 60 and above were born between the 1940s and 1960s, a time when China was still impoverished and underdeveloped. Their childhoods were marked by material scarcity, which shaped them into hardworking, resilient, and competitive individuals who value collectivism and communal living.

Most of them grew up in traditional Chinese family structures – extended families with four generations under one roof. They typically have two or more siblings, sometimes even four to six, and enjoy frequent family gatherings. They place less emphasis on personal privacy and are willing to share all aspects of family and work life.

As the generation that benefited the most from China’s reform and opening-up policies, the majority of 60+ individuals in first-and second-tier cities enjoy relatively secure retirement pensions. Many purchased their own homes two decades ago when property prices were only a tenth of what they are today, leaving them free of bank debt or loans. Most have one or two children (the one-child policy was implemented from the early 1980s). Community canteens provide healthy daily meals, and community hospitals offer basic health support and social assistance.

As a result, they are less likely to experience social isolation compared to their Western counterparts. On the contrary, as long as they are in relatively good health, they tend to be cheerful and optimistic. In fact, they are arguably the demographic with the best mental health in China today. The material hardships of their childhoods have made them deeply appreciative of their current comfortable lifestyles, and they are willing to approach their later years with a positive attitude.

Key Issues Faced by the 60+ Population:

• Psychological stress due to identity shifts after retirement and declining physical functions.
• Increased loneliness caused by friends or relatives falling ill, the loss of a spouse, or children leaving home (especially in single-child families).
• Widespread concerns about chronic illnesses, cognitive decline, and dementia.

Mental Health Trends for the 60+ Population: Strengthening Social Connections

• Enhancing social connections through community activities, online social platforms, and volunteer work.
• Early intervention for chronic diseases and cognitive decline through exercise, outdoor activities, cognitive training, and healthy lifestyles.
• Retirement planning, group travel, and mindfulness practices such as Buddhist meditation at temples.

40+ Population
The Sandwich Generation Navigating Career Burnout,
with Family Pressure and Health Anxiety

After China’s reform and opening-up in 1978, the economy began to grow rapidly. The 40+ population (those born in the late 1960s to early 1980s) witnessed the country’s transition from a planned economy to a market-influenced economy during their formative years. Their living standards improved significantly, material conditions became better, educational opportunities increased, and they had more career choices and entrepreneurial opportunities.

Since the 40+ generation was not well-off before their age of 10-15, they observed their parents working hard, saving diligently, and living frugally. As a result, most 40+ individuals still hold the values of the previous generation, which are reflected in their emphasis on family, appreciation for their jobs, careful financial planning, and a strong desire to raise successful children.

Family sizes have shrunk for the 40+ generation, and while resources are more concentrated, the connections between family members have weakened. Most 40+ individuals are only children, meaning they lack siblings and must shoulder greater family responsibilities alone – caring for aging parents while raising their own children. This has led to increased family pressure compared to the previous generation.

As only children, the 40+ generation lacks the emotional support of siblings. They grew up accustomed to solitude, value their privacy, and are less inclined to share personal matters with others. Traditional Chinese education emphasizes maturity and endurance, which further discourages them from openly expressing or sharing their emotions.

Following China’s reform and opening-up, Western cultural influences flooded in, and societal values shifted from uniformity to diversity. The 40+ generation grew up under the dual influence of Chinese and foreign cultures, becoming more open-minded and international. Many had the opportunity to study or work abroad. However, they also face cultural identity conflicts, particularly between traditional and modern values, as well as Eastern and Western ideologies.

The rise of consumerism has brought material abundance, but it has also introduced greater economic pressures. Rising housing prices and the burden of mortgages and car loans have become significant sources of stress in their lives. Since 2022, China’s economic downturn has led to job losses or business closures for some in the 40+ demographic.

As the first generation in China to experience the internet, the 40+ population has seen a dramatic shift in how they access information, broadening their horizons. However, they also face challenges such as information overload and internet addiction.

With higher levels of education compared to their parents’ generation, the 40+ population has a more awakened health consciousness and pays closer attention to their health issues.

Key Issues Faced by the 40+ Population:

• Intense workplace competition, lack of novelty and fulfillment in work, imbalance between work and life, and prolonged high-pressure states.
• Fear of being left behind in a rapidly evolving era, leading to mental stress.
• Economic pressures, including rising living costs and financial responsibilities.
• Mental stress from children’s education, parents’ health, and marital relationships.
• Health anxiety, as they become aware of declining physical functions and the onset of chronic illnesses (e.g., fatty liver, hypertension, diabetes).

Mental Health Trends for the 40+ Population: Diversification, Personalization, and Digitalization, Primarily Aimed at Stress Relief

• Embracing solitude to create more personal time. Having grown accustomed to being alone, the 40+ generation finds relaxation in solo activities such as traveling, photography, exercising, binge-watching shows, scrolling through short videos, and gaming.
• Cultivating personal hobbies for further relaxation and stress relief. Examples include spa treatments, gourmet food, daily exercise, challenging new sports, sunbathing and forest walks, music and art therapy, mindfulness meditation, joyful socializing, pet ownership, and contributing to public welfare.
• Setting boundaries by saying “no” to family and colleagues. Avoiding being overwhelmed by traditional moral responsibilities and overcommitting to family or work duties, while neglecting their own inner needs.
• Accepting imperfections and lowering expectations, embracing the reality of aging and the transition into later life.
• Adopting healthy lifestyle habits to improve mental well-being: maintaining a balanced diet, engaging in moderate exercise, ensuring adequate sleep, quitting smoking and limiting alcohol, and learning to manage chronic illnesses.

18+ Population
Living in China’s Most Materially Abundant Era,
Yet Maybe the Most Spiritually Lost Generation

China’s 18+ population (those born in the late 1980s and early 2000s) grew up during a period of rapid economic growth. While material living standards have significantly improved, they also face greater competitive pressures.

China’s education system, from elementary school to university, is highly competitive, with the college entrance exam (Gao Kao) being a particularly intense source of stress. The increasing number of university graduates has led to fierce competition in the job market, with many facing the dilemma of “graduating into unemployment.” Workplace competition is intense, and career development bottlenecks and uncertainties are on the rise.

Most of the 18+ generation are the only one child in their family, bearing higher family expectations. Having grown up overly reliant on the previous two generations, the 18+ population often lacks independent living skills, financial awareness, and clear life goals or future plans. In terms of interpersonal relationships, as the second generation of only children in a collapsed extended family system, they have poor social skills and struggle with handling relationships. As adults, they are prone to workplace conflicts and often resign quickly under pressure after setbacks.

However, housing prices and living costs in first-and second-tier cities have skyrocketed, while wages have largely stagnated.

Rates of non-marriage and divorce are rising. The number of people unwilling to socialize and opting to stay at home is increasing. Many spend over six hours a day on electronic devices, lead sedentary lifestyles, and have irregular eating habits, leading to a rise in chronic illnesses among the young (e.g., obesity, hypertension).

As digital natives, they have been exposed to the internet and social media from a young age, making digital life the norm. Online learning, remote work, and virtual socializing have become commonplace. However, the “perfect life” showcased on social media fosters comparison and feelings of inadequacy, while information overload and fake news create confusion and anxiety. Internet addiction is also a growing issue.

The 18+ generation is more willing to pay for experiences, seeking personalized and unique experiences rather than merely material possessions. They participate in immersive entertainment activities (e.g., script murder games, escape rooms, VR experiences), opt for in-depth travel, cultural experiences, or adventure activities, and attend music festivals, art exhibitions, and cultural markets. They pursue niche cultural experiences (e.g., indie music, independent films, underground culture) that differ from those of previous generations, choose customized products or services (e.g., tailored clothing, jewelry, travel itineraries), and express their personal style through niche brands or handmade goods.

Influenced by both Chinese and foreign cultures, globalization, and cultural diversity, their thinking is more open-minded. However, unlike the previous two generations’ admiration for Western culture, the 18+ generation has a stronger sense of cultural identity with China. They support domestic brands, engage with traditional culture (e.g., Chinese traditional dress, Tea Ceremonies, Calligraphy, Traditional Chinese Medicine), and participate in cultural activities celebrating Chinese trends (e.g., Chinese traditional music festivals, traditional culture exhibitions etc ).

Key Issues Faced by the 18+ Population:

• Loneliness, anxiety, declining self-esteem, depression, and self-doubt.
• Social anxiety, emotional suppression, and difficulty building deep interpersonal relationships.
• Difficulty focusing and maintaining attention.
• Career burnout and uncertainty about the future.
• Economic anxiety and a lack of security about the future.
• Low mood, health anxiety, and physical discomfort further affecting mental state.

Mental Health Trends for the 18+ Population: “Who Am I, and What Is My Purpose in This World?”

• Embracing “homebody culture” and home-centered living: Creating a comfortable home environment with a focus on interior design and smart devices. Enjoying solitude or small-scale social interactions. Staying indoors to binge-watch shows, play games, or watch live streams, while relying on food delivery and online shopping to meet daily needs.
• Choosing to “lie flat” or “resist involution” to counter societal pressures: Adopting minimalism, reducing material desires, and cutting unnecessary consumption. Rejecting excessive competition and seeking inner peace through low-stress lifestyles. Supporting environmental sustainability and participating in second-hand trading or the sharing economy.
• Interest-driven lifestyles: Joining various interest groups or communities (e.g., photography, cycling, script murder games, esports). Learning new skills (e.g., programming, painting, music, cooking) and exploring the world through travel, camping, or hiking.
• Pursuing diversified career development: Taking on multiple jobs or side hustles (e.g., freelancing, part-time work). Building personal brands through social media and seeking career freedom and a sense of achievement.
• Health and fitness craze: Regularly going to the gym or attending yoga and Pilates classes. Focusing on healthy diets, trying vegetarian, light meals, or customized nutrition plans. Using health apps to track exercise, sleep, and dietary data. Relieving stress through spa treatments, aromatherapy, meditation, and mindfulness practices.
• Using social media to showcase life, gain inspiration, and build networks: Participating in online challenges, topic discussions, and virtual community activities.
• Pets as important companions and emotional support: Owning pets and spending on their needs (e.g., food, medical care, grooming). Engaging in pet community activities and sharing pet care experiences.