A recent study revealed that one-quarter of the children (ages 8 to 15) in China's wealthiest city have considered taking their own lives. Perhaps more surprising is that the results were made public.
Long a taboo topic in China, particularly when it comes to young people, suicide is becoming part of public discussion, opening the doors to education and prevention in a country with a suicide rate more than twice that of the United States.
The findings in Shanghai run counter to the image of the mercantile city as China's progressive model for social change. The survey indicates that children in this booming metropolis of 20 million are under pressure to excel at school and sports, as well as in their social lives.
"Not all the reasons for suicide are modern reasons, but there is some evidence to suggest that in the area of the examination system, there is tremendous pressure on kids today, especially urban kids," says Arthur Kleinman, chairman of Harvard University's anthropology department, who has studied social trends in China for three decades.
From the youngest ages, a child's performance on key academic exams often determines his or her path in life - from which schools they attend to their careers.
The preliminary results (released in October) from Fudan University professor Gao Hongyun's ongoing study of 2,500 Shanghai kids, showed that 24 percent said they had considered suicide, 15.2 percent had thought seriously about acting on it, and 5.85 percent actually attempted to kill themselves.
Asian nations generally have higher suicide rates than Western countries. In Japan, there are about 27 suicides per 100,000 people. In China, at least 250,000 people kill themselves each year, more than double the worldwide average of 10 suicides per 100,000, according to the World Health Organization.
Still, the Shanghai results surprised Professor Gao because other studies have shown that suicide is more common in rural China, where people are poorer.
The new study is seen, on the one hand, as a positive step toward shedding light on the problem and educating families about how to help adolescents. Ten years ago, "you wouldn't have seen reports like this," says Michael Phillips, a Canadian researcher who led the initial studies over the past decade on suicide in China. Dr. Phillips, now director of the Beijing Suicide Research and Prevention Center, says the nation has made gains in stripping away taboos - the first step toward education, prevention, and healing.
But Gao cautions, "it's very difficult to draw a conclusion from this study." First, the Shanghai study is not complete, so the results may change. Second, suicide experts agree that studies like this are shaped by how questions are asked.
Still, Phillips says, the Shanghai study indicates that children are willing to talk about the issue. And Shanghai is moving to address the problem.
Local newspapers are highlighting cases of young women who attempted suicide and failed, saying later they did not want to die. Other stories have focused on the addition of special watchmen at the Shanghai subway to guard against people jumping in front of trains.
Gao agrees there has been progress and local officials are committed, but much work remains. Shanghai is planning its first crisis-intervention center and suicide hotline. In October, Phillips's team hosted an international conference to train Chinese counselors about prevention on college campuses. Yet Phillips says, China needs to make a commitment from the top levels of government.
And Gao adds that prevention starts at home: "Every parent expects their child to be perfect; parents should accept their children's actual levels and abilities."