Mental health of people living in Taiwan under global threats

Dear Editor,

Global threats often exacerbate people's mental health. Amid the COVID-19 pandemic, for instance, research shows that 53.2 million cases of major depressive disorders and 76.2 million cases of anxiety disorders emerged between 2020 and 2021 alone (Santomauro et al., 2021). Taiwan is no exception—in a population-based survey, Researchers found that 45.4% of the 2094 people surveyed experienced COVID-induced stress, which is correlated with heightened levels of loneliness and suicidality (Wu et al., 2022). In addition to COVID-19, people's mental health could also be further threatened by crises that often occur concurrently with disease outbreaks, such as conflicts and climate disasters, consequential events that are known for their power and potential for causing disruptions and distress across society. However, despite progress in research and practice, there is a lack of investigations on the impacts of global threats on the health and wellbeing of people living in Taiwan. Even though threats such as COVID-19, conflicts and climate disasters are global in nature, Taiwan is unique in its vulnerability to these challenges.

First, in addition to challenges shared by the global community, people living in the region face added stressors due to geopolitical tensions between Taiwan and mainland China. Arguably, though both regions might agree on the notion of unity, they drastically disagree on which party should act as the governing body. This entrenched disagreement has resulted in a race for influence between policymakers in Taiwan and mainland China, which could partly explain why different from mainland China and much of the world, Taiwan is not a member of the World Health Organization. This non-membership status of Taiwan is only one of the many examples of the island's limited, if not dwindling, access to international support and resources, even against crises like COVID-19. Combining with the fact that Taiwan resides in a geographic area that is prone to natural disasters such as earthquakes and tornados, coupled with the fact that the island is not immune to human-induced hazards like climate disasters, these vulnerabilities suggest that the scale, scope and severity of mental health threats faced by people living in Taiwan are substantially more pronounced than the rest of the world.

Furthermore, the legitimate possibility of potential armed conflicts with mainland China means that people living in Taiwan also face added unknowns and uncertainties, if not stress and distress, that could further erode their mental health (Kienzler, 2019). While the growing uncertainty of potential war in the region might already have a detrimental impact on people's health and wellbeing, situations may have been further deteriorated by conflicts in Ukraine. Evidence shows that exposure to mass violence could exert a heavy toll on people's mental health, especially vulnerable populations like children, adolescents and young people. In a longitudinal study following the 2013 Boston Marathon bombings and the 2016 Orlando mass shooting among 4165 Americans, for instance, researchers found that media consumption of these events has a detrimental impact on people's mental health, both in terms of acute and long-term posttraumatic stress (Thompson et al., 2019). Different from events such as mass shootings or bombings, the war in Ukraine is considerably more overwhelming, as a result of its duration, its volatility, and its ever-compounding repercussions. Furthermore, what is also unique about the Russian-Ukraine conflicts is that, many thanks to the extensive and restless, if not relentless, media coverage of the war, people's exposure to the mass violence they introduced may be unprecedented. Free-to-download social media apps and high-speed Internet, for instance, mean that media coverage of the brutality of armed conflicts is becoming ever more vivid, extensive, and yet less likely to be pre-screened by gatekeepers to protect people's mental health, especially vulnerable populations like young people. Considering the pervasiveness of modern technologies, the 24/7 whenever and wherever access to media coverage of conflicts also suggests that, compared to people living in conflict zones like Ukraine, it is possible that the rest of the world may have even greater exposure to and confrontation with the extreme brutality that humanity can command and convey, oftentimes with ease, in wars (Su et al., 2022).

The growing prevalence of discussions on the alleged similarities between Taiwan and Ukraine could also introduce additional stress to people living in Taiwan (Su et al., 2022). Taiwan has been discussed and likened to Ukraine even before the onset of the war. This means that people living in Taiwan not only have to cope with the possibility of armed conflicts against mainland China, the ongoing conflicts in Ukraine and elsewhere, along with the accompanying near-ubiquitous media coverage of them, they also have to tackle the disturbing, if not debilitating, discussions of becoming the next Ukraine in the near term. As research on media effects suggests, regardless of whether the similarities between Taiwan and Ukraine are well-founded, the mere media coverage of the possibility of war might be already more than enough to challenge residents’ mental health and wellbeing. These combined mental health threats, overall, call for timely global actions to prevent the situations from worsening, such as developing effective and empathetic interventions that could protect people's mental health in the long run.

Essentially, having timely, effective and empathetic interventions in place can enable the global community to act swiftly to protect people's mental health as global threats evolve. These interventions might be particularly needed for children, adolescents, and young people—vulnerable populations with pronounced susceptibility to media-enabled/magnified mass violence or (dis)information, yet with limited experience in developing efficient coping strategies against the changing global climate. To ensure the help does not incur harm, researchers should also ensure these interventions are developed in a culture-sensitive manner. This means that rather than using divisive and polarizing languages or funding schemes that could hinder residents’ willingness to receive help, such as labeling grants or interventions as for “people living in the province of Taiwan” as opposed to “people living in Taiwan”, the global community should ensure mental health solutions tailored to the local residents are designed and delivered in a way that is apolitical and empathic. By making apolitical or people-centered international collaborations a recurring theme in global mental health initiatives, there is also hope that media professionals, health experts, and government officials in Taiwan, mainland China, and elsewhere could become closer in the preservation of peace and prosperity in the region and beyond, as opposed to perpetuating crises and conflicts. As war is preventable, peace is preservable and mental health is protectable. The mental health and wellbeing of people living in Taiwan are in our hands, and the global community has a consequential decision to make.

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Data are available upon reasonable request.

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CRediT authorship contribution statement

Zhaohui Su: Conceptualization, Writing – original draft, Investigation, Methodology, Resources, Software, Validation, Writing – review & editing. Barry L Bentley: Investigation, Methodology, Resources, Software, Validation, Writing – review & editing. Ali Cheshmehzangi: Investigation, Methodology, Resources, Software, Validation, Writing – review & editing. Dean McDonnell: Investigation, Methodology, Resources, Software, Validation. Sabina Šegalo: Investigation, Methodology, Resources, Software, Validation, Writing – review & editing. Claudimar Pereira da Veiga: Investigation, Methodology, Resources, Software, Validation, Writing – review & editing. Yu-Tao Xiang: Investigation, Methodology, Resources, Software, Validation, Writing – review & editing.

Declaration of Competing Interest

The authors have no conflict of interest to declare.