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Two high-profile mass killings and a car crash at a primary school in just over a week are raising questions about how well-equipped China is to deal with the stresses of a slowing economy and related mental-health issues.

Since November 11, the country has reeled from news of a driver reportedly angry at his divorce settlement killing 35 people by ramming his car into a crowd in Zhuhai; a former student on a stabbing rampage at a vocational college in Wuxi, killing eight; and a car ploughing into a crowd of school children and pedestrians in the city of Changde on Tuesday.

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The events have led to a spike in worries about the overall health of society in China, where mass casualty attacks have occurred with alarming regularity throughout 2024. There have been nine so far this year, compared with six in total in the preceding decade.

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As the economy slows, employment opportunities are more precarious and fewer people are being lifted by China’s long-running economic miracle. The repercussions on mental health from such economic pressures are growing, experts say.

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Xiaojie Qin, a Beijing-based psychotherapist and director at mental health non-profit CandleX, says that a pervasive sense of societal unfairness and disparity can lead in extreme cases to violence against random bystanders.

“Some people who were left behind and socially and economically more marginalised can feel they are not being treated fairly, and some people who don’t have enough emotional regulation, they have outbursts, sometimes violent outbursts,” she said.

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The widespread censorship of discussion around the attacks has also appeared to heighten concerns as more people question the veracity of information they are receiving from official sources, analysts said.

“It can exacerbate societal fears and distrust of the government within China, particularly if seemingly random, large-scale violent incidents persist as they have this year,” said Drew Thompson, a senior fellow at the S. Rajaratnam School of International Studies in Singapore.

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"The lack of access to mental health services is one reason disaffected people resort to violence, but the lack of an independent legal system that protects individuals’ rights over the interests of the party or government results in a lack of trust and faith in the courts,” said Drew Thompson [a senior fellow at the S. Rajaratnam School of International Studies in Singapore].

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