Chen Kebin says his 74-year-old sister, who lived in Shanghai alone, was "nervous and short of breath" when he spoke to her on the phone in early April.
WARNING: This article discusses suicide and mental illness.
Five days later, he received a phone call from his niece, who told him his sister took her own life.
Like millions of Shanghai residents, Yanan had been living in lockdown in her small apartment for several weeks, after restrictions were put in place late March to curb a COVID-19 outbreak.
Mr Chen believed being locked inside the apartment would have scared Yanan because she had experienced claustrophobia in the past.
He said other lockdown-related stresses including food shortages also contributed to her declining mental health before her death.
"I knew she was lonely. She was old and struggled a lot to order vegetables online, and [with using] mobile phones as well," Mr Chen said.
Mr Chen is speaking publicly about his sister's death to raise awareness about the impact of Shanghai's lockdown on residents' mental health, and to encourage people to seek help.
Shanghai's two-month lockdown, which ended on June 1, was one of the strictest in the world.
Some struggled to access food and medical supplies, while others feared their infected children would be put in quarantine facilities alone.
The harsh measures implemented in the city of 25 million people were part of China's broader COVID-zero strategy.
And while many people took to the streets to celebrate the end of lockdown, health experts warn the resulting mental health crisis in Shanghai will linger.
Demand for mental health support rises
Jin Lihua, a social worker who helps to promote mental health education in Shanghai, believes the mental health crisis is not going to end anytime soon.
"People have to line up for hours for mandated PCR tests," she said.
"[Without the test results] … you won't be able to go anywhere. There are still many causes like this that trigger people's anxiety."
Demand for mental health services increased during Shanghai's lockdown, a situation some health workers described as a "crisis".
In April, Chinese state media reported the number of phone calls to the city's official mental health helpline tripled.
A recent survey of 1,021 Shanghai residents by Chinese science blog Data-Humanism found more than 40 per cent of respondents experienced depression during the lockdown.
The research noted that queries on China's search engine Baidu for 'counselling' rose by 253 per cent.
Xiaoka, founder of a Shanghai-based mental health support group, said people felt lost and uncertain about the future during the lockdown.
"Indeed, many people can leave home now. Some are feeling better, some may not," she said.
"For those who lost their loved ones, they must still be in pain. And those who didn't get access to medicine or were able to see doctors, they might experience lingering fear."
But Xiaoka, who only wanted to be known by her pen name, pointed out that Wuhan's lockdown also triggered a mental health crisis, and people who couldn't access medication really struggled.
One study showed suicide deaths in Wuhan, where the virus was first detected, increased by 66 per cent during the city's lockdown in early 2020, compared to the same period in 2019.
But there is no data that shows an increase in suicide deaths during Shanghai's lockdown despite the rise in demand for mental health support.
Experts caution that there are multiple complex factors that lead a person to take their own life.
Data on lockdowns and suicide in other countries, like Australia, shows suicides deaths have not increased during lockdowns.
How Shanghai residents are getting help
Angelo Wong lives in Melbourne and has been helping to recruit and train volunteers from Australia for a privately-run suicide prevention helpline for people in China.
He has also recently founded his own local mental health group for the Chinese community and is building a Chinese-language helpline for migrants.
Mr Wong said the helpline for people in China was busy 24 hours a day, seven days a week.
The operation is staffed by 200 volunteers, in China and abroad, answering calls from across the country.
Mr Wong said overseas volunteers were well placed to help because of the time difference with China.
"The peak hour is usually three or four o'clock in the morning. That's when people felt most vulnerable," Mr Wong said.
He said many Shanghai residents called the helpline because they were stressed and anxious.
For people who continue to feel angry and stressed in Shanghai, Isabella Choi, a clinical psychologist and mental health researcher at the University of Sydney, said it was important they acknowledged those feelings.
Dr Choi said people could also build a daily routine to take back control of their lives.
"Or [they can find] alternative ways to keep active, keep connected with friends and family, building pleasant activities [into their day] every day."
Xiaoka said it was also important for Shanghai residents to be able to freely express their feelings online about lockdowns, and not to be censored.
"You need to allow people to express their anger. Otherwise people will be choked off," she said.
