Suicide and depression understanding

The Philippines has the highest incidence of depression in Southeast Asia. In 2004, over 4.5 million cases of depression were reported in the country. Three percent of Filipinos are clinically diagnosed as depressed. Today, 8.27 million Filipinos suffer from some form of mental disorder, including depression.

To see her child die ahead of her is among the worst fears any parent could have. Such is exactly what happened to Jean Goulbourn, who lost her daughter, Natasha, to depression.

“Depression is a condition that knows no social class; it could strike anyone regardless of intelligence, educational attainment and financial standing.” This is what Jean realized while nursing the pain brought about by her daughter’s unexpected demise. Hoping that the grief she felt would not be suffered by others, Jean and a group of friends formed the Natasha Goulbourn Foundation (NGF) on May 23, 2007.

Today, NGF continues to be a non-profit, non-government organization duly registered with the Securites and Exchange Commission to promote an enhanced and a better understanding of depression — a common mental disorder recognized by the World Health Organization (WHO) as a major cause of disability and suicide, and ultimately, a global burden. By 2020, WHO predicts that depression will become the second biggest cause of suffering — next only to heart disease.

Depression: The silent killer

The changing demands of a socio-economic and politically demanding society, coupled with people’s fast-paced lifestyles, are the reasons more and more people are getting depressed, says the WHO. “Chemical changes in the brain can also lead to depression without any external trigger,” adds a research by NGF.

WHO characterizes depression by signs and symptoms such as low mood or down feeling; lack of appetite or eating disorder and weight loss; fatigue or loss of energy and restlessness; intense anxiety, agitation and inner tension; and withdrawal from normal company like family, friends and co-workers.

These problems can become chronic or recurrent, substantially impairing an individual’s ability to cope with daily life. Psychiatrist Dr. Eleonor Ronquillo adds that depression affects relationships and performance in school and at work. “Depression can be incapacitating. In fact, impaired work performance is often an early manifestation,” she explains.

Who are at risk of getting depressed? Ronquillo says women are at a greater risk than men (5.8 percent of men and 9.5 percent of women become depressed every year), as well as those separated and divorced; having a close family member with depression; had an early parental loss; experiencing negative stressful events and chronic stress; lacking in social support, and those living in urban areas.

At its most severe manifestation, depression can lead to suicide, WHO warns. “Suicide is a major risk during the course of depression. The individual usually gives an indication of his suicidal intention before attempting suicide and this must be taken seriously,” says NGF.

According to Health Assistant Secretary Dr. Elmer Punzalan, people commit suicide because of the pressure to succeed, confusing complexity of society, family breakdown, loss of beloved, drug and alcohol abuse, and/or mental illness. “Sixteen out of 100,000 take suicide, one death every 40 seconds,” he shares.

Of these, six percent are caused by depression, says Ronquillo. “Of the 10 to 20 million global suicide attempts, one million succeed in killing themselves,” she stresses. “In the Philippines, although suicide rates are lower, those who took suicide are as young as 10 years old.”

According to her, suicide is more common in Filipino males than in females, while the most common tools used were gun and hanging, with the latter as the most prevalent in the Philippines. Silverware cleaner has also become a favorite among the young. “Attempted suicide is higher among women because they use less violent means,” she says.

A global threat

Depression is not just a problem within an individual, the WHO corrects. “The burden caused by psychiatric disorders has been underestimated. At present, out of the 10 leading causes of suffering worldwide, five are psychiatric conditions, including depression,” says a WHO report.

“Depression is a significant public health problem,” the report continues. “Though estimates from developing countries are not available, depression costs the US economy more that $43 billion annually in medical treatment and lost productivity.”

General population surveys conducted in Southeast Asia revealed that depression has a lifetime risk of seven to 12 percent among men and 20 to 25 percent for women. These rates are unrelated to race, education, income or civil status. Depressed patients show impairment in all major functions, such that their personal care equals or surpasses than those with chronic illnesses like hypertension and diabetes. The depressed spends more days away from work, become medically ill more often and die at a younger age than the general population.

According to the WHO’s 2002 study, the Philippines has the highest incidence of depression in Southeast Asia. In 2004, there were over 4.5 million cases of depression reported in the country. Three percent of Filipinos are clinically diagnosed as depressed. Punzalan says today, 8.27 million Filipinos suffer from some form of mental disorder, including depression.

In NGF’s study of depression in relation to modern Philippine society, the foundation found that the OFW group has the highest risk of suffering from depression, not only among the workers, but also for the ones left behind.

Migration is breaking apart the children’s family and their future, says clinical psychologist Dr. Maria Teresa Villasor. Among the tremendous effects of migration in the family are problems like children dropping out of school, early pregnancies and drug abuse as a result of their misplaced coping, emptiness or longing. “After all of the sacrifices that the OFW and his or her family has gone through, most of them realize that it has done more harm to their children’s lives than good, some of them permanently damaged in the process,” says NGF.

“With about 8.1 million OFWs around the world, imagine how much depression among these OFWs and their families will impact the Philippines and the world?” Villasor points out.

“Depression and suicide have an impact to our country not only to those left behind,” Punzalan affirms. “Our nation needs physically productive and healthy people to be able to be progressive. Therefore, we need to find proactive and effective solutions.”

Crushing the stigma

Punzalan notes that of the 90 depressives, only 30 would seek help. The other 30 will suffer the symptoms, but are ashamed to seek help because of the stigma associated with the illness. These people would rather keep it to themselves and suffer in silence.

“Not all Filipinos are expressive, and when they do act out, it becomes violent like in the recent hostage-taking crisis,” adds Villasor.

According to Punzalan, the following are the factors why only 30 percent of the cases are treated: psychiatric services are not available and tend to be concentrated in the cities; general physicians lack sufficient skills to diagnose and treat mental disorders; patients present primarily bodily symptoms rather than emotional complaints thus, diagnosis for depression is not made; and most importantly, the prevalent stigma may prevent many individuals from approaching a psychiatric facility.

Social stigma is not only attached to the mentally ill, but also to those who work with the mentally unsound, to mental health programs, and even to budget allocation. “The Mental Hospital is one of the country’s biggest hospitals, but also the one with the least budget of P13 million,” Punzalan shares. “People would rather spend on their basic needs than to psychiatric treatment. Government would rather put their money in kidney or heart transplant than in mental health.”

Intervention

These issues, particularly stigma, have cloaked depression in myths and mystery, driving those suffering from depression to darkness and prolonged suffering and in extreme cases, to commit suicide.

“A suicidal person knows he has a family, that many people love him, but suicidal instinct knows no rational thinking,” Ronquillo reiterates. “As soon as the person says he wants to die, nobody loves him, or is saying how much he loves people, that’s already a sign of intent to take suicide and an opportunity to intervene.”

What the family or friends can do is to help the person connect with others; help him to become positive through positive reinforcement; encourage physical activity around the house like gardening and arts and crafts; allow the depressed person to get enough sleep; serve nutritious food; provide a happy diversion at home like games; and recommend treatment.

“Ask questions, but remain calm, listen more, do not argue, do not leave him alone, and get rid of any harmful object,” Ronquillo advises. “In most cases, talking about suicidal thoughts prevents suicide.”

Broadcaster TJ Manotoc, who experienced depression as a teen, attests to the importance of family support in overcoming depression and suicide. “My mom made me accept depression and understand it, so now that I have my own family, I can handle life’s daily stresses. My career success is the proof that I succeeded over my anxiety attacks,” he says.

According to the WHO, depression is treatable through medication or psychotherapy. “For P36, you can already buy an anti-depressant,” says Punzalan. WHO recommends consulting a doctor when: symptoms persist for at least two weeks; when there is significant impairment of social and occupational functioning; normal stresses of life do not explain the symptoms; and when rest and relaxation have not helped.

TJ, however, believes that depression can be treated even without medication. “A hug is a cure-all,” he declares.

Singer Kuh Ledesma, whose failed marriage made her suffer from depression together with daughter Isabel, espouses that a strong spiritual foundation is the best cure for depression. “Jesus was there even before there were psychiatrists. Faith can go where no doctor can,” she enthuses.

“God wants us to reach our highest potential, to live our full lives,” she advises those with suicidal thoughts.

In the national and global scale, depression and suicide intervention remain as challenges to governments. To address the issues, Punzalan advises the local government to provide a holistic approach to health, education to the general population, more psychiatric schools and clinics, and effective service delivery and legislation.

Government should also do something to stop the exodus of psychiatrists, he suggests. “There are many psychology graduates, but they went abroad for greener pastures,” he frets. In 2007, he says there are only 388 psychiatrists in the country, a ratio of .53 psychiatrists per 100,000 people, when the ideal is one in every 100,000.

For more information about suicide and depression, NGF is at Suite 209 LRI Design Plaza, 210 Nicanor Garcia St., Makati City. Tel. nos.: (+632) 897-2217 or (+632) 505-9045, telefax: (+632) 896-2068. E-mail: ngfoundation@gmail.com, Web site: www.natashagoulbournfoundation.org.  –Deni Rose M. Afinidad, Daily Tribune