Depression is a common mental disorder that is characterized by sadness, loss of interest in pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration. These problems can become chronic or recurrent, substantially impairing an individual’s ability to cope with daily life. At its most severe manifestation, depression can lead to suicide. Most cases of depression can be treated with medication or psychotherapy.
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 Philippines. Three per cent of Filipinos are clinically diagnosed as depressed. Of the ninety depressives, only thirty will seek help. The other thirty will suffer the symptoms but will be ashamed to seek help, because of the stigma associated to the illness. These symptomatic would rather keep it to themselves and suffer in pain and in silence. The other thirty will suffer the symptoms not knowing what is wrong with them. Knowing what depression is all about is already a big step in managing the illness. There is an urgent need to empower individuals suffering from the illness with resources, professional help and organizational linkages that can open new doors and bring light in their journey of suffering and pain to that of positive self-discovery and well-being. The families and friends of people suffering from depression are equally important stakeholders who also need to know and understand the illness to enable them to respond and provide constructive support to their love ones during these difficult times.
For further information:
1. World Health Organization http://who.int/topics/depression/en
2. WHO Regional Strategy for Mental Health 2002
3. World Health Organization Issues and Challenges “Social Determinants of Health, Mental Health and Substance Abuse.
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Government & Depression
What the government is doing to address emerging Mental Health Problems
Depression is a significant public health problem, is relatively common and its recurrent nature profoundly disrupts patients’ lives. Though estimates from developing countries are not available, depression costs the US economy more than US$ 43 billion annually in medical treatment and lost productivity.
General population surveys conducted in many parts of the world, including some SEAR (Southeast Asian Region) countries, have revealed a high rate of depression with a lifetime risk of 7-12 % for men and 20-25 % for women. These rates of occurrence are unrelated to race, education, income, or civil status. Depressed patients show impairment in all major areas of functioning–personal care, family that is almost equal to or greater than that for patients with other chronic illnesses like hypertension, diabetes, coronary artery diseases, and arthritis. Patients with depression spend more days away from work, become medically ill more often, suffer greater physical disability, and die at a younger age than the general population. Depressive symptoms, but not meeting the medical criteria for depression, are frequently seen in patients with other diseases and cause increased use of medical services as well as increased rates of morbidity and mortality.
Unfortunately, despite the seriousness of depression and all the associated consequences which can be effectively treated at any level of care all over the world, only 30% of cases with these disorders are properly diagnosed or treated. The situation may be worse in SEAR (South East Asian Region) or countries.
A number of factors may be responsible for this state of affairs:
· Psychiatric services are not available in all parts of the Region, and tend to be concentrated in the cities.
· General physicians, who are the primary health care providers, lack sufficient skills to diagnose and treat mental disorders.
· At the primary health care level, depressed patients may present primarily with bodily symptoms rather than emotional complaints. Thus, the diagnosis of depression is not made.
· In spite of recognizing depressive symptoms, many patients may want to overcome them by their “will power”.
· The prevalent stigma associated with mental illness may prevent many individuals from approaching a psychiatric facility.
The WHO has called for global action to address the crisis of mental health. The Year 2001 has been dedicated to mental health “in recognition of the burden that mental health pose on people and families affected by them and to highlight the important advances made by researchers and clinicians in reducing suffering and accompanying disability caused by the illness. The WHO have enjoined all sectors and stakeholders to work towards the day when “good health will also mean good mental health”
Given the changing and fast paced lifestyle of people amid a very dynamic socio-economic and political environment, the burden from mental ill health, disorder and disability is expected to increase as declared by the World Health Organization in its various reports on mental health.
Similarly, the Philippines has long been confronted with a volatile socio-economic condition and the drug menace to the population, compounded by natural and man-made disasters, garbage crisis and other environmental crisis that pose potential public health problems.
In a local baseline survey 1964-67 IN Sta. Cruz, Lubao, Pampanga, Manapsal of the DOH Division of Mental Hygiene, Bureau of Disease Control, found that the prevalence of mental disorders was 36 per 1,000 adults, children and adolescents. The WHO Collaborative Studies for Extending Mental Health Care in General Health Care Services (involving seven countries) showed that 17 per cent of adults and 16 per cent of children who consulted in three health centers in Sampaloc, Manila have mental disorders. Depressive reactions in adukts and adaptation reaction in children were found in Sapang Palay, San Jose del Monte, Bulacan. The prevalence of adult schizophrenia was 12 cases per 1,000 population in 1988-1989 (Manalang et al).
In Region 6, (Iloilo, Negros Occidental and Antique, Perlas et al study (1993-1994) showed that the prevalence of the following mental illness in the adult population were: Psychosis (4.3%) and panic (5.6%). For the children and adolescents, the top five most prevalent psychiatric conditions were: enuresis (9.3%), speech and language disorder (3.9%), mental subnormality (3.7%), adaptation reaction (2.4%), and neurotic disorder (1.1%).
The Philippine’s Response to the Emerging Mental Problem
In response to the call made by the WHO during the fifty-second session of the WHO regional Committee for the Western Pacific held in Brunei Darussalam, in September 2001, the then Secretary of Health, Dr. Manuel M. Dayrit, issued Department Of Health (DOH) Administrative Order No. 8 Series of 2001 or the National Mental Health Policy.
The promotion of mental health which has become imperative and an essential goal for all countries and its people. Local and international data continue to show that about one per cent of population is affected with severe mental and neurological disorders, and another 4-5% suffers from mild to moderate neurological problems, including the abuse of alcohol and drugs.
Attainment of Good State of Mental Health for All Filipinos
A.O. No. 8 prescribes the national policy framework towards the attainment of a good state of mental health for Filipinos.
The National Mental Health Policy applies to all sectors, disciplines and institutions including government, non-government or private entities whose functions and activities contribute to the improvement of the mental health of all Filipinos. The policy is designed for all health systems, programs and services at the national and local levels.
Total Health Care for All
The National Mental Health Policy is a commitment to ensure a community of Filipinos who are mentally healthy, able to contribute to the development of the country to attain better quality of life through access to an integrated, well planned, effectively organized and efficiently delivered health care system that responds not only to the physical health needs but also to the mental health needs of Filipinos. The response to the nation’s mental health problems, concerns and efforts must be addressed through the formulation and implementation of a coherent, rational, and unified response through the formulation and implementation of the national mental health programme strategy.
Public Health Impact of Mental Illness
In 2007, then DOH Secretary Dr. Francisco T. Duque issued Administrative Order No.2007-2009 or the Operational Framework for the Sustainable Establishment of a Mental Health Program. The framework was issued to address the public health impact of mental illness, which was identified by WHO as a global priority. At the same time, mental health was the focus subject of the World Health Report for 2001. That year, WHO developed the Regional Strategy for Mental Health which serves as a guideline in the formulation of policies and program designed to respond to the challenges posed by mental health problems.
In the Baseline Survey for the National Objectives for Health showed that the more frequently reported symptoms of an underlying health problem were sadness, confusion, forgetfulness, delusions and uncontrolled use of cigarettes and alcohol. On the other hand, the most recent study on prevalence of mental health problems conducted by the National Epidemiology Center (NEC-DOH) in 2006 showed revealing results though the target population was limited only to government employees from the 20 national agencies in Metro Manila. Among the 327 respondents, 32% were found to have experienced a mental health problem at least once in their lifetime. The three most prevalent diagnoses were specific phobias (15%), alcohol abuse (10%), and depression (6%). The prevalence rate from the survey was much higher by 17% than those previously reported.
Mental health problems were significantly associated with the following respondent characteristics. (The following characteristics refer only to the respondents of the survey and do not apply to the general Philippine population).
1. Ages 20-29 years
2. Those who have big families
3. Those with low educational attainment
4. Males were most likely to have substance related problems than females.
The mental health policy is reaffirmed in the National Objectives for Health, a DOH document that outlines the goals and objectives to be achieved by the health sector towards improving the health status of the country. It also specified strategies for national reform from a shift from an institutional-based mental health system to one that is consumer/patient-focused (community-based approach), with an emphasis on supporting the individual in their community.
AO 2007-2009 provides the guidelines for stakeholders in the government and private sector in the development and implementation of programs and services following the guideline of the National Policy on Mental Health Policy through plans and programs that protect the rights and freedom of persons with mental illness in order to reduce the burden of mental and neurological disorders in the country.
Suicide Risks & Important Factors
Directed by Edber Mamisao and produced by ArkeoFilms
When a person is pushed to the point of considering suicide, it is because living has become too painful to bear and that person is looking for a way out to eliminate this terrible psychic pain. That person may never really try to commit suicide but may get very close to doing it and might walk out into the traffic aimlessly with no reference to traffic lights or crazily oncoming traffic, almost hoping get run over and killed.
Sometimes depression can cause people to feel like putting themselves in harm’s way, or killing themselves. Although the majority of people with depression do not die by suicide, having depression does increase suicide risk compared to people without depression.
To read more about Suicide in the Philippines, you can look at a time trend analysis from 1974-2005 here.
You may also be interested in read more about SUICIDE AND SUICIDE PREVENTION IN ASIA (posted by the WHO) here.
An essential advice to anyone thinking about suicide, is to get help immediately:
• Call a doctor’s office.
• Call a 24 hour hotline to be connected to a trained counselor at a crisis center.
• Call for emergency services.
• Go to the emergency room of the nearest hospital.
• Ask a family member or friend to take you to the hospital or call your doctor.
The National Institute of Mental Health, a division of the USA’s Centers for Disease Control reports:
Suicide is a major, preventable public health problem. In 2007, it was the tenth leading cause of death in the U.S., accounting for 34,598 deaths. The overall rate was 11.3 suicide deaths per 100,000 people. An estimated eleven (11) attempted suicides occur per every suicide death.
Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.
Research shows that major risk factors for suicide include depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.
However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal. Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims.
Women display a higher risk for suicide. According to the NIMH:
Suicide was the seventh leading cause of death for males and the fifteenth leading cause of death for females in 2007.
Almost four times as many males as females die by suicide.
Firearms, suffocation, and poison are by far the most common methods of suicide, overall.
Statistics on Suicide in the Philippines:
DOH Data on Suicide (2004)
AGE SUICIDE RATIO
20-24 / 334 deaths
25-29 / 264 deaths
15-19 / 261 deaths
10-14 / 74 deaths
WHO (2003) data shows that for every 100,000 Filipinos, there are 93 suicides
According to ASIA PACIFIC Journal of Public Health in the Philippines five (5) die of suicide per day = approximately 150 per month
According to DOH 2007 survey: 15 out or 900 teenagers try to commit suicide
Look for the Warning Signs
What are warning signs and why are they important?
There are a number of suicide warning signs known “suicide risk factors.” The risk for suicide increases with an increase in the number of risk factors present, such that when more risk factors are present at any one time the more likely that they indicate an increased risk for suicidal behaviors at that time.
THE FIRST THREE WARNING SIGNS ARE:
• Threatening to hurt or kill self
• Looking for ways to kill self; seeking access to pills, weapons or other means
• Talking or writing about death, dying or suicide
The other warning signs indicate a mental health evaluation needs to be conducted in the near future and that precautions need to be put into place immediately to ensure the safety, stability and security of the individual. These signs are:
2. Rage, anger, seeking revenge
3. Acting reckless or engaging in risky activities, seemingly without thinking
4. Feeling trapped – like there’s no way out
5. Increasing alcohol or drug abuse
6. Withdrawing from friends, family or society
7. Anxiety, agitation, unable to sleep or sleeping all the time
8. Dramatic changes in mood
9. No reason for living, no sense of purpose in life
Other behaviors that may be associated with increased short-term risk for suicide are when the patient makes arrangements to divest responsibility for dependent others (children, pets, elders), or making other preparations such as updating wills, making financial arrangements for paying bills, saying goodbye to loved ones, etc.
SPECIFIC FACTORS THAT MAY INCREASE OR DECREASE SUICIDE RISK
Risk and Protective Factors:
Factors that may increase risk or factors that may decrease risk are have been found to be statistically related to the presence or absence of suicidal behaviors and may serve as guidelines to weigh the relative risk of an individual engaging in suicidal behaviors.
No one risk factor, or set of risk factors, necessarily conveys increased suicidal risk. Nor does one protective factor, or set of protective factors, insures protection against engagement in suicidal behaviors.
Ideally, with the elucidation and knowledge of an individual’s risk and protective factors as a backdrop, the sensitive Responder will inquire about the individual’s reasons for living and reasons for dying to better evaluate current risk for suicide.
Factors that may increase a person’s risk for suicide include:
1. Current ideation, intent, plan, access to means
2. Previous suicide attempt or attempts
3. Alcohol / Substance abuse
4. Current or previous history of psychiatric diagnosis
5. Impulsivity and poor self control
6. Hopelessness – presence, duration, severity
7. Recent losses – physical, financial, personal
8. Recent discharge from an inpatient psychiatric unit
9. Family history of suicide
10. History of abuse (physical, sexual or emotional)
11. Co-morbid health problems, especially a newly diagnosed problem or worsening symptoms
12. Age, gender, race (elderly or young adult, unmarried, white, male, living alone)
13. Same- sex sexual orientation
Factors that may decrease the risk for suicide are also called protective factors. These include:
1. Positive social support
3. Sense of responsibility to family
4. Children in the home, pregnancy
5. Life satisfaction
6. Reality testing ability
7. Positive coping skills
8. Positive problem-solving skills
9. Positive therapeutic relationship
PLEASE DOWNLOAD THE SUICIDE FIRST AID GUIDELINES (from Dr. Dinah Nadera)in Filipino here.
What Causes Depression?
The cause of depression is not fully known. A number of factors may be involved, such as chemical imbalances in the brain or family history. Depression isn’t caused by personal weakness, lack of willpower, or a ‘bad attitude.’
Signs and Symptoms
People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness.
Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is.