DEPRESSION

I. RATIO OF HOW MANY ARE AFFECTED

A. PHILIPPINES BASED STATS

In countries like the Philippines where mental health is rarely discussed, it usually takes a high
profile case before people begin talking about suicide and depression.
There are only a few studies on suicide, but those that exist all show the need for better data, and
more importantly, a national prevention program.
Suicide is the second leading cause of death globally among people 15 to 29 years of age,
according to the 2014 global report on preventing suicide by the World Health Organization.
In the Philippines, the estimated number of suicides in 2012 was 2,558 (550 female, 2009 male),
according to the same report.
Meanwhile, the age-standardized suicide rate (per 100,000) in 2012 was 2.9 for both sexes – a
13.5 percent increase from 2.6 in 2000. For females, there was a 13 percent decrease from 1.4 in
2000 to 1.2 in 2012. For males, there was a 24.4 increase from 3.9 in 2000 to 4.8 in 2012.
The figures in the Philippines are lower than the annual global age-standardized suicide rate of
11.4 per 100,000 population (15.0 for males and 8.0 for females). The Philippines also has the
lowest suicide rate among ASEAN-member countries.
However, it is important to consider that suicides are likely to be underreported.

Breaking taboos

"Registering a suicide is a complicated procedure involving several different authorities, often

including law enforcement. And in countries without reliable registration of deaths, suicides
simply die uncounted," WHO noted in its report.
The WHO also noted that because of stigma surrounding suicide, it is difficult for many people
to seek help. "Raising community awareness and breaking down taboos are important for
countries making efforts to prevent suicide,” it said.
In some countries, suicide is illegal. This is not the case in the Philippines, but there are other
major barriers to the development of a national suicide prevention program.
Among these barriers, which psychiatrist Dr. Dinah Pacquing-Nadera cites in her paper on
suicide in the country, is "strong Catholic faith which frowns upon suicide, discouraging families
from reporting."
Jean Goulbourn, president of the mental health advocacy group Natasha Goulbourn Foundation,
explained that many Filipinos do not understand depression.
"Ang akala nila baliw ang depression. Ang unang-unang kailangan nilang malaman ay... ang
depression ay hindi baliw," she said in a previous interview.
Although there are 4.5 million depressed Filipinos – the highest in Southeast Asia — only one
out of three who suffer from depression will seek the help of a specialist, according to WHO.
One third will not even be aware of their condition.
“In the Philippines, many people still think that depression is not an illness, but something that
one eventually snaps out of, and that’s the reason why so many people who are suffering from
depression feel embarrassed to seek help,” said Senator Grace Poe, who filed a resolution on the
increasing incidence of suicide and depression in the country.
Filed in 2013, the resolution highlighted the importance of a focused suicide prevention program,
as well as improving data quality and better reporting on suicide deaths.
Suicide and the youth
There is little available data on suicide among the youth in particular, but the 2013 Young Adult
Fertility and Sexuality Study (YAFS4) showed a decline in the proportion of youth who ever
thought of suicide.
Conducted by UP Population Institute and the Demographic Research and Development
Foundation, YAFS4 found that among 15 to 19 year old, the rate was 13.4 in 2002, and 8.7 in
2013.
The study also noted a low level of suicide attempts in the same age group, with 3.4 in 2002 and
3.2 in 2013. However, there was an increase in the proportion of suicide attempts among those
who had thought of suicide, with 25 in 2002 and 36.7 in 2013.
Among Filipino students surveyed in the 2003–2004 Global School based Student Health Survey
(GSHS), 42 percent had felt sad or hopeless for two weeks or more in the past year, 17.1 percent
had seriously considered committing suicide in the last year and 16.7 percent had made a plan
about how they would commit suicide.
According to the GSHS, females were more than twice as likely as males to have had suicidal
thoughts, but males were more likely to carry out a suicidal act than females. As with the other
studies, it was likely that youth suicide rates were underreported due to the associated stigma.
Meanwhile, another study titled “Suicide in the Philippines: Time Trend Analysis (1974-2005)
and
Literature Review” revealed that "while suicide rates are low, increases in incidence and
relatively high rates in adolescents and young adults point to the importance of focused suicide
prevention programs."
Using data from Philippine Health Statistics, as well as published papers, theses, and reports, the
study by Maria Theresa Redaniel, David Gunndell and May Antonnette Lebanan-Dalida found
that suicide rates have been steadily increasing in both sexes from 1984 and 2005.
For males, the rate increased from 0.23 to 3.59 per 100,000 and for females, the rate increased
from 0.12 to 1.09 per 100,000. The authors noted that these increases might be explained by
improved reporting and changing social attitudes.
The study also showed that in the mid-90s, rates in all age groups peaked, and was most
pronounced in the 15 to 24 age group. This is unlike patterns in most countries, where rates tend
to increase with age, but the authors noted that "reasons for this excess in young people in the
Philippines require further investigation."
According to the study, family and relationship problems were the most common causes. In its
profile of non-fatal self-harm cases, around 52 to 87 percent of suicide hospital admissions
reported having problems with the spouse, boyfriend or girlfriend, or parents.
The study also highlighted the need to improve data quality and reporting of suicide deaths to
inform and evaluate prevention strategies.
As in other studies, the authors wrote that there is likely to be underreporting because of non-
acceptance by the Catholic Church and the associated disgrace and stigma to the family.
This is also something that the Natasha Goulbourn Foundation has tried to address by reaching
out to the Catholic Bishops' Conference of the Philippines so that those who died by suicide can
still receive a Catholic burial.
As there is still no national suicide prevention program, public education is done mostly groups
like Natasha Goulbourn Foundation and the Philippine Psychiatric Association, which is pushing
for a Mental Health Act.
“The important things to remember are that suicide is a worldwide phenomenon, it's a public
health issue hitting the youth and causing economic losses, and that it's preventable,” Nadera
said. — RSJ/KBK/JST, GMA News

SPECIAL REPORT: Suicide and the Pinoy youth By CARMELA G. LAPEÑA

Published July 17, 2015 8:38pm

(http://www.gmanetwork.com/news/lifestyle/healthandwellness/524070/special-report-
suicide-and-the-pinoy-youth/story/)

B. GLOBALLY BASED STATS

Globally, 1 in 13 suffers from anxiety

U. QUEENSLAND (AUS) — Depression and anxiety are found in every society in the world—
a finding that debunks old theories that only people in the West get depressed.
These new findings come from the world’s most comprehensive study of anxiety and depression
research to date, published by researchers at the University of Queensland.
In two separate studies of anxiety disorders and major depressive disorder (that is, clinical
depression) study authors found that surveys of clinical anxiety and depression have been
conducted across 91 countries, involving more than 480,000 people.
[sources]
The findings, published in the journal Psychological Medicine, show that clinical anxiety and
depression are serious health issues all around the world.
Anxiety disorders were more commonly reported in Western societies than in non-western
societies, even those that are currently experiencing conflict.
Clinical anxiety affected around 10 percent of people in North America, Western Europe, and
Australia/New Zealand compared to about 8 percent in the Middle East and 6 percent in Asia.
The opposite was true for depression, with people in Western countries least likely to be
depressed.
Depression was found to be lowest in North America and highest in some parts of Asia and the
Middle East.
About 9 percent of people have major depression in Asian and Middle Eastern countries, such as
India and Afghanistan, compared with about 4 percent in North and South America, Australia,
New Zealand, and East Asian countries including China, Thailand, and Indonesia.
Alize Ferrari, lead author on the depression study, says findings suggested that depression
appeared to be higher in parts of the world where conflict is occurring.
However, she warns that it can be difficult to obtain good quality data from some low- and
middle-income countries.
“More investigation of the methods we use to diagnose depression and measure its prevalence in
non-western countries is required, as well as more research on how depression occurs across the
lifespan,” she says.
Lead author of the anxiety study, Amanda Baxter, also urged caution when comparing mental
disorders across different countries.
“Measuring mental disorders across different cultures is challenging because many factors can
influence the reported prevalence of anxiety disorders,” says Baxter.
“More research is also needed to ensure that the criteria we are currently using to diagnose
anxiety is suitable for people across all cultures.”
Both major depression and anxiety are found more commonly in women than in men.
The study also found that, while clinical depression is common throughout the lifespan, anxiety
becomes less common in men and women over the age of 55. About one in 21 people (4.7
percent) of people will have major depression at any point in time.
Anxiety—the most common of all mental disorders—currently affects about one in 13 people
(7.3 percent).
The studies are the world’s most comprehensive reviews of research on major depression and
anxiety, the Global Burden of Disease (GBD) Study that will be released later this year. It will
include estimates for 220 diseases including 11 mental health disorders.
The GBD 2010 Study is the first major effort since the original GBD 1990 Study to carry out a
complete systematic assessment of global data on all diseases and injuries. It will produce
comprehensive and comparable estimates of the burden of diseases, injuries, and risk factors for
1990 and 2005, with projections for 2010.
This project is funded by the Bill & Melinda Gates Foundation and is collaboration between
Harvard University, the Institute for Health Metrics and Evaluation at the University of
Washington, Johns Hopkins University, The University of Queensland, and the World Health
Organization (WHO).
Source: University of Queensland

Posted by Vanessa Coppard-Queensland September 5th, 2012

(https://www.futurity.org/globally-1-in-13-suffers-from-anxiety/)

II. WHAT CAUSES IT OR THE SOURCE OF THE MEDICAL ISSUE

CAUSES AND SYMPTOMS OF ANXIETY

Experts believe the two primary underlying causes of anxiety are genetics and stress. Studies
have shown that some families have a higher than average number of members with anxiety-
related issues, which suggests a familial link. Anxiety disorders can also be the result of stressful
or traumatic events, such as abuse, the death of a loved one or chronic physical illness.
While not all of the following behaviors imply the presence of a full-blown anxiety disorder,
they may be a red flag and warrant an evaluation by mental health professional. The symptoms
vary based on the type of anxiety disorder.
Generalized anxiety disorder: This is characterized by persistent, excessive and unrealistic
worrying about everyday things.
Panic disorders: The most obvious symptom is a spontaneous seemingly out-of-the-blue panic
attack and a preoccupation and fear of a recurring attack. A panic attack is characterized by the
abrupt onset of intense fear or discomfort that reaches a peak within minutes, including at least
four of the following symptoms.
  Palpitations, pounding heart or accelerated heart rate
 Sweating
 Trembling or shaking
 Sensations of shortness of breath or smothering
 Feelings of choking
 Chest pain or discomfort
 Nausea or abdominal distress
 Feeling dizzy, unsteady, light-headed or faint
 Chills or heat sensations
 Paresthesia (numbness or tingling sensations)
 Feelings of unreality or being detached from oneself
 Fear of losing control or “going crazy”
 Fear of dying

Social anxiety disorder: Symptoms vary from person to person, but the following are some of the
most common experienced by people with social anxiety disorder:

 Blushing
 Excessive sweating
 Nervousness
 Dry throat and mouth
 Trembling
 Muscle twitching
 Nausea or other abdominal distress
 Rapid heartbeat
 Shortness of breath
 Dizziness or lightheadedness
 Headaches
 Feeling detached
 Loss of self-control

Phobias: Irrational fears can involve a variety of things, including the fear that people are
watching or following you, an extreme fear of objects (e.g. dogs or spiders), or situations (e.g.
flying, elevators or social situations). Irrational fears can become obsessive in nature, leading to
persistent and intrusive thoughts that create significant anxiety and detrimental behaviors.
Obsessive compulsive disorder (OCD): Repetitive, irrational thoughts may be accompanied by
compulsive actions, routines and rituals performed over and over again. The thoughts and rituals
associated with OCD can cause terrible inner turmoil and interfere with optimal daily
functioning.
Post-traumatic stress disorder (PTSD): While both men and women can experience the cardinal
symptoms of PTSD (hyperarousal, re-experiencing, avoidance and numbing), some behaviors
are more prevalent in women than men, including:

 Feeling jumpy
 Trouble feeling emotions
 Avoiding trauma reminders
  Depression
 Anxiety

CAUSES AND SYMPTOMS OF DEPRESSION

The exact cause of depression is unknown, although experts believe it is related to chemical
changes in the brain and a likely genetic link since depression tends to be more prevalent in some
families. Depression can also be triggered by certain stressful events such as abuse, the death of a
loved one, physical illness, chronic pain, substance abuse, medication side effects and sleeping
problems.

Symptoms vary depending on severity of the depression, the person’s age, co-occurring mental
health disorders and a number of other mitigating factors, but may include:

 Agitation, restlessness, irritability and anger

 Becoming withdrawn or isolated
 Fatigue and lack of energy
 Feeling hopeless, helpless, worthless, guilty and self-hatred
 Loss of interest or pleasure in activities that were once enjoyable
 Sudden change in appetite, often with weight gain or loss
 Thoughts of death or suicide
 Trouble concentrating
 Insomnia or sleeping too much

(https://www.recoveryranch.com/resources/addiction-facts/causes-anxiety-depression-
symptoms-signs/)
III. WHERE CAN IT LEAD TO

Untreated Depression

Untreated clinical depression is a serious problem. Untreated depression increases the chance of
risky behaviors such as drug or alcohol addiction. It also can ruin relationships, cause problems at
work, and make it difficult to overcome serious illnesses.
Clinical depression, also known as major depression, is an illness that involves the body, mood,
and thoughts. Clinical depression affects the way you eat and sleep. It affects the way you feel
about yourself and those around you. It even affects your thoughts.
People who are depressed cannot simply “pull themselves together” and be cured. Without
proper treatment, including antidepressants and/or psychotherapy, untreated clinical depression
can last for weeks, months, or years. Appropriate treatment, however, can help most people with
depression.
How does untreated clinical depression affect physical health?
There is mounting evidence that clinical depression takes a serious toll on physical health. The
most recent studies exploring health and major depression have looked at patients with stroke or
coronary artery disease. Results have shown that people with major depression who are
recovering from strokes or heart attacks have a more difficult time making health care choices.
They also find it more difficult to follow their doctor's instructions and to cope with the
challenges their illness presents. Another study found that patients with major depression have a
higher risk of death in the first few months after a heart attack.

How is sleep disrupted by untreated depression?

One of the most telling symptoms of clinical depression is a change in sleep patterns. Though the
most common problem is insomnia (difficulty getting adequate sleep), people sometimes feel an
increased need for sleep and experience excessive energy loss. Lack of sleep can cause some of
the same symptoms as depression -- extreme tiredness, loss of energy, and difficulty
concentrating or making decisions.
In addition, untreated depression may result in weight gain or loss, feelings of hopelessness and
helplessness, and irritability. Treating the depression helps the person get control over all of
these depression symptoms.

What are common signs of insomnia with untreated depression?

Common signs of insomnia include:
 Daytime fatigue
 Irritability and difficulty concentrating
 Sleep that never feels like "enough"
 Trouble falling asleep
 Trouble going back to sleep after waking up during the night
 Waking up at all hours of the night
 Waking up before the alarm clock goes off
What are signs of drug and alcohol abuse with untreated depression?
Alcohol and drug abuse are common among people with clinical depression. They’re especially
common among teens and among young and middle-age males. It is very important to encourage
these people to get help, because they are more likely to attempt suicide.
Signs of drug and alcohol abuse include:
 Inability to maintain personal relationships
 Secretive alcohol use
 Self-pity
 Tremors
 Unexplained memory loss
 Unwillingness to talk about drugs or alcohol
Are the signs of untreated depression in men different from those in women?

Men who have untreated clinical depression may exhibit more anger, frustration, and violent
behavior than women. In addition, men with untreated depression may take dangerous risks such as
reckless driving and having unsafe sex. Men are not aware that physical symptoms, such as
headaches, digestive disorders and chronic pain, can be symptoms of depression.

Why is untreated depression considered to be a disability?

Depression can render people disabled in their work life, family life, and social life. Left untreated,
clinical depression is as costly as heart disease or AIDS to the U.S. economy. Untreated depression
is responsible for more than 200 million days lost from work each year. The annual cost of
untreated depression is more than $43.7 billion in absenteeism from work, lost productivity, and
direct treatment costs.

How does untreated depression affect family?

Living with a depressed person is very difficult and stressful for family members and friends. It’s
often helpful to have a family member involved in the evaluation and treatment of a depressed
relative. Sometimes marital or even family therapy is indicated.

Can untreated depression lead to suicide?

Depression carries a high risk of suicide. This is the worst but very real outcome of untreated or
under-treated depression.
Most people who suffer from clinical depression do not attempt suicide. But according to the
National Institute of Mental Health, more than 90% of people who die from suicide have
depression and other mental disorders, or a substance abuse disorder. Men commit almost 75%
of suicides, even though twice as many women attempt it.
The elderly experience more depression and suicide than you might think. Forty percent of all
suicide victims are adults over the age of 60. Older adults suffer more frequently from depression
because of the frequent loss of loved ones and friends as they age. They also experience more
chronic illnesses, more major life changes like retirement, and the transition into assisted living
or nursing care.
Are there certain risk factors for suicide with untreated depression?
What are warning signs of suicide with untreated depression?
Warning signs of suicide include:
 Talking, writing, or thinking about killing or hurting oneself or threatening to do so
 Depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse
 Having a "death wish;" tempting fate by taking risks that could lead to death -- for
example, driving through red lights
 Losing interest in things one used to care about
 Making comments about being hopeless, helpless, or worthless
 Putting affairs in order, tying up loose ends, or changing a will
 Saying things like "it would be better if I wasn't here" or "I want out"
 A sudden switch from being very sad to being very calm or appearing to be happy
 Suddenly visiting or calling people one cares about
 Talking about suicide
 Increase in drinking alcohol or using drugs
 Writing a suicidal note
 Watching well publicized murder and/or suicide reports in the media
 Conducting on-line searches on ways to commit suicide
 Seeking methods to kill oneself, such as getting a gun or pills
Who can be treated successfully for clinical depression?
More than 80% of people with clinical depression can be successfully treated with early
recognition, intervention, and support.
Depression affects almost 19 million people each year, including a large portion of the working
population. People with untreated depression can usually get to work. But once there, they may
be irritable, fatigued, and have difficulty concentrating. Untreated depression makes it difficult
for employees to work well.
Most people do best with depression treatment using psychotherapy, medications, or a
combination of both. For treatment-resistant depression, one that does not respond to medication,
there are alternative treatments. One example is electroconvulsive therapy or ECT.
(https://www.webmd.com/depression/guide/untreated-depression-effects#1)
IV. RECOMMENDATIONS ON HOW TO CURE AND PREVENT THE ISSUE
Treatment
Anxiety disorders and depression are treatable. Many people experience meaningful symptom
relief and improvement in their quality of life with professional care. However, treatment success
varies. Some people respond to treatment after a few weeks or months while others may take
longer. If people have more than one anxiety disorder or if they suffer from other co-existing
conditions, treatment may take longer. An experienced provider will conduct a comprehensive
assessment before discussing an individualized treatment plan.
 Therapy
 Learn More About Cognitive-Behavior Therapy (CBT)
 Medication
 Residential Treatment
 Complementary and Alternative Treatment
 Transcranial Magnetic Stimulation (TMS)
(https://adaa.org/sites/default/files/Anxiety%20and%20Depression.pdf)