‘’ Anna” had been suffering from depression and anxiety attack since adolescence. Her depression started when her parents broke up while her anxiety attacks started her mother started working in Cebu, leaving Anna her psychological problems, but when she was 17, Anna did the ultimate act giving in to her depression, she committed to suicide by hanging.
This true story brings home the reality of the problems of depression and anxiety that could afflict individuals regardless of age, status, race, social standing or gender, and the intensity and severity of the pain they bring that could be lead to the ultimate act of suicide. Even the great Sir Winston Churchill suffered from depression in his lifestyle. Severe depression marked by prolonged and very deep sorrow and lowered self-esteem, and anxiety, a serious state of deep worry and panic, affect a large number of individuals today. Shimberg (1991) identifies depression as “ the most common biological disorder seen in psychiatry today that nobody can escape because people are either directly affected by it or try to cope with a family member who is affected with depression”
Aside from the ever-present danger and risk of suicide, depression and anxiety rob affected persons with loss of happiness and well being that could lead to physical, psychological and well social ailments. Many are prevented from going to school from finding or maintaining lucrative jobs, and from enjoying social activities with family and friends.
All of these negative effects and fatal impact on depression and anxiety make this study highly significant. This aims to show that depression and anxiety when left undetected o untreated would lead to suicide among teenagers and adults alike.
The second part of this study will present the salient facts about depression, its types, causes, risk factors, effects and dangers from suicide, as well as therapy and preventive measures to stop afflicted individuals from committing self-destruction.
The next part will present all the facts about anxiety, the different types or manifestations, cause, risk factors, effects, dangers of suicide and also therapy and preventive measures. The least part will focus on suicide. -the types and methods, the statistics of suicide due to depression and anxiety and the preventive measures that must be done by those nearest to the afflicted people with suicidal tendencies.
Depression can be defined and described in various ways. Kyes and Hofling (1980) define it as a pathologic state, brought on the feelings of loss and/ or guilt and characterized by sadness and lowering of self-esteem.¹It may also be simply defined as a brain disorder that affects thoughts, moods, feelings, behavior and physical health.
More specifically, depression is best defined in terms of its attributes, or the observable signs, symptoms and charges it brings to an afflicted person. These include: (1) a marked alteration in mood such as sadness, loneliness and apathy; (2) a negative self-concept associated with self-reproaches and self-blame; (3) Regressive and self-punitive wishes such as the desires to escape, hide, or die; (4) vegetative changes including anorexia, insomnia, loss of libido ; and (5) change in activity level including retardation or agitation.³
B.Types of Depression
Today, psychiatrists categorize depression into the different types based on their characteristics. The first type termed Major depressive episode is marked by symptoms that appear without any cause that can be pinpointed. It prevents the person from doing normal daily activities and may be isolated (occur once) or recurrent. The second type called Manic episode is marked by dominating abnormal euphoria (extreme happy agitated state) or irritability. The third is Mixed episode marked by alternating mood, between mania depression for at least one week. This episode also goes by the name manic depression or bipolar disorder. The fourth and last in this group of psychiatric categories is Dysthymic disorder marked by the affected individual can still perform normal activities.⁴
The reaction states in the depression are also classified in terms of state or intensity of impairment and disturbance. Neurotic depressive reaction is identified as a state of depression of neurotic intensity wherein realty testing is largely unimpaired and physiologic disturbances are mild. On the other hand, Psychotic depressive reaction is that state depression of psychotic intensity in which realities testing severely impaired and physiologic disturbances (vegetative signs) are usually conspicuous. The third state called Reactive depression is a depressive state which the precipitating stress can be clearly discerned and seen to be of some magnitude. The fourth state called Unipolar depression is a condition characterized by recurrent episodes of depression, usually of psychotic intensity, without episodes of mania.⁵
Another type of depression is called Seasonal Affective Disorder or SAD. This is a pattern of major depression related to seasonal changes which might be caused by decreased levels of sunlight and increased melatonin (mood-controlling hormone) in the brain.⁶
Unlike SAD which can be explained by a biochemical cause the cause of depression and its various types and states difficult to pinpoint. Scientists and experts believe that a combination of factors such as genetic vulnerability, environmental factors, stress, physical illness, or neurotransmitter imbalances in the brain could lead to depression. The known causes of depression are inherited vulnerability; environmental triggers; medications; illnesses; personality; alcohol; nicotine; and drug abuse; and diet.⁶
Inherited vulnerability as cause of depression means that having a family history of depression increases the risk of developing depression. A person who has a parent or relative with this condition is in danger of getting bogged down with depression. Researchers have isolated several genes involved in bipolar depression, although not all with this negative heredity trait develops the problem. It has been clarified that there are other factors that can lead t depression and one of these are environmental triggers such as stressful life events including loss or death of a loved one, divorce, break up of a relationship, loss of a job, financial worries, and sickness or loss of health or independence.⁷
Although depression just like stress, is a part of life, when the depression starts to control a person’s life for over two weeks and leads to passive behavior prolonged sorrow, lack of appetites and a loss of the general zest for living, then he or she has shifted from simply being depressed to suffering from depression. This type of depression caused by a situation, specific event or life changing situation is called reactive or situational depression.⁸
In addition to inherited vulnerability, environmental triggers and stressful events or situations, personality traits can also be cause of depression having low self-esteem, being too dependent, self critical, pessimistic and negative, and being easily overcome by stress can make a person prone to depression.⁹
Also, medications and illnesses, as well as habits such as drinking alcohol, smoking and drug abuse as well as poor dietary habits can also cause depression. Prolonged use of certain medications such as beta blocker propanolol or Inderal, some blood pressure medicines and drugs for treating arthritis and Parkinson’s disease may cause depression. Sometimes, steroid medications such as Prednisone and oral contraceptives, and anti-cancer medicines can also being on depression. Those chronically sick from heart disease are also greater risk for suffering from full blown depression. This connection between heart disease and hypothyroidism has been established by studies.¹⁰
Studies also found that contrary to previous beliefs, people did not turn to alcohol, nicotine or drugs to get comfort from depression but it is these substances that make them prone to depression and anxiety disorders. Studies found that about 30% of depressives and 60% of bipolar depressives abuse alcohol and drugs. Moreover other bad habits such as not eating well and lack of foliate and Vitamin B-12 may also result in depressive symptoms.¹¹
With the various cause of depression cited above and one might ask what the risk factors are and who are at risk for depression. Shimberg (1991) point to stages in life that might trigger the problem including forced retirement; being left behind by children who get married or leave for school; becoming an adolescent. These life stages and occurrences individuals at the risk for depression. Childhood depression and post depression are forms of depression that often do not get recognized.¹² Moreover, according to Kyes (1980), some research had indicated that depression and bipolar disorders might earlier by experts. This indication is linked to increase in the adolescent suicide rate in recent years.¹³
Experts also warn that outside of those already mentioned as at risk for depression because of the altered stage in life, families of those who are depressed at most at risk for depression. The reason for this is the destruction that depression cause on the depressed and all family members round them: damage to relationships, end to careers, lost dreams and chaos and torment for the family. So mothers of depressed children become depressed, and children of depressed parents also become more likely to get depressed.¹⁴
In terms of age, race, status, gender and other factors, experts point out that depression can affect all ages and all races, but typically the first episode occurs between the ages of 25 and 44. Although older people are no more at risk than other age groups, depression are higher among single individuals and those not in long-term relations- among divorced people and those who live alone. Women are more prone to major depression, dysthemia and seasonal affective disorder. It is said that one out of four women will experience some type of depression so women are at 25% higher risk, although both genders have about the same risk for bipolar depression. ¹⁵
More important than knowing the risk factors causes of depression is knowledge of preventive measures and the signs and symptoms of depression so that its negative effects and serious impact can be avoided. When left untreated and undetected, depression can result only in the worst consequences of disability, dependency and even suicide. Statistics reveals that as high as 70 percent (70%) of people who committed suicide may have some form of depression.¹⁶
D.Effects and Dangers of Suicide
Indeed, the impact of depression is severe because it negatively affects all aspects of health and depresses thinking, moods, feelings and behavior, as well as weakens physical health. The depressed person loses interest in normal day to day activities and experience lack of pleasures in activities previously enjoyed. This loss of happiness is called anhedonia; it erases all the enjoyment previously experienced in life. Hence, the depressed person feels very sad, helpless and hopeless and suffers from crying spells. These effects last for a long time. ¹⁷
In addition to the above major affects of depression, the afflicted individual also suffers from disturbed sleep; marked less or gain in weight; agitation or slowed body movements; fatigue; diminished self-esteem; persistent thoughts of death and suicide; impaired thinking or concentration and loss of libido or interest in sex. Depressed individuals either sleep too much or suffer from insomnia. They may wake up in the middle of the night or at dawn and not fall asleep again. They often become agitated, irritable and easily gets angered at little things. On the opposite extremes, they become robot like, moving slowly and speaking in a monotone. They feel fatigued and weary, filled with guilt and feelings of worthlessness. Because of these, they think of suicide and not death, unable to make the right decisions and forgetting things. They lose interest in sexual relations. It is when they become overwhelmed that depressed individuals commit suicide.¹⁸
A study by Cassidy, Flamegon and Spellman (1957) found that 58% of depressed individuals were psychologically affected, often saying that they had nothing to look forward to, were afraid to be alone, could not remember anything, had black moods and blind rages, felt all mixed up, very unhappy or simply brooded around the house. Some (18%) felt that their head was heavy, pressured in the throat or had headaches. Some left a pain in the head like a balloon about to burst urinated frequently and had upset stomach. A few (11%) felt tired, exhausted or jumpy. They confessed to inability to do work, lack of strength and trembling like a leaf. A small number (2%) experience a mixture of medical and psychological problems such as getting scared and not being able to breath, suffering from stiff necks and loss of power, feeling a weakness in their arms.¹⁹
In the major form of depression, depressed persons become so fatigued that they sleep throughout the day and night. They are unable to work or do simple chores due to exaggerated sadness and lack of lethargy that cannot overcome. Compounding their depressive feelings are those of worthlessness, excessive guilt and receiving thoughts of suicide affected by the lifetime of these major depressive effects are 5-12 out of 100 men and 10-26 of women. The American Psychological association (APA, 1994) also point slowly increasing severity of the problem. Maj. Et al. (1992) state that about 75% of those who suffer from a depressive episode may suffer it again within five years .²⁰
People who suffer from bipolar disorder or manic depression marked by alternating moods of depression and mania are affected differently. In this period of a manic episode, they become restless and feel energetic even with only three hours of sleep. They become very talkative, with racing thoughts and flighty ideas. They easily get distracted and increase their social work, school or sexual activities. They also become excessively involved in pleasurable activities that could lead to painful consequences such as uncontrollable buying sprees, sexual indiscretions or foolish business investments. All these can affect their work and social relationships.²¹
Less marked affects can be seen in the people with dysthemia or chronic low-level depression. While they may also suffer from disturbed sleep, energy and self-esteem, they are not debilitated; those who suffer from it often lack self-confidence or motivation and remain in abusive relationships.²²
E.Therapy and Prevention
Because depression especially major episodes can lead to suicide, treatment measures must be followed starting with techniques including giving of tranquilizing drugs for mania or antidepressant drugs for depressions, electroconvulsive therapy, milieu therapy, occupational and recreational therapies, and supportive psychotherapy. In addition to these, the most important treatment objective is to change whatever underlying personality problems are causing the depression through psychoanalysis or psychotherapy.²³
Three specific forms of psychotherapy that can effectively treat depression are cognitive therapy, behavior therapy and interpersonal psychotherapy. These are combinations of one of the recommended such as tricyclics or selective serotonin reuptake inhabitations can effectively treat the condition. Other specified forms of treatment are electroconvulsive therapy and phototherapy for seasonal depression.²⁴
The type of treatment given to a depressed person depends on the physiological symptoms that can be observed including disturbance of sleep or loss of the desire to eat. In such cases, anti depressant medications that act to increase the amount of nor epinephrine, serotonin or both available in the synapses. These substances identified as neurotransmitters are found in decreased amounts in depression. Antidepressants that have been found effective are tricyclic antidepressants, monoamine oxidate (MAO) inhibitions and selective serotonin reuptake inhabitations (SSRIS). The SSRIS are preferred because of fewer side effects and they are better tolerated for longer treatment. One example is Prozac. For those suffering from bipolar depression, lithium is usually given in all cases where these medications are used; care should be taken to prevent patients from using them in suicide attempts.²⁵
The need to prevent depressed individuals from suicide attempts cannot be overemphasized. Statistics reveals that about 15% of the population experiences major depression and some point in life, putting them at risk for suicide. This danger increases due to the fact that depression is often not diagnosed, or when diagnosed, it is not treated adequately. Physicians need to always assess the risk of suicide by direct questioning because patients often fail to put their thoughts into words if they are not encouraged to do so.
When such specific plans of suicide are discovered and if significant risk factors exist such as a past record of suicide attempts, deep hopelessness, accompanying medical illness, substance abuse, or social isolation and loneliness, the patient or depressed individual must be referred right away to a mental health specialist. The physicians should try to dig deeper with hope and empathy in dealing with the depressed patient, and become sensitive to hidden feelings denial a [atient who shows signs of anxiety, panic or agitation is at significantly increased risk of suicide. Almost 15% of patients with untreated depression will commit suicide but majority of these will have asked for help within a month of their suicide.²⁶
Because of the ever present danger and risk of suicide among depressive individuals, therapy and treatment should be implemented with clear steps for preventive measures. These include providing a safe environment to protect them from self-injury or suicide; providing a structured environment to encourage the patients to engage in daily and recreational activities ; to reactivate their interests away from personal concerns ; and to motivate them for the treatment and introduce psychotherapy and occupational therapy always, the doctors and caregivers should aim at building trust through one-to-one relationships, showing interest and giving positive support to help build the patients ego and self-esteem. They have to help provide adequate nutrition, sleep and exercise for the patients.²⁷
Aside from and often occurring with depression are feelings of anxiety, best described as “ an abnormal and overwhelming signs such as sweating, tension, and increased pulse ; by doubt concerning the reality of the threat ; and by self-doubt concerning one’s capacity to cope with it. ²⁸ It must be pointed out that anxiety is a normal and useful feeling when it warns of possible danger, but uncontrollable anxiety becomes a disorder when the affected person becomes bombarded with intense, frequent and continuous false alarms. These false alarms may result in dysfunctional avoidance behavior such as refusal to leave the house for fear of a panic attack.
Such anxiety disorders are reported as most frequently occurring type of mental disorders in the general population as reported by the American Psychological Association (1994). About 5% of the population suffers from acute or chronic anxiety, with women twice more likely to be affected. More than two percent (2%) of Americans for example have generalized anxiety disorder and are persistently axioms and disturbed. They become excessively and unrealistically worried about life circumstances. About a third of the populations also have at least one irrational or unreasonable fear or phobia.²⁸
Such exaggerated worry often goes together with depression, which experts think is also caused by imbalance of neurotransmitters. As opposed to normal worry that encourages people to plan and prepare for the future, and to get financial security for the family and the future, anxiety disorders lead to feelings of apprehension, nervousness and nagging uneasiness that resemble a heart attack, accompanied by fast heartbeat, palpitations, seating and dizziness. People with anxiety disorders may also suffer from headaches, insomnia and relentless fatigue.²⁹
B.Types of Anxiety
Anxiety disorders are usually classified as generalized or free floating anxiety; phobic anxiety; or panic attacks. Free floating anxiety refers to morbid states of anxiety that are relatively persistent and generalized. On the other hand, phobic anxiety refers to directed of focused anxiety which is an unreasonable and unfounded fear of an object or situation that leads to avoidance situation. Such phobias are of three main categories. The first are phobias of specific objects or situations such as fear of thunder, spiders, etc. The second are social phobias connected to social situations such as speaking or eating in public; while the third is agoraphobia, anxiety of leaving ones home or familiar surroundings and being in crowded place. The last major category of anxiety disorders, panic attacks, refer t brief but very intense attacks of anxiety.³⁰
Such panic attacks are or panic disorders are distinguished from real panic because the intense fear and feelings of doom or terror are not justified by the situation. These attacks are accompanied by shortness of breath, dizziness, heart palpitations, trembling, chest pains and even fear dying or going crazy.³¹
In the related disorder called agoraphobia mentioned earlier, the fear is connected to inability to escape such as from crowded grocery stores, elevators, a bridge, or a train, car or bus. The investigating factor is fear of having a panic attack in a public place; hence the afflicted person avoids leaving home altogether. A similar anxiety disorder is obsessive- compulsive Disorder which is characterized by recurring obsessions and compulsions that lead to severe distress that interfere with life. Obsessions are persisting thoughts or ideas like the notion of a terrible accident about to happen to a loved one or that underwear is filled with germs compulsions and intentional behaviors or mental acts performed to act on an obsession, often as a magical technique to world off the obsessive threat, such as taking a bath over or washing the hands repeatedly. Those with OCD give in to irresistible acts that they perform repeatedly even if they know are irrational.³²
One type anxiety disorder that has become common is Post- traumatic Stress Disorder or PTSD. This is marked by flashbacks and recurrent thoughts of a psychologically distressing experience outside the range of usual human experience such as seeing someone killed; being tortured; being raped; or losing one’s home in tsunami or natural disaster. The signs include nightmares, flashbacks, lessened responsiveness to the world, and psychological numbness.³³
C.Causes and Risk Factors of Anxiety
Whether anxiety is generalized or free-floating, phobic, obsessive- compulsive or caused by traumatic stress or panic attack, it is often exaggerated worry that goes together with depression. Hence, like depression, it is also caused by an imbalance in neurotransmitters as experts believe.³⁴
Also, like depression, anxiety disorders can be traced to several root causes including genetic vulnerability, and environmental factors. Family studies have shown that genetic factors. Family studies have shown that genetic factors and heredity contribute to anxiety disorders such as panic, simple phobia and obsessive-compulsive. People suffering from anxiety disorders have family members with anxiety and mood disorders. This generic vulnerability is believed to be due to mechanisms involving the neurotransmitters epinephrine and norepinephrine. Obsessive- compulsive syndromes, for example, have been found to be the result of imbalance among neurotransmitter systems. As for environment, growing eyes in a home with pathologically anxious parents or family members give a significant environmental risk for anxiety disorders.³⁵
One group of anxiety disorders, the phobias, can be traced to traumatic or painful roots. Psychiatrists believe that they often result from one single incident that was very frightening, painful or traumatic enough to leave a scar in the unconscious mind, one famous example was Rita Hayworthis phobia for riding elevators. A famous actress, she was once trapped in a lift in a tall building in Madrid when all of sudden, it plunged 20 floors down before the emergency brakes worked. After this event, she developed a phobia for elevators and moved only ride escalators or go to the event of walking up to a destination. She confessed that even thinking above riding an elevator would make her feel cold; she had developed claustrophobia.³⁶
However, experts also point out that phobias maybe caused by a series of disturbing experiences or situations. This series of unpleasant, frightening events can deeply ingrain the fear in a person’s subconscious mind. One example is the case of famous Mike Douglas who developed acrophobia or fear of flying. At the first, he saw gasoline pawing out of the gas tanks of a B-24 Liberator he had to ride on a assignment. Although the plane did not burn the sight of gasoline hitting the airplane’s wings terrified him. On another tour, the plane he rode on lost an engine and they had to crash-land. Douglas had to be carried from the wreckage and since these two experiences, he had developed from the wreckage and since these two experiences, he had developed acrophobia.³⁷
In addition to different types of phobias, teenagers can develop anxieties because of difficulties connected with their struggles with issues of freedom and separation from parents, and the need to establish their personal identity. Teenagers often experience fear, ambivalence, and confusion about assuming the role of adults, and these may result in deep emotional conflicts and anxieties. High degree of anxiety among teenagers may be indicated by their overly passive, compliant and conforming behaviors.³⁸
Oftentimes, anxiety is caused by exaggerated concerns with the possibility of being physically or emotionally hurt in the future. For example, a student suffering from anxiety would experience continual thoughts of failing in a coming test and everyone thinking that he is stupid.³⁹
D.Effects of anxiety and Dangers of Suicide
Like depression, anxiety has harmful effects on the affected individual. They might feel apprehensive and nervous, troubled by nagging and constant uneasiness about the future. Attacks of anxiety are similar to a heart attack accompanied by rapid heartbeat, palpitations, sweating and dizziness. Anxious people also from headaches, insomnia, and relentless fatigue. When left untreated, anxiety disorders increase the risk for hypertension and heart disease.⁴⁰
In the case of phobias, the extreme fright results in physical changes including quickening of heartbeat and responses, dilation of the pupils, and pouring of large amounts of energy producing adrenalin.⁴¹ This response is called the Flight or Fight response and is commonly known to become harmful to health when prolonged.
In the case of teenagers, those suffering from anxiety often become preoccupied with physical complaints and feelings. They experience disturbed interpersonal relationships and become plagued and bothered by unrealistic fears. Because they cannot express their fears and anxiety, they may act out their feelings through dysfunctional behaviors like aggression, juvenile or drugs, and truancy. But the worse impact of anxiety is suicide.⁴²
Indeed, the danger of suicide due to anxiety cannot be ignored. A study conducted in Sweden involving 3000 patients suffering from anxiety disorders found that before they reached 70 years old, one third or about 1000 died because of suicide. Hence, anxiety disorders predisposed affected people to commit suicide. ⁴³
E.Therapy and Prevention
To relieve suffering and prevent suicide, proper management of anxiety attacks, treatment techniques and preventive measures must be followed by the afflicted individual and those who care for them. Persons affected by anxiety can learn the techniques of muscle relaxation and biofeedback. They have to take prescribed anti-anxiety medications such as benzodiazepines, selective serotonin reuptake inhibitions (SSRIs) and buspirone (bulpar) to help relieve anxiety symptoms.⁴³
According to western (1996), benzodiazepines are useful for short-term treatment of anxiety symptoms. The earliest medicine of this type was valium but this has since been replaced by alprazolen or xanax which is more effective in treating panic symptoms. These medications increase the activity of GABA neurotransmitters that inhibits activation throughout the nervous system. Hence, anxiety is reduced by increasing inhibitory neurotransmitters. In the case of panic disorder, psychiatrists prescribe antidepressant medications for faster relief of anxiety.⁴⁵
In addition to medications which can be habit forming, those suffering from phobias can turn to other techniques to combat phobias. Trudy weirs man, director of the Phobia Workshop in New York suggests an eight-step plan to fight phobias. The plan includes the following steps;
“(1) accepting the phobia;
(2) Realizing that phobia cannot kill;
(3) Not running and focusing instead on the present situation;
(4) Making a chart of feelings and thoughts during a phobic situation;
(5) Relaxation using the tighten-relax method;
(6) Keeping in touch with reality to divert attention such us opening mail;
(7) Belief in one’s own ability to function with fear levels;
(8) Seeking professional help when all else fails’’ ⁴⁶
However, it must be pointed out that the anxious individuals need all the help they can get. Those who come in contact with the, especially parents, teacher and guidance counselors must be careful and be very cautious with teenagers rather the ignore behavior that often signs of serious disturbance and anxiety. For example, a teenager was suspended from school because of tribal rebellion, truancy and drug use. In the absence of social support from school officials and friends, the teenager overdosed on a bottle of pills in an attempt to commit suicide. The treatment revealed problems of depression.⁴⁷
People who come in control with anxious or depressed individuals must be aware of suicidal wishes that are expressed. Such suicidal wishes are extreme expressions of the desire to escape the suffering they imagine in the future and the burdens they believe they are placing on their families. In order to lighten the burden of suffering, hopelessness and mistaken ideas of the facility of their lives, the guidance counselor, teacher or psychiatrist must help the anxious person to examine their reasoning and think about alternative solutions to their problem. They must be guide in correcting their mistaken ideas about things that make them feel hopeless burden that add to their family’s sufferings once they recognize that there is a hope or alternative way, they will be motivated and forget about suicidal thought.⁴⁸
Indeed, the need to correctly assess those people who are in danger of committing suicide and to follow the strategies to prevent them from putting into action suicidal thoughts cannot be overemphasized. School Nurses especially need to be vigilant in diagnosing teenagers with suicidal tendencies. The signs and symptoms of emotionally disturbed teenagers include the following.
Social isolation related to inability to engage in personal relationships;
Potential for self-directed violence related to suicidal behavior;
Anxiety related to situational or maturational crisis;
A.Methods and types of suicide
Mass media have successfully raised the awareness of people about the various methods and types of suicide. Some intentionally cause their own death directly by using firearms, knives, or poison while others hang themselves. There are also those who commit suicide indirectly by continuous intake of harmful substances such as alcohol, drugs or tobacco, though most people are aware only of direct suicide. Other types of suicide that have become well-publicized are euthanasia (doctor assisted suicide) and teen age suicide. The issue of teenage suicide has raised to the forefront with the case of the teenager committing suicide in a Pampanga mall recently.
B.Statistics of Suicide
Gelman (1994) cited in Smith (1992) reported that in the United States of America alone, about 30,000 people die from suicide every. Belluck (1998) cited in Smith (1992) reported that suicide ranked as the 8th leading cause of death among young people in the 15-24 age range. Among adolescents, there has been a marked increase in suicide rate since 1950. ⁴⁹
In addition, statistics reveal that for every successful suicide, there are 5-10 attempted suicides. Moreover, women are reported to make more suicide attempts than men, but four times as many men actually commit suicide. Suicide cases have been increasing in both the teenage and elderly age group.⁵⁰
Furthermore, out of the estimated 30,000 people who actually committed suicide in the United States, 10-50 percent or about half suffer from major depression. For depressed people, the most dangerous time for suicide is when they are already to come out and recover the depression. When they are severely depressed, they are weakened and emotionally paralyzed so that they could not act on the impulse to kill themselves.⁵¹
Just like depression, the anxiety disorders also predispose people to suicide and place them at risk for untimely death. As stated earlier, a study conducted in Sweden found that of more than 3000 impatient who have been diagnosed with anxiety disorders, about one third or 1000 deaths before age 70 were due to suicide. Aside from those suffering from depression and anxiety disorders, those suffering from schizophrenia and personality disorders also die from suicide. Suicide is the primary cause of death among schizophrenics who are often faced with alienation and homelessness. Those with personality disorders are also prone to suicide because of the chaos and social problems they encounter in life.
In order to prevent individuals afflicted with depression, anxiety and other disorders from committing suicide, careful assessment of their status has to he made. Those near to them must recognize the level to depression or anxiety and the potential for suicide. Also, the presence of suicide ideation or thoughts of suicide have to be determined. The behaviors of these afflicted individuals have to be observed closely to note any clues to possible suicide. Most of the time, the person concerned will talk about suicide plans.
Hence, it is important that a anxious individuals from self-destructive acts. Care must be taken especially at times when the patients depression in lifting. Support and care must be established so that the afflicted persons will know that those around them are concerned about their welfare. At all times, the depressed and anxious must be encouraged to express their feelings and anger. Relevant questions must be asked such as: “Do you wish your well dead?”, etc. All concerned should recognize such continued desire to commit suicide.
More importantly, those around afflicted individuals should help increase their self-esteem by focusing on their strengths and success a structured schedule and involvement in activities with others should be helpful, as well as a structured plan to use to cope with future suicidal thoughts. The client should be helped to plan for continued professional help to relieve depression and anxiety in order to fully prevent suicide. In the case of teenagers, those educators, social workers, psychiatrists and others near them should help prevent teenage suicide by taking note of the risk factors and signs of suicide. These signs include changes in their behavior, anger, irritability, depression, sadness, withdrawal, changes in eating and sleeping habits, and preoccupation with death are the other signs of suicidal tendencies. Those young people who are contemplating suicide often report headaches, stomach aches and ailments and also talk about killing themselves.
In the end, public health workers and care givers could not be less vigilant in assessing suicide risks and in implementing measures to prevent suicide among others people suffering from depression, anxiety disorders and others disorders and severe stress. This is especially there in hospitals and health agencies. For example, a patient who had undergone mastectomy became quiet and withdrawn after a mastectomy operation upon learning that confirmation of cure would take months, she refused to eat and eaten jumped out of a window.
Those who are most prone to depression and anxiety leading to suicide are those with chronic or incurable disease with loss or severe damage to body parts, and those with other concerns in addition to illness such as death of loved one, loss of property, divorce, separation and other overwhelming problems. The severity of depression and anxiety will depend on the evens catastrophe, or critical incident that has occurred. Whatever the case, the caregivers must always be aware of the damage from suicide.
In conclusion, those concerned with individuals who are likely to commit suicide have to be aware of points at which to repeat suicide assessments. These individuals at a time prior/ before sustained therapentic response; first 6 months after hospital discharge; in presence of a new, painful, or disabling medical condition; in the presence of anxiety, panic or substances abuse; at evidence of relapse or recurring symptoms; at times of major stresses, losses, threats or shame inducing events; with comorleid personality disorders; or coming out of acute risk factors.
Suicide, as what statistics has shown in recent years, have been increasing at a fat rate and is becoming more common especially among the young; but, it could be prevented with prompt and appropriate intervention. Depression and anxiety, the most common causes of suicide, when left unchecked and untreated could lead to suicide among teenagers and adults alike. Hence, it is important for all who come in contact with depressed and anxious individuals to encourage them to undergo therapy and treatment.
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