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SPECIAL REPORT: Suicide and the Pinoy youth

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 olds, 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 Schoolbased 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. 
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

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