DEPRESSION/SUICIDE A Global Health Challenge By Dr. Izuagba Kelechi

Health & Fitness HEALTH ALERT
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Introduction/Definition

It would be imperative to begin this lecture with the definition of health.

Health as defined by WHO is “A complete state of physical, mental and social well-being of an individual and not merely the absence of diseases or infirmity”.

Unfortunately in today’s increasingly demanding world, mental and social aspects of health have been neglected to the fate of individuals and the society

Depression is a very common mood disorder and as such, a major public health issue in our country. Depression results from a complex interaction of social, psychological and biological factors including adverse life events e.g. bereavement, financial problems, unemployment, abuse and neglect, divorce etc..

Globally, over 300 million people of all ages suffer from depression and close to 80,000 people die due to suicide.

Suicide on the other hand is a deliberate self-harm which results to loss of life or simply put, the act of killing oneself. It is quite different from parasuicide which is a deliberate self-harm in which life is “not” lost and maybe due to external intervention or that the technique used was not severe enough to cause death. Some prefer to call it “Attempted suicide “.

Depression is one of the most widespread mental illnesses that often co-exist with chronic/ physical illnesses such as HIV/AIDS, cancers and cardiovascular diseases.

It is common in the female gender with several risk factors which have been studied but these risks exist independent of race or ethnicity.

The gender difference in depression prevalence maybe due to hormonal factors, gender difference in socialization, gender difference in coping style, difference in frequency and reaction top stressful life events, social roles and cultural influences.

There are effective treatments for depression and if left untreated, it can lead to significant decline in productivity and worse case, suicide.

Severe depression is currently reported to be the leading cause of suicide in persons aged 15-29 years in Nigeria.

Classically, depression can be mild, moderate or severe with resulting psychotic symptoms such as suicidal ideation.

A clinical diagnosis of depression is made if a major depressive episode has lasted for at least 2 weeks duration and with at least 4 major symptoms as listed below.

SIGNS AND SYMPTOMS OF DEPRESSION

1.     Anhedonia – this is lack of interest or pleasure from activities that used to be pleasurable.

2.     Persistent low energy [Anergia]

3.    Irritability

4.    Significant changes in weight and appetite

5.    Insomnia/ intermittent awakening

6.    Decreased concentration in form of forgetfulness

7.    Social withdrawal

8.    Low self-esteem/ confidence

9.    Decreased self-care

10.                       Deceased libido

11.                       Hopelessness/ lack of motivation or drive

12.                       Ideas of guilt and unworthiness

13.                       Multiple somatic symptoms with no clear physical cause e.g back pain, crawling sensations, peppery body sensations etc.

14.                       Ideas of self-harm/ suicidal attempts

WHAT DO YOU TELL A DEPRESSED PERSON?

1.    Tell a depressed person that depression is very common and can happen to anybody and that depressed people tend to have unrealistic negative opinions about themselves, their life and their future.

2.    You must show empathy as though you’re in their shoes

3.    You must have a good listening skill and never judge them for their actions

4.    Tell them they are not alone and they should look beyond stigma and secrecy to seek help

5.    Tell them that depression is treatable and suicide can be prevented

6.    Address any current psychosocial stressors and offer him/her an opportunity to talk in a private place

7.    Ask about his subjective understanding of his symptoms

8.    Identify supportive family members and involve them as much as possible

9.    Encourage him to connect with people by building relationships with people around him.

10.                       Educate him on sleep hygiene e.g. sleep in a cool, quiet, comfortable room, avoid caffeinated drinks, avoid day time nap, bath before sleeping etc.

11.                       Advise him on lifestyle modifications especially on how to manage stress e.g. yoga, physical activities/ exercise and meditation

12.                       Seek for professional help if symptoms persist.

HOW CAN WE MANAGE DEPRESSION?

Depending on the severity of depression which can be mild, moderate or severe depression, treatment involves the BIOPHYSICAL modalities.

The biological modality involves the use of drugs [Anti- depressants] but there are considerations before they can be used to their deleterious side effects.

Anti-depressants are not used in mild depression and in children less than 12 years of age. Hence, the psychological and social interventions can be applied here.

This basically involves; PSYCHOEDUCATION which helps to inform and educate the person and his family members about their problem. It also helps to identify and reactivate the person’s prior social activities by actively encouraging him to resume prior social activities.

For severe depressions, it’s best to admit such person in a hospital and monitor him closely while on treatment with anti-depressants.

On admission, restrict his movement and assign a nurse to him who must always be at alert and must always apply suicidal cautions. Remove any harmful object around him which he can possibly use to harm himself.

When patient gets better, discharge by handing over medications top his relatives otherwise they can take all the drugs at once and the toxicity of the drugs when taken in higher doses can lead to death [SUICIDE].

Suicide has become so common in Nigeria especially among the youth. The “commonest” cause of suicide by far is “SEVERE DEPRESSION” which may arise due to life stressors like chronic/ terminal disease, loss of loved ones, financial crisis, broken relationships, loneliness etc.

–         Other causes of suicide includes severe alcoholism which is defined as excessive consumption of alcohol to the point if psychological dependence which produces detrimental effects or causes deterioration in the person’s physical, social and economic functioning.

–         Substance use disorders arising from peer group pressures

–         Organic states e.g. epilepsy

–         Psychotic disorders e.g. schizophrenia

COMMON AGENTS USED FOR SUICIDE

Previously, the hanging on rope method was the norm but presently, chemicals and corrosive agents have been implicated.

The most popular agent used is the SNIPER. An organophosphate used for killing insects and pests.

The recent reported cases from sniper use were seen more among the youths which leave us with the question on how did it become the most popular agent?

This is obviously from the “SOCIAL MEDIA” networks.

A lot of youths now have access to Facebook, Instagram and Twitter where these cases are shared, when they see they have similar life circumstance with the deceased and what they used to end their life, they tend to imitate them and that’s how sniper use became popular.

Other means of committing suicide includes;

–         Drowning

–         Jumping from heights

–         Use of firearms/ weapons

–         Use of toxic drugs especially in high doses

CONCLUSION

The major barriers to assess for mental problem and the rates vary by different aspects of social contexts.

Most suicide occur due to underlying stressors e.g mental health support group should be encouraged to ensure that advocacy is amplified, conversations are widespread and to make care accessible.

In overcoming the stigmatization attributed by receiving metal health care, we need to educate people that mental health problem is not the end of life and that effective treatment is possible. We also need to lend our voices to sensitize the general public in form of TV, radio adverts, public speaking in order to inform and enlighten people that mental health problem is real and can happen to anybody. Therefore, one must open up his mind, speak up and seek for help when depression sets in.

NGOs such as mentally aware initiative, Anti- suicide and depression squad, She writes woman, listening ear Africa and volunteering time and efforts by supporting financially and strategically to curb this public menace.

Society puts pressure on all of us and so do social and cultural conditioning. We must break free from this mental yoke and live freely. The society expects you to be married, have children, become billionaires by a certain date as if you have a best before date on your forehead. Men suffer pain and cannot express themselves without being told to be a man, man up, men don’t cry and then one day, the rage flares. We must therefore be our brothers keepers, learn to love and care for each other irrespective of our social strata.

For the youth, if social media gives you a complex because everyone seems to be “balling” then take a break and unfollow people who oppress you. Most people on social media are fake and you must not be woo-ed by what you see there.

Parents must learn to love, care, stop abusing and pressurizing their children/ wards. Everyone’s time zone differs.

Recently, the federal government banned the importation of sniper but will that solve the problem, NO!!!. Until the grassroots problems are solved which includes alleviating extreme poverty and hunger, creating job opportunities for the youths and empowering them, ensuring public awareness on mental health, providing adequate and sustainable mental health care services in primary, secondary and tertiary hospitals.

“WE ALL NEED TO MINIMIZE THE STIGMA OF MENTAL ILLNESS, EMPATHIZE AND WATCH OUT FOR OUR FAMILY AND FRIENDS. ALL HANDS MUST BE ON DECK!!!”

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