MANILA, Philippines — The Philippines has one of the highest cases of depression in

Southeast Asia, affecting more than three million Filipinos, a lawmaker in the House of
Representatives said.

Rep. Rida Robes of San Jose del Monte, Bulacan revealed this in a privilege speech
last Tuesday evening as she lamented the rising rates of suicide among the country’s
youth.

She expressed alarm over depression becoming as prevalent as the common cold in
the country, affecting around 3.3 million Filipinos.

“It is recognized by our own Department of Health (DOH) as a serious health condition,
and the weight of haplessness, hopelessness and helplessness—the three dreaded ‘H’
symptoms of depression—gravitate towards what now are the new high-risk group: the
young population,” she said.

Citing a 2017 World Health Organization report, Robes said eight in every 100,000
Filipinos commit suicide. Of this figure, six are males, while two are females, aged 15 to
29 years old.

The same report showed that an average of 3,000 people worldwide take their own lives
every day, or a suicide case every 40 seconds.

Robes said the study attributed the increase in suicide cases to social media, changing
lifestyle and lack of family and community support, which led to a convergence of “risk
factors” like social disconnection and weakening of “helpful factors” such as genuine
relationships and healthy lifestyles.

“Many of them lack a sense of purpose in life and experience disconnectedness and
deteriorating relationships brought about by social media and technology. At home,
relationships or guidance may not be better either, when parents would lack quality time
with their children due to their busy schedule or if when one or both of them work
abroad,” the lawmaker lamented. School life is also a source of high level stress, she
added.

Robes has asked colleagues in Congress to pass a law that would restore the study of
values education as a stand-alone subject in basic and higher educational curricula.
Legislation on responsible social media usage among young people should also be
passed, she further stated.

Robes also vowed to move for the conduct of a congressional inquiry on the
construction and loading of senior high school curriculum, and probe into the age-
appropriateness of difficult subjects such as calculus, statistics and research, as well as
the exercise of its oversight powers over the implementation of Republic Act 11036,
also known as the Philippine Mental Health Law.

She likewise called on the DOH to step up the implementation of RA 11036, particularly
the launching of strong and widely promoted anti-suicide helplines.

“The Department must also be prompted to implement community-based mental health

programs with the same vigor and determination it shows in championing anti-AIDS,
anti-dengue and anti-Japanese encephalitis campaigns,” she appealed.

The lawmaker also urged religious institutions, civil society organizations and private
corporations to contribute their share in addressing these emergent problems through
counseling, stress debriefing, establishment of helplines for young people.

Lastly, she suggested the relaxation of steep licensing requirements for guidance
counselors, to allow public schools to hire the required number of guidance counselors
to help students cope with mental health issues.

Key facts
 Depression is a common mental disorder. Globally, more than 264 million
people of all ages suffer from depression.
 Depression is a leading cause of disability worldwide and is a major
contributor to the overall global burden of disease.
 More women are affected by depression than men.
  Depression can lead to suicide.
 There are effective psychological and pharmacological treatments for
moderate and severe depression.

Overview
Depression is a common illness worldwide, with more than 264 million people affected
(1). Depression is different from usual mood fluctuations and short-lived emotional
responses to challenges in everyday life. Especially when long-lasting and with
moderate or severe intensity, depression may become a serious health condition. It can
cause the affected person to suffer greatly and function poorly at work, at school and in
the family. At its worst, depression can lead to suicide. Close to 800 000 people die due
to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for mental disorders, between 76% and
85% of people in low- and middle-income countries receive no treatment for their
disorder(2).  Barriers to effective care include a lack of resources, lack of trained health-
care providers and social stigma associated with mental disorders. Another barrier to
effective care is inaccurate assessment. In countries of all income levels, people who
are depressed are often not correctly diagnosed, and others who do not have the
disorder are too often misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World
Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated
response to mental disorders at the country level.

Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be
categorized as mild, moderate or severe.

A key distinction is also made between depression in people who have or do not have a
history of manic episodes. Both types of depression can be chronic (i.e. over an
extended period) with relapses, especially if they go untreated.
Recurrent depressive disorder: this disorder involves repeated depressive episodes.
During these episodes, the person experiences depressed mood, loss of interest and
enjoyment, and reduced energy leading to diminished activity for at least two weeks.
Many people with depression also suffer from anxiety symptoms, disturbed sleep and
appetite, and may have feelings of guilt or low self-worth, poor concentration and even
symptoms that cannot be explained by a medical diagnosis.

Depending on the number and severity of symptoms, a depressive episode can be

categorized as mild, moderate or severe. An individual with a mild depressive episode
will have some difficulty in continuing with ordinary work and social activities but will
probably not cease to function completely. During a severe depressive episode, it is
unlikely that the sufferer will be able to continue with social, work or domestic activities,
except to a limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and
depressive episodes separated by periods of normal mood. Manic episodes involve
elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a
decreased need for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological
factors. People who have gone through adverse life events (unemployment,
bereavement, psychological trauma) are more likely to develop depression. Depression
can, in turn, lead to more stress and dysfunction and worsen the affected person’s life
situation and depression itself.

There are interrelationships between depression and physical health. For example,
cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches
to prevent depression include school-based programmes to enhance a pattern of positive thinking
in children and adolescents. Interventions for parents of children with behavioural problems may
reduce parental depressive symptoms and improve outcomes for their children. Exercise
programmes for the elderly can also be effective in depression prevention.

Diagnosis and treatment

There are effective treatments for moderate and severe depression. Health-care providers may
offer psychological treatments such as behavioural activation, cognitive behavioural therapy
(CBT) and interpersonal psychotherapy (IPT), or antidepressant medication such as selective
serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Health-care providers
should keep in mind the possible adverse effects associated with antidepressant medication, the
ability to deliver either intervention (in terms of expertise, and/or treatment availability), and
individual preferences. Different psychological treatment formats for consideration include
individual and/or group face-to-face psychological treatments delivered by professionals and
supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be
an effective form of treatment for moderate-severe depression but are not the first line
of treatment for cases of mild depression. They should not be used for treating
depression in children and are not the first line of treatment in adolescents, among
whom they should be used with extra caution.

WHO response
Depression is one of the priority conditions covered by WHO’s mental health Gap Action
Programme (mhGAP). The Programme aims to help countries increase services for
people with mental, neurological and substance use disorders through care provided by
health workers who are not specialists in mental health. WHO has developed brief
psychological intervention manuals for depression that may be delivered by lay workers.
An example is Problem Management Plus, which describes the use of behavioural
activation, relaxation training, problem solving treatment and strengthening social
support. Moreover, the manual Group Interpersonal Therapy (IPT) for Depression
describes group treatment of depression. Finally, Thinking Healthy covers the use of
cognitive-behavioural therapy for perinatal depression.

References
1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018).
Global, regional, and national incidence, prevalence, and years lived with disability for
354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic
analysis for the Global Burden of Disease Study  2017. The Lancet. DOI.

2. Wang et al. Use of mental health services for anxiety, mood, and substance disorders
in 17 countries in the WHO world mental health surveys. The Lancet. 2007;
370(9590):841-50.