[COLUMN] Pandemic and suicide

THE COVID-19 pandemic has understandably increased the incidence of depression around the world, greater among the poor. Depression is a most significant risk factor in suicide. Complicated by the COVID-19 pandemic in today’s busy, impatient, materialistic, political, and fast-paced society, people are subjected to aggravated stressors in life every day. Encumbered by their personal circumstance, especially the past year in this pandemic, some are unable to adjust and cope, and develop depression. Suicide is a senseless option. It is a preventable alternative.

What is depression?

Depression is a state of emotion where the individual has some or all of the following senses, feelings, or moods: downhearted, unhappy, anxious, irritable, unable to concentrate, socially withdrawn, empty inside, has inordinate fatigue and reduced interest in activities which used to be fun, hopelessness, indecision, impaired sleep, misery, helplessness, confusion, monosyllabic speech or abnormally quiet.

What is the prevalence of depression?

In the United States, about 9 percent or 28 million American adults “have feelings of hopelessness, despondency, and/or guilt that generate a diagnosis of depression,” according to the US Centers for Disease Control and Prevention. Three percent or 9.6 million adults have major depression, a chronic and severe form of depression. In the Philippines, the rate is about 5.3 percent. Worldwide, the rate is between 2.6 percent to 29.5 percent – a pandemic, actually, according to an international study conducted by the World Health Organization. In general, women are 70 percent more prone to develop depression, in part due to hormonal changes, especially during menstruation, after pregnancy and menopause. In the past 50 years, the rate has catapulted from 3.33 percent to 7.06 percent, from 1991 to 2002. The rate for the various types of depression in the United States are: Postpartum – 10 to 15 percent; SAD (Seasonal Affective Disorder) – 4 to 6 percent; Bipolar – 2.6 percent; Dysthymia (minor depression that lasts 2 years or longer) – 1.5 percent; Psychotic depression (most severe form) – 5 percent.

Are there screening tests for depression?

Yes, there are. Mental health specialists can administer preliminary tests such as the BDI (Beck Depression Inventory), or the HRS (Hamilton Rating Scale), which is composed of 20 questions to screen the patient. Today, computerized phone interviews are gaining effectivity as a screening tool. These tests are only a small part of the evaluation process because the specialists have the symptoms of the patient and other criteria to aid them make the correct diagnosis.

What foods relieve depression?

Foods that are high in tryptophan, an amino acid involved in serotonin production, provide relief to some people with depression. Niacin (Vitamin B3), which is essential in the production of tryptophan, can be found in dried peas, beans, whole grains, dried fortified cereals, and especially in oily fishes like salmon and mackerel. It is reported that Omega-3 polyunsaturated fatty acids in fish oil may actually reduce depression. PMS Escape, a high carbohydrate drink claimed to increase tryptophan levels and would control the depression related to pre-menopausal syndrome, has been found to have impurities by the FDA and subsequently withdrawn from the market. Calcium supplements and Vitamin B-12 have been reported to reduce pre-menstrual depression. Also, some studies showed that there is, among depressed people who drink caffeinated beverages, a lower incidence of suicide, which seems to suggest that coffee or tea reduces depression.

How about exercise?

Believe it or not, physical exercise may be as effective as psychotherapy in the management of mild to moderate depression. Prolonged aerobic workouts lead to higher levels of serotonin, adrenalin, endorphins and dopamine in the brain (producing the popular term “runner’s high”). Physical exercises, brisk walking, ballroom dancing, yoga, tae-bo, etc. lead to better emotional health. As an extra bonus from physical exercise, weight loss and improved muscle tone lead to a sense of well-being and higher self-esteem. Those individuals with strong spiritual faith have a relatively lower predisposition to depression. These people might benefit from meditation, yoga, and other techniques for obtaining spiritual security, inner peace and happiness. Severe depression needs medical treatment.

Does depression play a role in suicide?

Yes, very significantly. Depression is present in about 90 percent of the more than 40,000 suicides that take place in the United States annually, and for every two homicides, there are 3 suicides. Suicide is the 10th leading cause of death in the United States overall and the second leading cause of death in the age group 10 to 34. According to the CDC, 1.3 million adults attempted suicide in 2014. About 78 percent of them are men, more than 4 times the rate for women. Depression lowers the mental threshold for self-destruction.

Did COVID-19 increase suicide rate?

Amazingly the pandemic did not, in spite of fake news in the media. Between 2019 and 2020, suicide deaths in the U.S. were 5.6 percent lower (from 47,511 down to 44,834). This was the third year of consecutive decline. Ideation of suicide was higher during the pandemic but the actual execution is reduced. Everybody around the world is busy trying to stay safe and alive. Indeed, life is precious.

Do you have depression?

If you do, it is most prudent to seek medical help, not necessarily psychotherapy. The first thing to do it to consult your family physician, who can help guide you. With early proper medication and/or advice, depression in most cases can be managed effectively and eliminated faster than one can imagine. Physicians today have invaluable tools in their armamentarium for the diagnosis and treatment of depression. Many individuals with depression, who have sought medical care, are so “cured” with simple oral medications that they look, behave, function and live as normally and happily as anybody else, lost in the sea of anonymity.

To save a life, call the  National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.

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The main objective of this column is to educate and inspire people to live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Public Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian and anti-graft foundation in the United States. Visit our websites: philipSchua.com and FUN8888.com; Email: scalpelpen@gmail.com.

Dr. Philip S. Chua

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States.

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