Read the warning signs

Is your teenager suicidal?

The recent suicide of a 15-year-old actress re-awakened the public’s awareness of the problem of depression in our youth. Just recently, there were four new consultations at my clinic for suicidal attempts by patients in the  age bracket of 10 to 15. 

The World Health Organization (WHO) suicide data (www.who.int) stated that “over 800,000 people die due to suicide every year and there are many more who attempt suicide. Hence, many millions of people are affected or experience suicide bereavement every year. Suicide was the second leading cause of death among 15- to 29-year-olds globally in 2012.”

Based on records from the National Statistics Office (NSO) of the Philippines, the suicide rate from 1984 to 2005 went up from 0.46 to seven out of every 200,000 men. On the other hand, it jumped from 0.24 to two for every 200,000 women. 

Depression can be helped and suicide can be prevented. Let me help you recognize the warning signs of severe depression that leads to suicide. These signs can help save the life of a friend, classmate or relative.

What are the warning signs of suicide in an adolescent?

1. Texting, talking or even joking about wanting to die and committing suicide.

2. Verbalizations like, “Happiness is not forever,” “I’d be better off dead,” “How I wish I could disappear forever to end my woes,” or “There’s no other solution or no other way out.”

3. Writing, blogging, drawing or speaking positively or dramatically about death (“If I’m gone, my parents might love me more.”).

4.  Composing songs or writing stories and poems about death, dying or suicide.

5. Preoccupation with reckless/dangerous activities/sports in unconscious efforts to harm oneself like reckless driving or driving when intoxicated.

6. Donating highly valued possessions.

7. Bidding goodbye verbally, through text or social media message to close friends and relatives as if for the last time.

8. Actively looking out for pointed/sharp objects/weapons, pills, or other ways to kill oneself.

What are the common symptoms of depression in teenagers?

Most often, the depressed adolescent will not manifest with the classical signs of depression. Instead, he or she may manifest with the following symptoms:

1. Irritability or angry mood outbursts.

2. Unexplained bodily aches and somatic pains.

3. Over-sensitivity to criticism leading to learned helplessness and feelings of inadequacy.

4. Social withdrawal or isolation.

What are the possible effects of teenage depression?

1. School problems like absenteeism, poor academic performance and poor attention span. Poor concentration is also exhibited by a previously good student.

2. Running away, acting-out or impulsive behavior.

3. Substance abuse as a way for the teenager to self-medicate.

4. Shattering of self-esteem like feeling of worthlessness.

5. Computer or online addiction as a way of escape from all worries.

6. Disruptive or violent behavior like homicidal rage, especially in bullying victims.

7. Other mental health problems including eating disorder, personality disorder, psychotic disorder and self-injury.

What can you do?

If you suspect that a teenager you know is suicidal, take immediate action! Inform the adolescent’s parents, teacher or person of authority who can urgently access professional help, out-patient psychiatric treatment or possibly hospitalization.

Severely depressed teenagers often give away clues or cries for help by writing, texting or verbalizing their thoughts of wanting to die or making manipulative “attention-getting” attempts at suicide. Don’t glide over such attempts because of the very alarming and rising number of teenage successful suicide attempts.

There may be other factors that aggravate the teenager’s depression like alcohol and drug abuse or the presence of other psychological problems like borderline personality disorder. After encouraging the depressed adolescent to open up, talk to him or her in a tactful and prudent manner. Voice out your concern and desire to help, stressing the immediate need to address the problem.

A mental health professional will assess the severity of the suicidal risk of the teenager and the kind of psychiatric condition that contributes to such repeated suicidal attempts. The doctor will then make the necessary recommendations for treatment.

A combination of psychopharmacotherapy (antidepressants like fluoxetine and escitalopram) with psychotherapy (or cognitive behavior therapy) has been found beneficial. Family therapy will also help family members deal with the stressful situation emphasizing the need to also take care of themselves.

Don’t leave your suicidal teenager alone. Be understanding, encourage him or her to do physical and social activities. And most importantly, make sure to stay involved in the teenager’s therapy sessions like accompanying him or her to the doctor’s clinic.

According to a prior survey of Dr. Aaron Beck, more than 80 percent of depressed persons expressed dislike for themselves. He further stated that when one is depressed, one will feel “The Four Ds” — defeated, defective, deserted and deprived. Cognitive therapy, as first taught by Beck, will help the depressed individual understand and address those factors that contribute to the lowering of self-esteem.

Beck said that to overcome such self-defeating mental habits, three steps are needed:

1. Teach and train oneself to see and jot down the self-critical thoughts that are ruminating in one’s mind.

2. Find out and understand why such disturbing thoughts are distorted.

3. Practice talking and thinking positively to counter such negative thoughts so you can develop a more realistic self-evaluation system.

According to Norm Cohen’s Feeling Worthless and Depression, this method of boosting self-esteem is called “Talk Back to That Internal Critic” by Dr. Beck. Another method of boosting one’s self-esteem according to Beck is “Developing a Mental Biofeedback.” This entails monitoring one’s negative thoughts by setting aside 10 to 15 minutes daily and writing them down. At first, the number of negative thoughts seems to increase because one actually gets better in identifying them. After about a week, one will reach a plateau and after approximately three weeks, the number of negative thoughts will decrease. This indicates that one’s harmful negative ideations are diminishing, a proof that one is on the road to recovery.

Almost all medical centers have psychiatrists among their hospital staff. There are 24/7 hospital personnel who can assess and address this psychiatric emergency. If you live outside Metro Manila, try to access the official website of the Philippine Psychiatric Association Inc. (www.philpsych.ph) to get the name of the psychiatrist in your region.

(For more information, e-mail Philippine Psychiatric Association Inc. at philpsych.org@gmail.com or call 0918-9424864 and 635-9858.)

(For questions on love, looks and relationships, e-mail this author at nina.halilijao@gmail.com. Condolence to the family of Dr. Dante Abcede, former president of the Philippine Psychiatric Association Inc. (PPA) and to the family of Dr. Thelma Santos-Warren, former psychiatrist of the VA Manila Out Patient Clinic for their untimely demise.)