Risk for depression and suicide in servicemen

Risk for depression and suicide in servicemen Depressive Disorder:Â  The Struggle of Our Nation’s Sons Abstract This paper discusses the causes and risk of depressive disorder developing amongst Full-Time National Servicemen and the possible risk of suicide ideation. The predicted outcome was that the cause of depressive disorder developing amongst Full-Time National Servicemen is associated with the influence their upbringing have in relation to how they cope with hardship. Survey result have proved that minor symptoms of depression is developing amongst most of the Full-Time National Servicemen but do not show signs of suicide ideation. In the discussion segment, several psychological theories will explain and validate the reasons to why Full-Time National Servicemen who are facing hardship have developed minor to even severe symptoms of depressive disorder. In conclusion, the causes are associated with the upbringing of an individual and the lack of fulfilment in various needs. Depressive Disorder: The struggle of our nation’s sons Singapore, minuscular yet strong and striving country that has gained recognition amongst the colossal shadow of nations with history dating far beyond what our young nation has. How did a nation so young acquire such stability in less than a century? The answer, ‘Military Force’ and no, it does not just refer to military prowess but also the transition of boys to men. Singaporeans are familiar with the term ‘National Service’, to serve as a Full Time National Servicemen (NSFs) in the Singapore Armed Forces (SAF), Singapore Police Force (SPF) or the Singapore Civil Defence Force (SCDF) for two year service period at the age of eighteen. It is a fearful yet enlightening process for the young sons of the nation, being given the responsibility to serve and protect the nation is no easy feat. As such, they are provided vigorous training that puts their mind and body to the test, pushing them to their limits to promote growth in both physical and mental capabilit y. For most, the process of going through National Service are filled with obstacles surpassing anything they have experienced, having to cope with their physical training, their mental aptitude being tested while juggling responsibilities of their individual roles amongst their friends, family and loved ones. Depressive Disorder has been a serious health problem all around the world; this does not exclude Singapore, as one in 17 people in Singapore having suffered with Major Depressive Disorder at least once in their lifetime. In the recent years, there has been several suicide cases involving Full-Time National Servicemen and with depressive disorder and suicide rates on the rise, extra attention should also be given to our nation’s sons who are going through hardships in order to keep the nation safe. Depressive Disorder In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013), Depressive Disorder is as described: Depression comes in various forms but one common feature is that they share similar features such as presence of sadness, emptiness, irritable mood while having significant cognitive changes that affects a person’s ability to function. The only difference is the duration, timing, and the cause of it. (pp. 155). During the fifty fourth World Health Assembly held by the World Health Organization and the ministers of health, it is stated in the report that depression is in the fourth position amongst the ten leading causes of global burden of disease and is expected to rise to the second place by the year 2020, World Health Organisation (WHO, 2001). This report reflects how common depression is and the seriousness of this mental disorder is not something to be taken lightly, considering that most of the people who commit suicide are also clinically depressed, (WHO, 2001). A study conducted by the Institute of Mental Health (IMH) shows that Major Depressive Disorder emerged as one of the top three mental illnesses along with Alcohol abuse and Obsessive Compulsive Disorder, with one in 17 people in Singapore have suffered from Major Depressive Disorder at some point in their lifetime and majority of it occurred by the age of 29 while most of those who were affected weren’t seeking help, (IMH, 2013). Suicide In a recent statistical report retrieved from the Samaritans of Singapore (SOS) for National suicide rate reflected that in the year 2012, the total suicide rate was at the all-time high rate since 1992, hitting the total of 467 and 298 of them were males, (SOS, 2013). Having more than half of the fatality being males also reflects how vulnerable Full-Time National Servicemen are to suicide ideation and the steadily increasing suicidal rate in Singapore as well as on the global scale. During a Parliament Question and Answer segment in the year 2013, it is reported that a based on a local research study from the year 2000 to 2004 showed that a third of the total suicide population because of relationship problems and another third was associated with financial or employment concerns, (Ministry of Health (MOH) Singapore, 2013) Gender According to research study, based on gender, females are more likely to develop depression as compared to males, in the ratio of two females to one male; the male population has a higher percentile of completing suicide as compared to females. (Kua EH, Mahendran R, Fung D, 2002), Risk Factors Several of the risk factors for depression could be triggered by challenging life events such as relationship issues, financial difficulties, physical illnesses, unemployment, lack of support and loss of loved one, all which can be associated with Abraham Maslow’s Hierarchy of Needs. Maslow’s theory revolves around human motivation and the Hierarchy of Needs is made up of a pyramid that is divided into several segments such as Physiological, Safety, Love/Belonging, Esteem and Self-Actualization needs, (Maslow, 1943). With the lack of fulfilment or rather, a lack of motivation, one could result in a state of depression. Due to the limited case study, literature review and research study of depressive disorder amongst Full-Time National Servicemen in Singapore, the purpose of the research study is to create awareness to the general public about depressive disorder amongst Full-Time National Servicemen as well as identifying the causes amongst the servicemen population. This would then hope to result in a reduced number of suicidal cases amongst our Nation’s sons. I predicted that this research study will be able to validate my assumption that the causes of depression amongst Full-Time National Servicemen is due to the environment they grew up in and their inability to cope with various roles and issues while going through the tough changes in environment during National Service. Full-Time National Servicemen are also not receiving enough attention in regards to mental health care even though they are significantly more vulnerable to developing depressive disorder whilst going through National Service which also relates to the increased risk of possible suicidal cases in the future. Methods Participants There are a total of 16 participants, all whom are male and were either still in their Full-Time National Service period or have recently completed their national service. Design An online survey was conducted using SurveyFace, an online survey tool. The survey is structured in a way that majority of the questions being closed ended, whereas the open ended questions are meant for participants to provide qualitative information in relevance to the question. The link was then shared through online social networking , Facebook. The topic of the survey was omitted to prevent participants from being hesitant towards a potentially sensitive subject such as depression. Procedure Participants consist of netizens, who had met the criteria stated on the survey link volunteered to participate in the survey by clicking the link posted on social networking site, Facebook. There are a total of 14 questions and responses are available as either individual forms or overall summary of responses. The survey takes approximately 10 minutes depending on individuals. Not all answers were required to answer and open ended answers vary in length depending on the participant. Results According to the results, slightly more than half of the participants had their expectation met about how National Service is going to be and majority of the total respondents found that their experience as a Full-Time National Servicemen is positive and beneficial. Results also indicates that more than half of the respondents associate the toughness of National Service with how they were brought while almost half of the respondents found it easier to cope with issues during National Service as compared to life as a civilian. More than two handfuls of respondents had negative past experiences that would manifest itself during times of hardship yet only a handful of the respondent’s issue were recurrent. Based on the Maslow’s Hierarchy of Needs, respondents attributed that the lack Self-Actualization is the leading cause of issues during National Service whereas Love and belonging needs and Esteem needs are tied at second. Based on the results, Majority of the respondents had also indicated to have at least one of the mild symptoms of depression and of the ten, eight also showed moderate symptoms of depression while five of them also have severe symptoms of depression. Results also reflected that majority of the respondents felt that the Singapore Armed Forces should provide more attention to Full-Time National Servicemen’s mental health. Half of the total respondents were provided by the SAF with means to cope with emotional distress while the other half did not. Less than a third of the respondents received mental health state evaluation from their superiors while almost all of the respondents felt that it is recommended that superiors conduct a mental assessment of Full-Time National Servicemen on a daily basis. Discussion According to Freud’s psychoanalytic theory in regards to the causes behind ‘melancholia’ or presently known as clinical depression, is the result of a surplus of pleasure in the society and the state of civilization itself (Freud, 1929). When a state of pleasure is prolonged, it would only produce a feeling of mild contentment, in other words with Singapore being one of the safest country, providing quality living for most, individuals have the tendency to be complacent about how privileged they are. They who grew up having what they want most of their life and not having gone through hardships during their early childhood developmental stage will have a hard time in the future, especially during National Service when one has to leave their comfort zone, experiencing hardships surpassing what most have gone through. For most part of the hypothesis was supported that majority of the Full-Time National Servicemen found that their upbringing contributed to how they perceive National Service and the intensity of the toughness that they experience as well as finding it harder to cope with issues while doing their National Service as compared to as when they were civilians. This could be explained through Bowlby’s Attachment theory which states that one’s early childhood experience has a significant amount of influence on the behaviour and development in the future (Bowlby, 1988) Most of the male population in Singapore have heard of stories about National Service, comparing how tough National Service used to be for the older generation and how blessed the younger generations are because of the vast improvement to the system and facilities. The younger generation are indeed having it easy now, even having the opportunity to bring along smart phones into their respective camps. Superiors are also more humane as compared to the olden days where punishment seemed to have no limits, from kissing the tree to having an endless march into the late night, pushing individuals to their physical and mental limit. Through all the hardships, there will be moments when individuals are put into a depressive state, feeling empty, sad, having irritable mood, accompanied by changes in the thinking process that could influence one’s ability to function. These are all common experience which everyone goes through at some point of their life but most do not know that these are also few of the various symptoms of depressive disorder which are stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (APA, 2013). Because of this reason, people often overlook the severity of early identification of individuals who may be well on the way at developing a full fledge clinical depression. Freud’s concept of overexposure, based on the pleasure principle, can offer one explanation for the prevalence of depression in developed countries. According to this theory, pleasure is, on one hand, omnipresent, and on the other, unattainable, as we have become almost deadened to the experience Problems of daily life does not simply vanish during times of hardship, instead, to those going through National Service, it may seem to blow out of proportion. Not having time to rectify the issues of their life outside of National Service due to the intense trainings, and the freedom of going home daily is something only a few are privileged with. Many NSF are burdened with the responsibility of their various role as an individual, be it as a son, brother, friend, boyfriend or even spouse to others while going through their National Service. With depression on the rise, the increased suicide rate would increase as well. Though there aren’t many recorded cases of suicide amongst National Servicemen, it does not mean that the intentions aren’t there. When an individual has suicidal thought, it only requires a moment of impulse to attempt suicide and in the worst case scenario, it may lead to death. Providing necessary care to individuals who are showing early symptoms o f depression is important as to prevent it from escalating into a more serious condition. Full-Time National Servicemen has also acknowledged that they are not receiving enough mental health concern as compared to physical health due to the lack of systems that look into individuals who may be emotional distress. This could be because as a member of the military force, they would expect soldiers to be able to have the physical capacity that allows them to perform task needed for survival during times of war but due to the intensity of the training, many may have failed to cope with the stress that comes along with it hence resulting in a state of emotional vulnerability. Only a few have stated that buddy systems are introduced during Basic Military Training (BMT) which offers individuals at least a partner to confide in when facing emotional distress but as soon as they get posted into their units, there seem to be a complete lack of system that could offer Full-Time National Servicemen the means to cope with emotional distress such as counselling service, suicide hotline and even the buddy system isn’t implemented. With the lack of such system, Full-Time National Servicemen have a higher risk of having their depressive symptoms overlook and may develop depressive disorder and in the worst case scenario, result in suicidal attempts. Conclusion In conclusion, the overall results has supported my prediction that an individual’s upbringing has significant impact on how they would perceive experiences in the future and their ability to cope with issues were negatively affected during their national service as compared their life as civilians. However, contrary to what I have predicted, results have shown the lack of support in regards to Full-Time National Servicemen having any form of suicide intention or ideation. This may have been because regardless of how tough National Service is to most, they would still regard it as a positive experience and a necessary phase in their life. Depression may still be on the rise and results have also reflected on how common depression is amongst the Full-Time National Servicemen, they do not show sign of suicide ideation which shows that it is still not too late to provide preventive measures in assuring that Full-Time National Servicemen are receiving sufficient attention to their mental health. By implementing a system that seeks to assure that Full-Time National Servicemen are receiving ample attention in regards to their mental health, it could greatly reduce the risk of depressive disorder from developing and would result in the vast improvement in the overall performance by the servicemen protecting our nation. Limitations The research has several limitations. Due to having past experience as a Full-Time National Servicemen, several questions may have contained biasedness and prediction was made with the aid of my past experience. The research study did not include participant’s ethnic group and religion hence losing out precious viewpoints in that aspect as Singapore is a multiracial country. Future Research A personal interview would have provided greater depth in information and may have contributed crucial information which the survey question could not gather. Personal interview would also allow participants to voice out areas of improvement in relevance to the topic that may have been omitted during the progress of study. Implications If there was a system that allowed superiors to conduct a daily check on Full-Time National Servicemen mental condition, it could greatly reduce the risk of depression from developing further and could save many lives just by identifying the individuals with early symptoms and providing them with therapy. Reference American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Bowlby, J. (1988). A Secure Base: Parent-child development and healthy human development. Kua, E.H., Fung, D., Mahendran, R. (n.d.). Mind Matters. Freud, S. (1929). Civilization and its Discontents. Institute of Mental Health. (10 October, 2013). Institute of Mental Health. Retrieved 28 January, 2014, from Institute of Mental Health Web Site: http://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS news release.pdf Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review. Mental Health: A Call for Action by World Health Ministers: Ministerial Round Tables 2001, 54th World Health Assembly. (2001). World Health Organisation. Ministry of Health (MOH) Singapore. (16 September, 2013). Retrieved 29 January, 2014, from Ministry of Health Web site: http://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2013/suicides-in-singapore-.html Samaritans of Singapore. (July, 2013). Retrieved 28 January, 2014, from Samaritans of Singapore Web site: http://www.samaritans.org.sg/National-Statistics.pdf