MGA GABAY: Pagsasagawa ng rebyu ng kaugnay na literatura at pag- aaral (review of related

literature and study) kaugnay ng isyung lokal at nasyonal na napili.

20 REVIEW RELATED LITERATURE

ESTADO NG MENTAL HEALTH SA PILIPINAS

Introduction

Mental health disorders affect a significant portion of the global population and are a public
health concern worldwide; it imposes personal, social, medical, familial and economic burdens
(Heo, Murphy, Fontaine, Bruce, & Alexopoulos, 2008). In 2016, mental health disorders
accounted for 16% of the total global burden of diseases (Rehm, 2019). In a nationally-
representative sample of older adults in six low and middle-income countries, an average of one
in every 13 participants suffered from depression (Lotfaliany et al., 2019). The rates of
depression in the U.S. alone is expected to increase by 117% between 2000 and 2050 (Heo et
al., 2008). Mental health researchers have begun to pay more attention to critical mental health
issues and its impact on the quality of life in different racial and ethnic populations (i.e. Asian-
Americans). However, research to date is largely drawn from high-income countries and
suggests that disadvantaged and marginalized groups have a higher mental health disorder
burden, but there has been a dearth of research studying this relationship within low- and
middle-income countries (Ruan et al., 2018). Likewise, there are few studies examining mental
health disorders, specifically depression, anxiety, and distress, among specific subgroups
including Filipinos living in the U.S. and even less among Filipinos living in their native country.

In 2004, over 4.5 million cases of depression were reported in the Philippines, according to the
Department of Health (DoH-PH, 2007). Reports show that the Philippines has the highest
number of depressed people in Southeast Asia and the National Statistics Office reported that
mental illness is the third most common form of disability in the country (Tomacruz, 2019);
younger individuals were at greater risk for depression (De Guzman, 2018). The total
expenditure on health as a percentage of gross domestic product is 3.78% and the per capita
government expenditure on health is $39.0 (Mental Health Atlas 2011 - Philippines, 2011). A
more recent report by the Global Burden of Disease in 2015 showed that 3.3 million people in
the Philippines lived with depression and an almost equal number of individuals suffered from
anxiety (Reddy, 2016). The numbers are most likely much higher since many who suffer from
depression and anxiety often hesitate to seek help due to the stigma that surrounds mental
disorders (Mental Health Atlas 2011 - Philippines, 2011). Clearly, existing reports on the rates of
depression in the Philippines varies widely from one report to the other. Likewise, the proportion
of the estimated 100 million individuals who suffer from anxiety and distress in rural areas,
especially from lower-income communities living in the Philippines is not well-understood. As
these numbers are anticipated to continue to increase, studies to better understand those at
increased risk for mental health disorders are needed to inform the Philippine government about
the programmatic needs of the service delivery system and highlight the need for assessment,
prevention, and treatment of mental health disorders (Heo et al., 2008).
Mental health has been given very little attention by the Philippine government and public
sectors. Even after the country has recently passed its first Mental Health Act and Universal
Health Care Law, only 5% of the healthcare expenditure is directed toward mental health. Also,
there are only 7.76 hospital beds and 0.41 psychiatrists per 100,000 people (World Health
Organization—Assessment Instrument for Mental Health Systems, 2007; Department of Health,
2018). This ratio was known to be lower than other Western Pacific countries with similar
economic statuses, like Malaysia and Indonesia (Lally et al., 2019). The Philippine government
does not even provide economic support for organizations that have been involved in the
formulation and implementation of mental health policies and legislation (World Health
Organization—Assessment Instrument for Mental Health Systems, 2007). Consequently, mental
illness has become the third most common disability in the Philippines, wherein six million
Filipinos live with depression and anxiety. Because of this, the country has the third highest rate
of mental disorders in the Western Pacific (Martinez et al., 2020). Also, the Philippine World
Health Organization (WHO) Special Initiative for Mental Health conducted in 2020 showed that
≥3.6 million Filipinos suffer from at least one kind of mental, neurological, or substance use
disorder (Department of Health, 2020). Suicide rates are reported to be at 3.2 per 100,000
population with higher rates among males (4.3/100,000) than females (2.0/100,000). However,
these numbers may be underreported because suicide cases may sometimes be misclassified
as “undetermined deaths” (Lally et al., 2019; Martinez et al., 2020). The WHO estimated that
154 million Filipinos suffer from depression, 1 million from schizophrenia, and 15.3 million
substance use disorders, while 877,000 die due to suicide every year (Department of Health,
2018). Thus, mental disorders could greatly affect employment and levels of education, most
especially in ages 25 to 52 years (Hakulinen et al., 2019). It was found in a study by Hakulinen
et al. (2020) that individuals with a severe mental disorder had notably lower levels of
employment before, and more especially after, the diagnosis of their disorder. Their overall
incomes came primarily from transfer payments, and the most affected were those diagnosed
with schizophrenia. After receiving a mental disorder diagnosis, more than half of these
individuals received no employment earnings.

Depression

The study provides no evidence of a significant difference between the pretest and posttest
means for depression, anxiety, and stress among college students after the online health and
well-being program. However, the depression, anxiety, and stress scales (DASS-21) findings
served as the basis for screening depression, anxiety, and stress among the participants that
might need immediate clinical intervention and referral.

Villarino, R. T. H. (2023). Effects of online health and well-being program on college students'
depression, anxiety, and stress mean scores: Pre-Post stude design. NRCP Research Journal,
vol. 22, no. 1.
[Link]

Descriptive analysis revealed that parents are frequent source of problems for first year college
students. Of the 393 participants in the study, one hundred twelve (112) or almost thirty percent
(30%) of the first year college students who participated in the study are suffering from
“borderline” to “extreme” levels of depression. Moreover, it was found that almost half (186 or
47%) of the respondents perceived that they cannot count on adults (e.g., teachers, guidance
counselors, school administrators) at their school for emotional support.

Go-monilla, M. J. A. (2015). Personal problems and depression among college students and
their perceptions of school social support. UE Research Bulletin, vol. 17, no. 1.
[Link]

According to the findings, 40% of respondents are easily stressed which shows that people are
triggered by the things that are happening in their lives. For some reasons, being under a lot of
pressure, especially when facing big challenges in life. On the basis of the results gathered,
after losing something, the majority of respondents experienced despair.

Tan, A.J. (2022). Understanding depression and determining its causing factors among male
grade 12 senior high school students in a private school in Manila, Philippines. International
Journal of Academic and Practical Research, vol. 1, no. 1.
[Link]

According to the results of the Mental Health of the Participants survey, the majority of the
participants reported really severe anxiety symptoms as a result of the pandemic. Furthermore,
the individuals are under a great deal of stress, and the majority of them, according to the
DASS-21, exhibit quite severe depression symptoms. The quality of life and mental health of the
participants are highly connected with their age, gender, year level, and family socioeconomic
situation.

Suni, K. A., Diola, D., Ballesteros, B., Distor, J. M. (2022). A correlational study: Quality of life
and mental health of psychology students amidst the pandemic. Psychology and Education: A
Multidisciplinary Journal, vol. 4, no. 2.
[Link]

Anxiety disorders - Jairah

According to the Filipino Doctor, Anxiety is a normal human emotion that everyone experiences
at times. Many people feel anxious, or nervous, when faced with a problem at work, before
taking a test, or making an important decision. Anxiety disorders, however, are different. They
can cause such distress that it interferes with a person's ability to lead a normal life.

An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear
are constant and overwhelming, and can be crippling.

Types of anxiety disorders:

Panic disorder. People with this condition have feelings of terror that strike suddenly and
repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain,
palpitations (irregular heartbeats), and a feeling of choking, which may make the person feel like
he or she is having a heart attack or "going crazy."
Obsessive-compulsive disorder (OCD). People with OCD are plagued by constant thoughts or
fears that cause them to perform certain rituals or routines. The disturbing thoughts are called
obsessions, and the rituals are called compulsions. An example is a person with an
unreasonable fear of germs who constantly washes his or her hands.
Post-traumatic stress disorder (PTSD). A condition that can develop following a traumatic and/or
terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a
natural disaster. People with PTSD often have lasting and frightening thoughts and memories of
the event and tend to be emotionally numb.
Social anxiety disorder or social phobia. Involves overwhelming worry and self-consciousness
about everyday social situations. The worry often centers on a fear of being judged by others, or
behaving in a way that might cause embarrassment or lead to ridicule.
Specific phobias. An intense fear of a specific object or situation, such as snakes, heights, or
flying. The level of fear is usually inappropriate to the situation and may cause the person to
avoid common, everyday situations.
Generalized anxiety disorder. Involves excessive, unrealistic worry and tension, even if there is
little or nothing to provoke the anxiety.

Treatment and Management

Treatment options for anxiety disorders:

Psychotropic drugs which include antidepressants, antipsychotics, and anxiolytic

Sedative/hypnotics like barbiturates, benzodiazepines, and phenothiazines
Health care providers that are trained to identify the presence of a mental disorder:

Primary care physician: Doctors are primarily skilled in medical health care but do have some
training in treating mental or psychiatric problems. Physicians will recommend specialized care
for patients with more than mild symptoms of a mental illness.
Psychiatrist: These are medical doctors (MDs) who specialize in the diagnosis and treatment of
mental or psychiatric illnesses. Psychiatrists are licensed to prescribe drugs as part of their
treatment regimen and are also trained in psychotherapy, a form of "talking" therapy.
Psychologist: These are experts in psychology and are trained in counseling, psychotherapy,
and psychological testing. Psychologists are not licensed to prescribe drugs to treat mental
illnesses.
Social worker: These are specialists who often work to assist underprivileged and maladjusted
people. Social workers are trained to recognize mental illness and conduct psychotherapy.
Psychiatric nurse specialists: These are registered nurses who are educated in psychiatric
nursing and specialize in treating mental or psychiatric illnesses.

[Link]

According to Department of Health, The condition known as generalized anxiety disorder (GAD)
causes fear, concern, and a persistent sense of being overwhelmed. It is also described as
ongoing, excessive, and irrational concern over ordinary issues. As such, excessive worry is a
central feature of GAD.
Cause

It affects around one in four teenagers between the ages of 13 and 18 and is twice as common
in women as it is in men. GAD often first manifests around the age of 30. Finally, risk factors for
generalized anxiety include being female, being single, having poor health, and having low
levels of education.
Stress, medical conditions, genetics, environmental factors, and substance abuse are the
causes of developing GAD. Additionally, experts have found the involvement of the limbic
system, an area of the brain that plays a role in our behavioral and emotional responses.

Signs And Symptoms

GAD patients usually present nonspecific reasons for shortness of breath, palpitations, fatigue,
headache, dizziness, and restlessness. Symptoms can also include excessive, nonspecific
anxiety and worry, unsteady emotions, difficulty concentrating, and insomnia.

Management (Diagnostic, Treatment, Other Care)

Physicians use the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V),
to diagnose patients with GAD. A patient must have the following core symptoms:

Excessive anxiety and worry for at least six months;

and difficulty controlling the worrying.
Additionally, three or more of the following associated symptoms:

 Restlessness, feeling keyed up or on edge;

 Being easily fatigued;
 Difficulty in concentrating or mind going blank, irritability;
 Muscle tension;
 Sleep disturbance;
 Irritability.
 Additionally, anxiety results in significant distress or problems at work or in the
community. It is not attributable to any physical cause.

Doctors may also perform other tests such as thyroid function tests, blood glucose levels, and
ECG to exclude other causes.

Treatment

There are two main treatments for GAD, cognitive-based therapy (CBT) and medications.
Usually, a combination of both treatments is required for the management to work. Cognitive-
based therapy includes mental health education, changing maladaptive thought patterns, and
gradual exposure to anxiety-provoking situations. The goal of this approach is to increase
anxiety tolerance instead of elimination.
On the other hand, possible medications to be given include antidepressants such as selective
serotonin reuptake inhibitors, antipsychotics, benzodiazepines, and buspirone.

What You Can Do (Prevention and Control)

Anxiety is unpreventable, but medication compliance primarily helps control the symptoms.
Additionally, working with a therapist is vital since relapse is common in these cases.
Furthermore, many drugs that treat GAD commonly have side effects. Thus, it is necessary to
discuss these side effects with your doctor. They can adjust your medication or plan a better
treatment strategy to help you stay with your medicine.

Understanding the Types of Anxiety Disorders

Psychiatric and mental disorders are often misunderstood. Until a few decades ago, most
psychiatric disorders were either left undetected or misdiagnosed. However, science and social
progress has paved the way for us to better define these disorders, including anxiety disorder
symptoms to watch out for.

Despite this, certain terms to denote certain disorders can still be confused.

That is the case for anxiety disorders. Anxiety, on one hand, is how we refer to the emotion of
unease or worry that comes with the uncertainty of situations.

‘Anxiety disorder’ is a blanket term for psychiatric disorders that come with a persistent feeling
of anxiety. Ahead, we’ll discuss how to differentiate anxiety from anxiety disorders. This includes
how to tell at what point it may be a disorder, the different kinds of disorders, and anxiety
disorder symptoms to watch out for.

Differentiating Anxiety Disorders and Anxiety

Anxiety, as a feeling or emotion, is normal to have occasionally. After all, a healthy mind will
worry about the bills, or the future, or relationships, or other important life events. What sets the
feeling apart from the disorder is how rational or reasonable this worry becomes.

Here are some of the key differences of anxiety and anxiety disorders:

Anxiety may involve, for instance, worrying about getting a response you’ve been waiting for.
While anxiety disorders can involve constantly worrying about nothing but one’s own thoughts to
the point that it impacts daily interactions.
Anxiety can also mean being embarrassed when you’re thrust into an awkward situation in front
of strangers. Anxiety disorders can involve being so afraid of potential humiliation that you avoid
getting into social situations, to begin with.
Being nervous or even panicking about a big test or presentation is an example of anxiety.
While having sudden panic attacks or being so preoccupied with worrying about the next
presentation can mean you have an anxiety disorder.

When Is It A disorder?

So then, at what point could anxiety be a sign of having an anxiety disorder?

Identifying anxiety disorder symptoms to watch out for involve:

Monitoring the brevity of your emotions. When feeling anxious is irrational and overwhelming or
even debilitating, this may be a good sign to approach a mental health expert.
Noting how an anxiety disorder may cause persistent and uncontrollable dread of everyday or
regular situations to the extent that it may be disabling you or interfering with your daily
activities.

If you are on the fence about going to a mental health expert or support group, it may be helpful
for you to approach a counselor or social worker, or even a well-informed and trusted friend to
be able to get some outside perspective on how you’re feeling.

Kinds of Anxiety Disorders

Since anxiety disorder is a blanket term, it includes many different subcategories:

General Anxiety Disorders involve only the excessive, irrational fear of future situations,
regardless of how high or how low the stakes are. These can manifest through negative
behavior that could lead to emotional and social consequences.
Obsessive-Compulsive and Related Disorders are characterized by persistent and intrusive
thoughts, or obsessions, that trigger compulsive behavior done to a very repetitive extent. This
compulsive behavior often momentarily alleviates the anxiety associated with these intrusive
thoughts.
Stimuli-Triggered Disorders (trauma, stressor-related anxiety) is an anxiety that is brought about
by specific things. These things could be previous trauma or current overwhelming stressors;
hence trauma- and stressor-related disorders fall under this.

 Specific Anxiety Disorders

 Specific phobias
 Social anxiety disorder
 Post-traumatic stress disorder
 Panic disorder

The Types of Specific Anxiety Disorders

Specific phobias

A specific phobia is having a persistent fear that is disproportionate to the actual danger that
whatever it is you fear could bring.

The presence or even just the anticipation of what you fear triggers the anxiety. Adults often
recognize that this fear is unreasonable although uncontrollable.

Social Anxiety Disorder

Social anxiety disorder is a debilitating fear of social situations due to the potential of
embarrassment or humiliation. If this fear carries on for six months, it may be best to consult an
expert.

Post-Traumatic Stress Disorder or PTSD

This is the most well-known among the anxiety disorders. In this condition, previous trauma like
loss or violence in the past, brings about the anxiety disorder. Acute stress disorder and
adjustment disorder are both variants of PTSD

Panic Disorder

This involves going through spontaneous and out-of-the-blue panic symptoms along with the
debilitating worry of having another one in the future.

Other specific anxiety disorders are separation anxiety, agoraphobia, selective mutism, or
substance-induced disorders.

Possible Physical Symptoms

Besides knowing how to delineate anxiety and anxiety disorder, there are physical symptoms
also.

Anxiety disorders come with chronic life stress because these stressors, regardless of how
irrational, still make our body go through the same process as rational stress.

Stressors stimulate the stress hormone system and the cardiovascular system because of the
fear and anxiety, this then turns anxiety disorders into a cause of constant increased activity.
Anxiety symptoms to watch out for include:

 rapid breathing
 increased heart rate
 weakness
 lethargy
 restlessness
 tension
 fatigue
 insomnia
 gastrointestinal issues
 sweating
 trembling

Under normal conditions, chronic stress levels are low, and whenever a threat is present, the
body releases hormones as a response.

The autonomic nervous system is responsible for the release of cortisol that increases the sugar
level in the bloodstream to allow the body to act based on just the fight or flight response.

However, if this occurs regularly and these biological responses are triggered excessively,
possible complications with the immune and cardiovascular systems could arise and someone
would be more at risk for these diseases.

Mental illness stigma in the Philippines is still rampant. But in recent years, there has been a
steady progression towards real, lasting change.

Slowly, the culture of prejudice against those diagnosed with mental disorders is shifting
towards acceptance and understanding.

We see this in how more spaces are opening up in Filipino society for healthy dialogue. Each
story is slowly reversing this sense of shame and pushing the conversation forward.

Recent legislation further supports these long overdue changes. In 2018, after almost 20 years
in Congress, the Mental Health Bill (Republic Act No. 11036) was signed into law. This affirms
mental health as a basic human right in the Philippines.

[Link]

(John Jamir Benzon R. Aruta, Renzo R. Guinto, 2022) The concept of climate anxiety, or the
psychological distress attributed to the climate crisis, has emerged in recent years. However,
there is a lack of consensus on its definition. Some scholars characterize climate anxiety
similarly with the affective, physical, and behavioral symptoms of anxiety disorders [1], while
others conceptualize climate anxiety as extreme worrying which includes a wide range of
emotions about climate change (e.g., anger, depression, hopelessness, frustration, etc.) [2].
Although often perceived as a negative psychological response to climate change [3], [4], [5],
climate anxiety can also be viewed as an adaptive psychological response to the actual threat
posed by the climate crisis. Meanwhile, eco-anxiety, a related term, tends to pertain to a wider
range of environmental problems such as deforestation and pollution [6]. Some argue that
climate anxiety and eco-anxiety can be used interchangeably since most environmental
problems are driven by and are contributing to climate change. From this point onward, we will
use the term climate anxiety when referring to eco-anxiety and climate anxiety.

Climate anxiety in the Philippine context

Climate anxiety has been mostly described in Western studies. For example, increasing climate
anxiety was found among Canadians after the 2021 Western North American heat dome [7].
Given that emotions are culture-bound [8] and climate-induced calamities do vary in different
places, there is a reason to believe that people can have a unique experience of climate
anxiety, especially those in the Global South or non-Western settings. Being known as one of
the countries that is most at-risk of climate change [9], the Philippines faces at least 20
typhoons every year (with some being categorized as super typhoons), which destroy houses,
ruin livelihoods, displace thousands and kill hundreds of people [10]. At least 25% of the country
experienced extreme droughts in the past decade, which increased to more than 40% in recent
years [11]. Early evidence is showing that Filipino youth experience climate anxiety (i.e.,
intrusive worrying, fear, and behavioral impairment) [4,5]. A recent global survey revealed that
the Philippines has the greatest number of young people experiencing high levels of climate
anxiety and other negative emotions (e.g., anger, hopelessness, frustration, etc.) associated
with the climate crisis [2]. However, the common measurement tools used in assessing climate
anxiety among Filipino youth are Western-based. For example, the Climate Change Anxiety
Scale [3], which was used to measure climate anxiety in Filipino youth [4,5] was developed by
and for individuals residing in the United States [3]. While Western-based anxiety measures can
be useful tools in assessing climate anxiety beyond Western countries, they can only partially
capture the experience of climate anxiety of people in the Global South, posing validity and
utility concerns. Interrogating climate anxiety through the lens of non-Western contexts is also
aligned with the global movement towards ‘decolonizing’ psychiatry and mental health [12

Moreover, the aforementioned studies on climate anxiety in the Philippines mainly studied
young people – little is known about anxiety and climate concerns of adult populations. Filipino
adults have generally low climate change awareness [13], which may influence the extent to
which they may be experiencing climate anxiety. Lower perception of climate change in Filipino
adults (but not in young Filipinos) may be explained by their traditional ways of thinking.
Filipinos often externalize their attribution of extreme weather events (e.g., “Natural disasters
are challenges given by God to strengthen me”), a reflection of deeply ingrained religious and
cultural beliefs. There may be an intergenerational difference between adults (who are from the
generation that created the climate crisis and have fewer number of years to be affected by it)
and young people (who contributed the least to the crisis and will inherit and suffer from it in the
decades to come). Geographic differences in climate anxiety may also exist as the climate
change events faced by Filipinos across regions differ due to the varying types, intensity, and
perceived consequences of the climate hazards that they experience. Filipinos in disaster-prone
regions reported greater levels of climate change awareness and engagement in adaptation [13]
– this could provide information on potential geographical variations in climate anxiety. Filipinos
residing in small low-lying islands, which may already be experiencing inundation due to sea-
level rise, might be experiencing climate anxiety differently compared with those who live in
farming communities hit by drought, typhoon-prone areas, or cities often affected by intense
flooding.

Indeed, understanding climate anxiety requires a more nuanced appreciation of the unique
context in which climate change consequences are experienced. Doing so is necessary for
creating and implementing context-specific psychological, educational, and societal policies and
interventions.

Pathways that may explain climate anxiety among Filipinos

Given our knowledge of and experience in the Philippines as well as emerging early literature,
we propose several pathways, which include: (1) direct and indirect experience of extreme
weather events; (2) slow onset events; (3) education and awareness about climate change; and
(4) awareness of insufficient global and local climate action, that may explain the production of
climate anxiety in the Philippine context. First, direct and indirect experiences of extreme
weather events can explain potential climate anxiety in Filipinos. Evidence from the field of
psychology points out that people's perception of climate change is influenced, partly, by
psychological distance (i.e., a cognitive bias leading to perceive threats and events as abstract,
less likely to happen to self, today, and in one's community) [14]. Substantial evidence shows
that direct experience of extreme weather events can make the psychological distance of
climate change more concrete and less abstract, hence influencing people to perceive climate
change as psychologically proximal [15]. The numerous typhoons hitting the Philippines every
year may trigger a proximal perception of climate change. Based on the Philippines’ average life
expectancy, a Filipino citizen may experience more than 1000 typhoons within one's lifetime.
Since climate change is anticipated to drive an increase in the frequency and severity of these
typhoons in the coming years, awareness of this reality could cause climate anxiety. Indirect
exposure to extreme weather events through social media and other outlets could also trigger
emotional responses to climate change [16]. The knowledge that extreme weather events also
affect their families, relatives, and friends may trigger prolonged and repetitive anxiety. Available
evidence on the mental health outcomes of survivors of extreme weather events in the
Philippines revealed increased depression, anxiety, and post-traumatic symptoms [17,18].
However, there are no available studies that examined climate anxiety as a psychological
response of Filipinos from extreme weather events. This area of research needs further
investigation.

Second, because huge attention is given to extreme weather events (as they are visual and
dramatic), slow-onset events such as sea-level rise, increasing temperature, ocean acidification,
land and forest degradation, and loss of biodiversity, among others, and their direct and indirect
effects on mental health are often unnoticed. Witnessing slow-onset events such as sea-level
rise and droughts could directly cause climate anxiety. Indirect effects of these climate change-
have had negative impacts on Filipinos’ livelihoods and food insecurity [19], [20], [21], which
may result to uncertainty leading to emotional distress including climate anxiety. As a tropical
archipelagic country with more than 7100 islands, sea-level rise has already become noticeable,
especially in small island communities, leading to continuous community displacement and
relocation [22], which is associated with mental health problems [17]. As slow-onset events now
begin to manifest, there is a need for scientific investigation on their psychological outcomes,
specifically on whether or how such events are associated with climate anxiety in Filipinos.

Recommendations for understanding and addressing climate anxiety in the Philippines

We offer several insights and recommendations that may help in advancing our understanding
of climate anxiety as well as in creating policies that motivate climate action and address the
psychological impacts of climate anxiety among the Filipino public. As part of an emerging
research agenda addressing climate change and mental health in the Philippines [28], there is a
need for more targeted research that aims to understand when, how, and to what extent
Filipinos experience climate anxiety symptoms. Research that seeks to understand when
climate anxiety becomes adaptive (i.e., inspires climate action) or maladaptive (i.e., excessive
anxiety that paralyzes people from taking climate actions) is imperative. Doing so would allow
the development of contextualized educational and climate communication programs that can
translate climate anxiety into climate action in Filipinos. Additionally, determining when climate
anxiety can be maladaptive would help mental health professionals to identify individuals who
might need psychological support as they try to understand their emotional reactions to the
changing climate. As evidence shows that proximity to the coast increases people's belief in
climate change [29] and Filipinos in disaster-prone areas suffer from negative mental health
outcomes [17,18], it is critical as well to determine which populations are most vulnerable to
climate anxiety and other psychological consequences of climate-related events.

The study of climate anxiety in the Philippines requires shifting from a purely clinical (psychiatry)
approach to mental health towards a broader transdisciplinary approach that can provide a
holistic view of how climate anxiety is linked to physical and psychological health and Filipinos’
engagement in sustainable behaviors. Furthermore, there is a necessity to shift from pure
disaster psychology framing of the climate-mental health nexus towards a broader
environmental and climate psychology perspective. Such a shift would allow for a more
integrated view of the etiology of climate change-induced mental health problems and more
contextualized interventions that recognize the role of the changing climate in people's mental
health.

1.
2. [Link]

1.

3. Addiction - umy
In total, 272 PWUD and 402 comparison participants were recruited. Most
PWUD were current drug users (53%), primarily of methamphetamine
(70%). Among PWUD, the prevalence of moderate to severe psychological
distress was 70%, and probable PTSD was 28%—both rates higher than
those among the comparison group. All four QOL domain scores (physical,
psychological, social, and environmental) of PWUD were lower than those of
the comparison group. Multivariable regressions showed that psychological
distress, current drug use, selling drugs, experiencing discrimination, and
 being never-married were associated with lower QOL. Higher individual
income, household resources, social activity participation, and service use
for drug use problems were associated with higher QOL among PWUD.
Stratified and interaction analyses revealed that the QOL of PWUD was
more sensitive to changes in individual income relative to the QOL of
comparison group.

Yamada C, Tsutsumi A, Izutsu T, Tuliao MTR, Matsuo H, Tanaka E. 2021. Quality of life among
people who use drugs living in poor urban communities in the Philippines. International Journal
of Drug Policy. 93:103160. doi:10.1016/[Link].2021.103160.
[Link]

The result shows that the female has a higher level of class performance than the male.
This means that girls are attentive and participative in online classes than the boys. It
also tells us that there is a significant difference in the level of
class performance of the senior high school students when grouped according to
gender.

Farillon LMF, Farillon KSF, Farillon EF. 2022. Computer games addiction and class performance of
selected Philippine senior high school students. Utamax. 4(3):186–201. doi:10.31849/utamax.v4i3.10292.
[Link]

This study employed a quantitative approach to determine a possible correlation

between mobile game addiction and cyberbullying with student academic performance.
A total of eighty-five (85) respondents from National University - Philippines answered
two questioPnnaires through Google Forms, namely, the Game Addiction Questionnaire
and Cyberbullying Questionnaire. Convenience Sampling was used to gather the
respondents of the two surveys. Both cyberbullying and mobile game addiction
(constructs) were neglected as causal factors for the students' academic performance.
However, it can be concluded that those who have been a victim of cyberbullying are
most likely to perpetrate or initiate cyberbullying.

Exploring Mobile Game Addiction, Cyberbullying, and its Effects on Academic Performance
among Tertiary Students in one University in the Philippines. 2018b Oct 1. IEEE Conference
Publication | IEEE Xplore. [Link]

4. Eating Disorders - Keizzel

The Impact of Natural Disasters on Violence, Mental Health, Food Insecurity, and
Stunting in the Philippines: Findings from the Longitudinal Cohort Study on the Filipino
Child
[Link]
We found that experiencing natural disasters, as measured by neighbourhood reports, was
associated with higher levels of family violence in the previous 12 months, parenting stress,
children witnessing physical violence, physical abuse of children, stunting in children, and
greater food insecurity. Associations with natural disasters measured using EM-DAT data
showed a similar pattern: exposure to greater numbers of natural disasters was associated with
higher levels of family violence, physical abuse of children, stunting in children, and food
insecurity. (Judith et al., 2020)

The Influence of Social Media Affinity on Eating Attitudes and Body Dissatisfaction in
Philippine Adolescents
[Link]

An unhealthy diet is a significant health-threatening risk factor, especially for adolescents, who
are in a period of rapid physical growth. In this study, 89.5% of the participants showed a high
risk of developing eating disorders. It is well known that negative eating attitudes can lead to
dietary disorders. In the study of Chang et al. [24], one-fourth of students responded that they
had negative eating attitudes that required professional attention, such as fasting or using diet
products during the past year. Therefore, education is urgently needed to promote healthy
eating attitudes in adolescents.

Eating attitudes in high school students in the Philippines

[Link]

Given the increasing literature on eating disorders worldwide, although it limits the
generalizability, the same phenomenon can also happen in the Philippines, since it is exposed
to different traditions (Lorenzo, Lavori, & Lock, 2002).

The results indicate the presence of abnormal eating attitudes among Filipino high school
students from Pasig Catholic College, which suggests that further study of eating disorders and
their associated risks is warranted.

A comparison of disordered eating attitudes and behaviors among Filipino and American
college students
[Link]

Filipino students were 10.9 times (p-value <0.0001) more likely to have eating disordered
attitudes and behaviors than their American counterparts controlling for the demographics
collected. This relationship remained significant when regression models were done for each
gender separately. In addition, married students and more specifically married female students
were more likely to have eating disordered attitudes and behaviors than single students or
single females.

Arguments are made as to why higher levels of eating disordered attitudes and behaviors are
observed among Filipino college students. These results provide important information about
the levels of eating disordered attitudes and behaviors in the Philippines and may be useful for
developing future education programs.

5. Traumas (Post traumatic stress disorders) -

The study of (Guevarra et al., 2021), presented insights from VHCs from the Philippines
that mong the reasons for delay or refusal of childhood vaccinations, a fear of side
effects emerged as the most salient concern, exacerbated by previous negative
experiences (including trauma) from a dengue vaccine controversy in 2017.
Respondents cited the dengue vaccine controversy as they expressed reluctance
(regarding any new vaccines) and suspicion (towards school-based vaccination, the
distribution channel used for the dengue vaccine). Heads of households opposing
vaccines, perceptions that vaccines are non-essential and influences from the social and
traditional media or neighbors contributed to further refusal and delay. Upon probing,
VHCs recounted health system concerns particularly with regards to healthcare workers
who are sometimes unable to answer their questions and can be dismissive or
disrespectful regarding caregivers’ concerns.

Landicho-Guevarra, J., Reñosa, M. D. C., Wachinger, J., Endoma, V., Aligato, M. F.,
Bravo, T. A., ... & McMahon, S. A. (2021). Scared, powerless, insulted and
embarrassed: hesitancy towards vaccines among caregivers in Cavite Province, the
Philippines. BMJ global health, 6(9), e006529.

A high number of participants had been bereaved due to a DRK (9.8%), had directly
witnessed a DRK (13.1%), and had been exposed to media reports on DRKs on a
daily/weekly basis (51.3%). Bereavement and direct witnessing were reported more by
those with current drug use (22.4% and 23.7%), compared to those without history of
drug use (6.2% and 10.5%). Bereaved participants were more likely to experience
severe mental distress (adjusted odds ratio [AOR]= 3.69, p=. 01). Those who had
witnessed a DRK were more likely to experience moderate mental distress (AOR= 1.87,
p=. 04) and probable posttraumatic stress disorder (AOR= 1.88, p<. 001). Those
exposed to media reports on DRKs on a daily/weekly basis were more likely to
experience moderate mental distress (AOR= 5.10, p=. 04). The findings highlight the
negative ramifications of DRKs on the mental health of exposed parties and the
importance of connecting those affected with mental health services.

Yamada, C., Tsutsumi, A., Izutsu, T., & Matsuo, H. (2023). Exposure to drug-related
killings and its psychological consequences in the Philippines. Traumatology, 29(2), 202.

The study results revealed that the majority of the learners’ state that resiliency is a type
of adaptability wherein they were able to adapt to the changes in their surroundings, on
how they can stand regardless of what they have encountered, they were able to
 overcome it and that made them a resilient person. The researchers conducted an
interview wherein most of their informants’ state that the fear and trauma they got from
experiencing a tornado affects their lives. It can hinder someone from achieving their
goals, they fear something they want to try because most of them state that it might
happen again, it might cause them danger again, and they overthink just a wind that they
think, another tornado will come again. When it comes to the effects of experiencing a
tornado, most of them stated that they got scared and traumatized. Despite all the
negative effects, tornados changed their perspective on life. It also recommended that
parents and teachers provide comfort, counseling, and monitoring of learners' behavior.

Banal, A. L. (2022). Students’ Resiliency towards Experiencing Tornado. International

Journal of Multidisciplinary: Applied Business and Education Research, 3(12), 2485-
2490.

This qualitative study results revealed that participants currently integrate visual arts,
music, dance, and drama interventions in psychotherapy with children who have
experienced trauma in the Philippines. Qualitative analysis of the data indicated the
following main positive effects: facilitating expression of feelings, relaxing clients,
building therapeutic relationships, building self-esteem, and supporting psychoeducation.
Several themes emerged related to the integration of faith and spirituality with
expressive arts interventions and the implementation of such interventions within the
context of community. Results from this qualitative study support the integration of
expressive arts interventions in psychotherapy with children who have experienced
trauma in the Philippines, with several cultural considerations provided.

Au, E. W. (2022). Expressive Arts in Psychotherapy with Children Who Have

Experienced Trauma in the Philippines: A Qualitative Study (Doctoral dissertation, Azusa
Pacific University).

6. Schizophrenia Disorders - joshua

In early 2020, the World Health Organization (WHO) Special Initiative for Mental Health
in the Philippines recorded at least 3.6 million Filipinos suffering from a mental,
neurological, or substance abuse disorder.1 In 2015, schizophrenia was the top mental
disorder in the Philippines,2 and it is estimated that 1 million Filipinos (1% of the
population) suffer from schizophrenia. Schizophrenia, a debilitating mental health
condition, is characterized by both positive (e.g., hallucinations, delusions, confused
thoughts, etc.) and negative (e.g., lack of pleasure, flattening, withdrawal, etc.)
symptoms.
 Matalam, & Hembra. (2022, December 15). Community-based Mental Health Project in
Davao Region. spmcjournal. Retrieved December 1, 2023, from
[Link]

The study was based on records culled from the new Philippine Health Information
System on mental health (PHIS-MH), comprising information from 2,562 patients who
consulted 14 participating public and private hospitals from May 8, 2014, to May 6 this
year. Of the 9,066 patient records collected, 4,122 were encoded and of this number
2,562 were uploaded into the system. The rest were still wary about sharing their
records in the system, according to Amarillo. “Even with this initial data, we should be
able to come up with a figure that will be useful for our country,” she said. Elaborating on
key findings, Dr. Tomas Bautista said that of the more than 2,500 patients who consulted
the participating health facilities, 42 percent were living with schizophrenia, a type of
psychotic disorder that can be disabling when left untreated. Majority of them were men
aged 20 to 44.

Uy. (2015, June 8). Schizophrenia Top Mental Disorder Afflicting Filipinos Who Seek
Help, Says Study. Inquirer net. Retrieved December 1, 2023, from
[Link]
filipinos-who-seek-help-says-study

In our country among the patients with schizophrenia, males have a greater risk of
experiencing prominent negative symptoms, while females display more affective
symptoms, including depression, impulsivity, emotional instability, sexual misconduct
and sexual delusions. (Leger, M., & Neill, J. C. (2016). A systematic review comparing
sex differences in cognitive function in schizophrenia and in rodent models for
schizophrenia, implications for improved therapeutic strategies.

C. Reyes. (2023, August 29). The Statistics of People With Schizophrenia in the
Philippines. Freedom of Information. Retrieved December 1, 2023, from
[Link]
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