SINGAPORE -- Every year, clinical psychologist Carol Balhetchet sees numerous patients in their teens or early 20s come through her Singapore office. Many suffer from depression, anorexia and other conditions; some have attempted suicide before consulting her.
Balhetchet's more than 20 years of experience have taught her that most cases stem from stress, and she thinks this factor is even more acute for today's young generations than it was in the past.
"There's academic stress, achievement stress, future job stress, and even [choosing] which university they go to is stressful," she said. "In today's society, very fast technology and very high financial economic progress -- that puts stress on our population. When it puts stress on the parents and family, then it in turn puts stress on our children, who are expected to succeed."
Data released in the city-state in July suggests the pressure is indeed mounting. A total of 397 people took their own lives in 2018, up 10% on the year, according to suicide prevention agency Samaritans of Singapore. Boys between the ages of 10 and 19 were particularly at risk, with 19 cases reported -- up from seven in 2017 and the highest number since 1991. "The prevalence of suicide mortality among youths and males is a significant societal concern," the agency said.
Youth suicide is not only a Singaporean problem but a regional one. Other countries, such as Japan, are also logging alarmingly high figures. There are no easy explanations, but experts say that as families have fewer children, each one feels more responsibility to be a high achiever. Constant exposure to social media may be difficult to cope with as well.
Globally, the World Health Organization says suicide was the second leading cause of death among 15- to 29-year-olds in 2016. That year, about 60,000 boys and girls between the ages of 10 and 19 died by suicide, out of around 800,000 cases across all age groups.
"The relentless pursuit of perfection in today's society exposes our teens to different stressors faced by generations before them," Wong Lai Chun, Samaritans of Singapore's senior assistant director, told the Nikkei Asian Review. "With the pressure to achieve and meet higher expectations, some may choose to put on a facade that they are coping well to avoid being viewed as weak."
Japan faces rising youth suicide rates despite an overall decline in suicide cases.
In 2018, 599 Japanese aged 19 or younger killed themselves, up by 32, or 6%, from the previous year, according to a government white paper. The rate -- the number of suicide deaths per 100,000 people -- for the 10-19 age group was 5.3, the highest in 40 years.
Trouble at school, including poor academic performance, was the most common reason for teenage suicide. But the government's report found that suicides among working teens were also rising, indicating there is more to the story than issues in the classroom.
Some Asian countries have been plagued by even higher rates of youth suicide than Japan.
India had the region's highest rate among teenagers in 2016, according to the WHO, at 11.2 deaths per 100,000 people. The figure for girls was 15, roughly double the 7.8 for boys.
Mental health professionals see multiple reasons so many young Indians are ending their lives.
"India has a considerable young population but at the same time there is a lack of employment opportunities," said Gagan Hans, a psychiatrist in New Delhi. He said other factors are poverty, academic stress, and domestic violence against women.
A recent paper published in The Lancet Public Health, a medical journal, shed light on the woes of young women. "Marriage is known to be less protective against suicide for women because of arranged and early marriage, young motherhood, low social status, domestic violence and economic dependence."
Bangladesh and Thailand also had relatively high teenage suicide rates in 2016, at 6.2 and 5.6 cases per 100,000 people, respectively. Advanced economies like Japan, South Korea and Singapore came next at 4.8, 4.4 and 3.7.
On the other hand, emerging Southeast Asian countries Indonesia, Malaysia and Vietnam had low teenage suicide rates of 2.0, 1.9 and 1.8.
In some countries, there appears to be a common thread of falling total fertility rates -- put simply, the average number of children born per woman of reproductive age. In the three decades from 1985-1990 to 2015-2020, the rate in Singapore dropped to 1.21 from 1.70, in Japan to 1.37 from 1.65, in Thailand to 1.53 from 2.30, and in South Korea to 1.11 from 1.57, according to the United Nations' World Population Prospects.
"With a smaller population of family members, the smaller family units, there are more expectations from parents to children," Balhetchet said. "Because if you have only one child or two children in your family, then they must succeed."
At the same time, the internet and social media appear to have played a central role in some recent suicide cases.
In Malaysia this year, a 16-year-old girl reportedly killed herself after posting a poll on her Instagram account asking followers whether she should live or die. The majority of respondents voted that she should die.
Malaysia's Befrienders, a nonprofit organization that provides free support for people in distress, argues there is a direct link between high rates of youth suicide and the rise of electronic communication and digital media, which have changed the way people interact and exacerbated peer pressure.
Befrienders director Ardy Ayadali told Nikkei that although technology makes communication easier, it also increases social isolation, as young people tend to hide behind their devices rather than talking with others face to face.
"Suicides are preventable but preventing them is no easy task," the WHO noted in a recent report. "Interventions range from providing the best possible conditions for bringing up our children and young people, through accurate and timely assessment of mental disorders and their effective treatment, to responsible reporting of suicide by the media and the environmental control of risk factors."
Asian policymakers are waking up to the problem, and are beginning to rethink education systems and offer more support.
In Singapore, intense and highly competitive education is credited with making the city-state one of the world's best academic performers. The city-state topped the Program for International Student Assessment test by the Organization for Economic Cooperation and Development in 2015. Success even in early schooling is widely seen as crucial for improving future job prospects.
For some, it is all too much to bear.
In 2016, the suicide of an 11-year-old boy shook Singaporean society. According to local reports, on the day he was to show his midyear exam results to his parents, the fifth-grade student locked himself in his bedroom and jumped out the window, falling 17 floors. It was the first time he had failed such a test.
This year, Singapore scrapped exams for first- and second-year elementary school students, who are typically around the ages of 7 and 8. By 2021, it will also do away with midyear exams for the third and fifth years of elementary school and the first and third years of secondary school.
The Japanese government, meanwhile, has stepped up suicide prevention measures, including consultation services over social media. In March, it published guidelines for counselors on how to react when chatting online with potentially suicidal individuals.
The number of consultations via social media networks reached 22,725 in the year ended March, 44% of whom were 19 or younger. Eighty-five percent were in their teens and 20s.
Yet, governments could do more, according to those on the front lines of the battle.
"Just consulting via social media is not enough," said Yutaka Motohashi, director of the Japan Support Center for Suicide Countermeasures. Young people who are in crisis, he said, need to be connected with real-world support. "There are already a lot of public support [programs], and both the public and private sectors should work together to build up a network so people in need can access appropriate help in the actual world."
Motohashi said high youth suicide rates raise a "fundamental question" for us all. "Can we make our society better and give young people hope?"
Nikkei staff writers Rurika Imahashi in Tokyo, Kiran Sharma in New Delhi, P Prem Kumar in Kuala Lumpur and Masayuki Yuda in Bangkok contributed to this story.