What are Symptoms of stress to look out for?

“We see more patients presenting with stress-related symptoms stemming from fears of going outside and/or of COVID-19 infection and deep concern about recently reported traumatic events like shootings and acts of violence. Stress can manifest in the body as loss of sleep or frequent waking in the night, abdominal pain, diarrhea, heart racing, racing thoughts, dizziness, sweating or unexplained fear of certain situations. Fearful episodes can be triggered by daily, seemingly routine tasks, such as visiting the grocery store.

“Toxic stress can be just as damaging as other physical ailments so it is important to take time to practice self-care by turning off the phone and limiting exposure to social media/media that may bring traumatic images to mind. Also take time to eat well, exercise and get at least eight hours of sleep. In addition, there are a number of meditation apps that can help people recenter and find peace, even if used for only for 10 minutes per day.”

 Source: Keck medicine of usc


How Covid-19 pandemic severely impacts mental health of young people? 

The Covid-19 pandemic severely impacted the mental health of young people, with increased levels of clinical depression being identified, a new study published in the journal Psychiatry Research reports. A decrease in alcohol consumption was also identified amongst young people during the pandemic.

 Researchers found evidence of a substantial impact on the mental health of these young adults due to the Covid-19 pandemic, with a significant rise in depression symptoms and a reduction in overall wellbeing during lockdown compared to the previous autumn. Levels of clinical depression in those surveyed were found to have more than doubled, rising from 14.9 per cent in autumn 2019 to 34.7 per cent in May/June 2020.

 Sleep quality was not seen to decline in the overall sample but, importantly, a correlation was seen between the rise in depression and lower sleep quality under lockdown. Also of concern, researchers identified a significant shift towards 'eveningness' (a preference to go to sleep and wake later), which has previously been associated with higher levels of anxiety and a greater prevalence of minor psychiatric disorders.

 Source: University of Surrey


Why are young people and those without a high school diploma most affected?

 These groups are more likely to be in lower socioeconomic brackets that have been most impacted by the pandemic. Young adults and people who did not finish high school likely do not have savings to balance out the pandemic’s financial stressors. Young adults also have not had the opportunity to develop coping skills that typically come with age. The young adult period is also a higher risk period for developing certain types of mental illness, such as Schizophrenia.

What are the signs someone may need to seek mental health treatment?

First, it’s important to understand that we all have periods when we feel sad or anxious. This is a normal part of life. These feelings become problematic when they are more sustained over weeks than simply days. When it affects your daily ability to function or you begin having suicidal thoughts, it is a sign you should reach out for help.

 What are the barriers to those seeking mental health services?

 Access to mental health care was challenging even before the pandemic. The report will help clinicians to better target interventions that focus on these higher-risk groups.

 Telemedicine has increased access to care, especially in areas such as rural communities, since people can access care without traveling. We have seen the no-show rates in clinics decrease due to the improved ease in access. However, there are still disparities. People who do not have computers, are unfamiliar with technology or do not have quality internet access cannot use these services. Telemedicine might also be a challenge for people with visual, auditory or intellectual disabilities.

 There is also considerable stigma to having a mental health condition that prevents people from accessing care, as they view seeking help as a sign of weakness. Payment for service is another barrier. For those without insurance, the cost of treatment can be insurmountable. Even for those with insurance, there is disparate coverage with some insurers charging higher co-pays for mental health and substance use disorder treatment.

 Source: Rutgers University-New Brunswick


How added trauma may affect peoples’ willingness to reenter society, and how to reduce fears and anxiety?

“People may feel hesitant to return to their normal activities because the world feels like a dangerous place. However, they may feel reassured to realize that vaccines, masks and other COVID-19 countermeasures are safe and effective in reducing risk of infection.  As for acts of mass violence, it may help to accept there is an inherent risk in everything we do, but we should try to not let this stop us from living fully.

The immediate sense of joy and satisfaction you experience will help balance any negative feelings. Another technique is to literally try to leave anxiety 'at the door.' As you exit a room, building, or even a Zoom call, tell yourself, you will put any worries behind you. The physical act of leaving can serve as an end point for stressful ruminations and reset your mental energies. I also recommend that people see a therapist or seek medical care when they experience a prolonged period of depression.”

 Source: Keck medicine of usc


Emotional Well being during Covid:


What are the signs of emotional suffering? 

One sign is a change in personality: Are you or someone you know not acting in a typical way? For example, people might appear angry or anxious or have trouble sleeping. They may not be participating in activities as they did in the past and could be withdrawn from their typical social interactions. Another sign is poor self-care, which can include hygiene as well as other concerns like an increase in substance use. If you recognize hopelessness, grief or guilt, you or the other person may need to  seek support from a professional. 


What can you do if you sense emotional suffering in yourself or others?

Your actions depend on the severity of what you see. If you notice more moderate signs of emotional suffering, engage with that person: Offer to talk or go for a walk with them and be sure to listen. If you notice signs in yourself, reach out to others for social interaction. If what you  are experiencing is more severe, contact a doctor or therapist for treatment or call the National Suicide Prevention Lifeline, which provides 24/7, free and confidential support [800-273-8255]. The most important thing is to not keep your emotions bottled up and get professional help if needed.

How do you maintain your emotional health?

There are daily actions that you can take such as making your bed each morning to create structure and routine and doing self-care measures such as breathing exercises, meditation and taking a break from your computer.

Realize that it is normal and healthy to feel a sense of disconnect, sadness, anxiety and a sense of being lost occasionally. Do a self-care checklist: How did you sleep last night? What is your emotional state? How does your body feel? Routinely do positive, healthy activities: Wake up a half-hour early to savor a morning coffee or tea, remind yourself of what you are most grateful for, take the dog for a walk, keep a journal and eat healthy and hydrate during the day to take care of your body.

Source: Rutgers University-New Brunswick


How Does Your Brain Process Emotions?

“We were interested in how loneliness and wisdom relate to emotional biases, meaning how we respond to different positive and negative emotions,”

“We found that when faces emoting anger were presented as distractors, they significantly slowed simple cognitive responses in lonelier individuals. This meant that lonelier individuals paid more attention to threatening stimuli, such as the angry faces.”

 “For wisdom, on the other hand, we found a significant positive relationship for response speeds when faces with happy emotions were shown, specifically individuals who displayed wiser traits, such as empathy, had speedier responses in the presence of happy stimuli.”

Electroencephalogram (EEG)-based brain recordings showed that the part of the brain called the temporal-parietal junction (TPJ) was activating differently in lonelier versus wiser individuals. TPJ is important for processing theory of mind, or the degree of capacity for empathy and understanding of others. The study found it more active in the presence of angry emotions for lonelier people and more active in the presence of happy emotions for wiser people.

Source: University of California San Diego Health


Managing Children’s Mental Health during the Pandemic?

Pandemic stresses are increasing anxiety, depression and overeating in children. Disruptions to daily routines, stress from remote learning, social isolation and anxiety over illness during the pandemic are taking a toll on children’s mental and behavioral health, leading to physical problems such as weight gain from overeating. 


What changes have you seen in behavioral and physical health of children since the start of the pandemic?

Robinson: Children are showing symptoms of increased anxiety, depression and even self-injury and substance use. Anxiety is intensified by the challenges of remote learning, concerns about becoming ill and isolation from peers, leading to decreased coping skills. As a result, a significant number of children are gaining too much weight due to overeating, whether from emotional issues or simply out of boredom. Weight gain, which can have an impact on lifelong health, can also have a serious impact on behavioral health, which in turn becomes a vicious cycle. 

Children are routine-oriented and benefit from structured activities. Leaving the house to attend school is an integral part of this necessary routine. School attendance allows for peer-to-peer interaction, which is essential during every developmental stage. Pandemic life is not conducive to normal developmental events and this is having a significant impact. During well-visits, primary care providers often discover children are not getting adequate sleep, are less physically active and are eating calorie-rich, non-nutritive foods.


What interventions can be done to decrease emotional eating and obesity during the pandemic?

Moscarella: Emotional eating typically occurs when children are depressed, anxious, stressed or frustrated. Parents should ask questions and determine if their children are eating for the right reasons. Is it out of hunger or just boredom? Questioning children about what they may be feeling can be difficult. Since some children may not feel comfortable discussing concerns with their parents, using a therapist may be the next step. During the pandemic, many therapists have started providing telemedicine services, which may help to decrease a child’s anxiety about becoming ill when visiting a clinician.

Encourage healthy eating routines. Children who attend virtual learning should have structured mealtimes and should not be allowed to snack all day long. Have healthy options with portion control on hand for snacks. Make a daily schedule that is visible to the child and consists of activities, meal/snack times and exercise. Do not use food as a reward for good grades or behavior. Avoid mindless eating, such as eating in front of the television or while doing schoolwork. Separate eating times from other activities to decrease the chance of overeating. Steer children to diversional activities, such as including board games or arts and crafts to lessen overeating.

Although it can be difficult to structure exercise during the winter, parents can consider creative ways to encourage movement, like shoveling snow, dancing or stretching to music.

If a child has gained weight, parents can talk to him or her about how improving their eating habits will lead to better health. A behavioral health provider can assess a child for a binge eating disorder due to anxiety and or depression and provide appropriate treatment.


When should parents seek behavioral health assistance for their child and what steps should they take?

Moscarella: Children often have a difficult time verbalizing feelings and often demonstrate emotions in a different way than adults. Younger children generally have regressive behaviors like bed wetting, clinging excessively to a parent or caregiver and increased periods of crying. Older children may lose interest in activities they previously enjoyed, perform poorly in school, have difficulty concentrating and being attentive, and become irritable. Children may report more headaches, stomachaches and generalized body discomforts. Adolescents typically become more agitated, withdrawn, act out or turn to alcohol and drugs. A decline in school grades can be seen across all age groups. Parents should look for a change in patterns of their child’s behavior and daily activities, including sadness, reports of being tired and changes in patterns of sleep, appetite and interaction with others.

Parents with concerns should make an appointment to see their child’s primary care provider. Children are comfortable in familiar environments, and this may help to facilitate a constructive conversation. Primary care providers can screen for both behavioral and physical health concerns. If significant behavioral health issues are discovered, the child will be referred to a behavioral health provider for further evaluation and treatment.

Comprehensive mental care should include a formal psychiatric evaluation, individual and family psychotherapy and referrals to community resources. However, the scarcity of psychiatric behavioral health providers can be a challenge. In these cases, primary care providers may begin treatment while a relationship with a behavioral health provider is established.


What types of therapies can be tried before turning to medication?

Robinson: Treatment typically begins with non-pharmacological interventions such as relaxation techniques that include art therapy, walking, reading, listening to music, exercise, spending time with a pet, playing an instrument, journal writing, completing puzzles or meditation. When children are anxious, it is often necessary to begin regular routines and to ensure that they are getting  a healthy diet and a sufficient amount of sleep.  

Non-pharmacological interventions are more effective when paired with psychotherapy and are often recommended to learn coping strategies. Valuable resources for parents regarding behavioral health concerns can be found on the Centers for Disease Control and Prevention website. If these interventions do not result in improvement, parents should seek the guidance of their pediatric primary care provider or a behavioral health provider.

Source: Rutgers University-New Brunswick