Category: Depression
Can the COVID-19 Vaccine Improve Your Mental Health?
Thirteen months ago, the world was experiencing the onset of a shared trauma … a pandemic was sweeping over the globe. The actions that were taken to keep people safe included community shut downs, stay at home orders and mandated isolation. Lindner Center of HOPE, like mental health providers around the world, began to see spikes in mental illness and addiction. Individuals who were already struggling with mental illness or a pre-disposition, saw exacerbated symptoms and an increase in severity of illness. People who were managing, saw new onset at higher levels of acuity. As time has passed since the beginning of the pandemic, the trauma has been sustained with higher percentages of people still struggling with mental illnesses and addictions. Additionally, data shows people who have experienced COVID-19 infection are also suffering with co-occurring psychiatric symptoms.
Fortunately, vaccines have been released to protect the population from the physical health threats of COVID-19. However, Lindner Center of HOPE’s President and Chief Operating Officer, Paul R. Crosby, MD, states the vaccine also offers mental health benefits as well.
“The first mental health benefit of the vaccine is simple,” Dr. Crosby said, “since the risk of COVID-19 infection diminishes significantly with vaccination, receiving the vaccine would also protect individuals from co-occurring mental illness that has proven to manifest with COVID-19 infection.”
“The second mental health benefit of the vaccine is the reduction in overall anxiety and stress, as risk and fear of infection is reduced. Vaccinated individuals can lift their isolation from other vaccinated individuals, can begin to see a return to other activities that improve mental health, like more exercise, improved sleep, new experiences through travel and more. A return to these healthier activities can hopefully also lead to a reduction in substance use, overeating or lack of participation in other things that bring joy.”
“The COVID-19 vaccine has significant potential in improving your mental health.”
For individuals experiencing symptoms of mental illness, it is critical to access help. Mental illnesses are common and treatable and no one should struggle alone.
Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic services for all ages and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.
Mental Health and the Environment of Connection
By Chris J. Tuell, EdD, LPCC-S, LICDC-CS
Lindner Center of HOPE, Clinical Director of Addiction Services; Assistant Professor, Department of Psychiatry & Behavioral Neuroscience
University of Cincinnati College of Medicine
At the end of the Vietnam War in 1975, 1 out of 5 soldiers (20%), returning to the United States from Southeast Asia, was addicted to heroin. It was estimated that approximately 100,000 American soldiers would be returning home, addicted to this destructive drug. Experts projected a drug epidemic, which would destroy countless lives and communities. It never happened.
Once soldiers returned home to families, friends and communities, the destructive nature of a hardcore drug, like heroin, failed to materialize. In fact, 95% of the soldiers who were once addicted to heroin, stopped using the drug almost immediately once they returned home.
For many years, our understanding of addiction was based on early research conducted in the first half of the 20th century. These studies involved rats and consisted of placing a rat in a solitary cage, providing the rat with a choice of water: plain water or water laced with cocaine or heroin. The study found that all the rats preferred the drug-laced water to the plain water. All the rats overdosed on the drug. The majority of the rats died in the study. This became our model of addiction for many years. The accepted belief became, if you are exposed to a drug, you will become addicted, and you may overdose and die.
Several years later, this original study was replicated, but with a significant difference. Researcher Bruce Alexander from the University of Vancouver, created, what was referred to as: a “rat park.” This park consisted of tunnels, multiple levels, toys, and other rat companions. Similar to the original study, all rats were given the same choice of water: plain water or water laced with heroin or cocaine. In Alexander’s study, rats preferred the plain water. Rates of overdose and death to the rats were significantly lower when compared to the initial study. How do we explain this difference in results? Perhaps, it is about the cage. Perhaps, it is about the environment.
Upon their return home, the soldiers from Vietnam who were struggling with a heroin addiction were able to re-connect with loved ones and community. A change in environment allowed for a change in connection, resulting in health, wellness and sobriety. Likewise, the environment of the rat in a solitary cage, as compared to the environment of the rat park, provided the rat with a “connection” with other rats, an environment which allowed the rat…to be a rat.
Individuals, who experience issues of mental illness and/or substance use disorders, have a natural tendency to withdraw and isolate from others. Depression, anxiety and addiction, greatly affect an individual’s ability to connect with others, let alone with one’s environment. This past year we have seen the devastating impact of COVID-19. We know that in order to maintain health and wellness, we need to maintain social distance and disconnect from one another. For now, this has and continues to be, what we need to do. It remains challenging for many of us to continue to avoid contact with loved ones and friends. We are separated from the very individuals who love us, support us, and are our sources of connection.
We have seen the rise of mental health issues during the past year. Nearly 20 percent of COVID-19 patients have developed a mental health issue (i.e., depression, anxiety) within three months of their diagnosis. During the past year, 4 in 10 adults in the U.S. have reported symptoms of anxiety or depression. Within the general population, rates of mental health issues and substance use have significantly increased across the board. In addition, the disconnection that we have witnessed has fragmented our society in general by harboring increased levels of fear, anger and animosity towards one another.
Hope on the horizon
Once “herd immunity” is achieved, the importance of re-connecting with one another becomes vital and essential to our health and mental wellness. We are social beings and need connection with one another. History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today’s elevated mental health needs will continue well beyond the coronavirus outbreak. Like the moth that needs to struggle out of the cocoon in order to develop the strength that it needs to survive in the world, we too are developing the strength that we need from the struggles we have endured. Re-connecting with one another is an answer. It gives us strength and it gives us hope.
Pros and Cons of TMS Therapy
Depression is common. More than 14 million American adults suffer from depression. Only a fraction of individuals suffering from depression seek treatment. Of those who do, greater than 30% fail to achieve satisfactory improvement. Not all patients improve when treated with medications or psychotherapy. Up to 25% of people suffering from depression will not respond to multiple trials of medication due to a lack of efficacy or difficulty tolerating medication. Likewise, many people struggle to respond to the best efforts of psychotherapy, either due to a lack of response or a lack of time and/or financial resources that are necessary for psychotherapy interventions. Alternate treatment modalities are critical to addressing the ongoing needs of patients who suffer from the debilitating effects of depression.
Understanding the Benefits of TMS Therapy
Depression has been linked to an abnormal function of nerve cells in a specific part of the brain. Highly focused magnetic field pulses used in Transcranial Magnetic Stimulation (TMS) therapy gently stimulate these nerve cells. Evidence shows that TMS is effective in the treatment of moderate to severe depression in patients with a history of treatment resistance. New data emerging from recent studies suggests that in most patients, the clinical benefits of TMS were maintained through 12 months.
How TMS Therapy Works
TMS is a non-invasive, localized treatment conducted using a device that delivers rapidly pulsating and localized magnetic fields that activate a subset of nerve cells in the front part of the brain. While treatment is administered, patients remain awake while sitting in a comfortable reclining chair. A treatment coil is applied to the head and the system generates highly concentrated magnetic field pulses. The TMS therapy is delivered in a series of 37-minute outpatient treatments, typically administered daily, (5 days per week) for 4 to 6 weeks.
Pros of TMS Therapy
- Does not require anesthesia, non-invasive, well tolerated.
- An outpatient service and patient continues normal daily routines.
- Current data demonstrates efficacy in patients who have struggled
with medication.
- May be good alternative for patients who responded to ECT in past.
- No significant memory impairment.
- FDA Approved in 2008 for the treatment of depression.
Cons of TMS Therapy
- Facial twitching during the treatment.
- Skin redness at site of coil placement.
- Anxiety before and during treatment.
- Mild discomfort (usually dissipates by end of first treatment).
- Headache.
- Process for insurance coverage can be cumbersome.
- Time required 30 treatments over 6 weeks.
Grief During the Holidays
By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief Medical Officer
Many people have experienced loss of several types during the COVID-19 pandemic – employment, financial security, social connections, a sense of safety, and loved ones. The way we grieve has changed because we cannot rely on our support systems to be physically there for us due to restrictions with social distancing. With the increasing number of COVID-19 cases, the holiday season will be different this year – no holiday parties, large family gatherings, or other traditions. It is difficult to be physically separated from loved ones, but even more difficult for those who may be experiencing their first holiday season after the loss of a loved one.
What are some ways that we can manage grief during this unprecedented holiday season?
- Take charge of your holiday season: Anticipating anxiety about the holiday, especially if it is the first one without a loved one, can be worse than the actual holiday. Taking control of your plans and deciding how you will spend your time can relieve anxiety. Do not spend time where you do not feel emotionally safe or comfortable.
- Find nourishment for the soul: Your faith community may offer resources. Look for a support group for people who have suffered a similar loss or for those who are alone. Due to the pandemic, many support groups are online.
- Give yourself permission to change your holiday traditions: Some traditions may be a comfort, while others may be painful. Some traditions will have to change due to the pandemic. It is ok to start new traditions. Many families are finding ways to celebrate virtually.
- Change how you give: Give a gift on behalf of your loved one to someone else or donate to a charity in memory of your loved one. If you are spending less due to not spending the holidays with loved ones, consider giving more to charitable organizations.
- Do not let guilt overtake you: You can enjoy the holiday without your loved one. Celebrating does not mean you do not miss or have forgotten about your loved one.
- Be gentle with yourself: Realize that familiar traditions, sights, smells and even tastes, may be comforting, or may trigger strong emotions. Be careful with your emotions and listen to yourself.
- Do not pretend you have not experienced a loss: Imagining that nothing has happened does not make the pain of losing a loved one go away or make the holidays easier to withstand. It is ok to talk with others about what you have lost and what the holidays mean to you.
- Pay attention to your health: It is often difficult for people who have experienced a recent loss to sleep. Make sure you get regular rest. If you feel overwhelmed, talk with your health care provider.
- Experience both joy and sadness: Give yourself permission to feel happiness and pain. Do not feel like you must be a certain way because of your loss or because it is the holidays.
- Express your feelings: Suppressing your feelings may add to distress. To express your feelings, talk with a supportive friend or journal.
- How can support persons help those who are grieving during this holidays season if we cannot physically be there? Be available to listen. Send cards, gift cards for meals, offer to help shop, or decorate the outside of the home. If you are concerned about their mental wellbeing, offer to help them find a support group or encourage them to reach out to their health care provider for help.
Resources
https://www.griefshare.org/holidays
https://whatsyourgrief.com/alone-together-14-ideas-for-a-virtual-holiday/
Crisis Text Line, text CONNECT to 741741 for 24/7 help from a crisis counselor.
Ohio Care Line, call 1-800-720-9616 for 24/7 support from behavioral health professionals.
When To Seek Treatment For Anxiety
By Angela Couch, RN, MSN, PMHNP-BC
Psychiatric Nurse Practitioner, Lindner Center of HOPE
Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.
For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?
According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:
* Feeling “paralyzed” by fear.
* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).
* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.
* You are having difficulty with sleep or eating due to excessive worry or anxiety.
Anxiety is causing significant physical symptoms.
* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.
* You worry about “everything” or “all the time”.
* The anxiety/worry you are experiencing about situations seem excessive.
* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.
* Anxiety is causing you to turn to self-medication with alcohol or substances.
So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.
How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.
The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!
Can you blueberry your way out of depression? The evidence on dietary supplements
By Nicole Mori, RN, MSN, APRN-BC
Research Advanced Practice Nurse, Lindner Center of HOPE
Depression is a common mental health complaint. Although there are effective treatments available, many patients fail to experience satisfactory improvement. There has been increased interest in nutritional supplements as an adjunct or alternative to medications in the treatment of depression. This has contributed to the growth of the dietary supplement industry (projected to reach 230 billion by 2026). Let’s examine the evidence for the dietary supplements that have generated interest in recent years.
Omega-3 fatty acids (EPA/DHA)
A systematic review shows mild-moderate improvement in depressive symptoms, with the best outcomes in studies where omega-3 supplementation is concomitant to standard antidepressant therapy. There is a great deal of heterogeneity in dosing, duration of treatment and EPA/DHA content. Products with a high EPA content appear to be more efficacious than other omega-3 supplements. However, quality of evidence is low due to methodological flaws. Differences in study design and methodology makes it difficult to analyze data across studies. Omega-3 supplements have a favorable safety profile and are well tolerated.
B group vitamins
Folate- Possible dose dependent response in depression but level of evidence is low. Although folate is well tolerated, it has been associated with risk for proliferation of carcinogenic cells in the colon.
L-methylfolate-Available as pharmaceutical product FDA approved for depression. Data shows efficacy at 15mg/d. Some studies show efficacy as augmentation strategy for depression as comparable to lithium and atypical antipsychotics. Usually well tolerated with lower risk for proliferation of cancerous cells than folate.
Vitamin D
A 2019 systematic review of clinical trials showed improvement in depression ratings associated with supplementation. Findings remain tentative due to paucity of studies and methodologic bias. Vitamin D is a fat-soluble vitamin commonly found in multivitamins and other commercially available products. In the absence of a deficiency, the recommended dose is not to exceed 600IU/day.
SAM-E (S-Adenosyl methionine)
Clinical trials show mixed results. A 2016 systematic review suggested SAM-E was no better than placebo. The low quality of evidence makes it difficult to draw conclusions about efficacy. There is a need for randomized clinical trials with antidepressant comparators. SAM-E usually well tolerated but there is a possible risk for inducing mania in patients with bipolar depression.
Tryptophan/5-HTP (5-Hydroxytryptophan)
There are few high quality studies of 5-HTP. Two depression studies suggest 5-HTP is superior to placebo. Overall, level of evidence is low. Possible risk for serotonin syndrome when administered concurrently with SSRI antidepressants. Maximum recommended dose is 50mg/kg/day.
Magnesium and Zinc
There is some positive data from animal studies but evidence for efficacy in humans is low quality. There is no conclusive data on the efficacy of magnesium and zinc as coadjutant therapy in depression. Zinc and magnesium are common micronutrients and usually well tolerated.
Probiotics
Depression has been associated with poor diet and altered intestinal flora. Research has shown a relationship between gut health and mental health. A 2016 metaanalysis of probiotics showed an effect in reducing risk of depression in normal subjects and reduced symptoms in subjects with depression. The effect was limited to subjects under age 60. Clinical studies vary greatly in terms of bacterial species, dose, duration of treatment as well as the method of measuring of depressive symptoms. Probiotic supplements are vastly heterogeneous in terms of species composition and dosage.
There is a need for further research to determine optimal composition, dosage, duration of treatment for efficacy. Furthermore, it is important to remember that quality of diet is a major determinant in the composition of gut flora.
In conclusion, evidence for the efficacy of dietary supplements in depression remains limited. Commercially available dietary supplements vary significantly in terms of composition and bioavailability. Although supplements are well tolerated, it is important to be aware of increased risks for adverse events in some patients. Supplementation with omega-3 fatty acids as an adjunct to standard antidepressant therapy seems to hold the most promise. Further research in the area of dietary supplements is needed to determine their role in the management of depression.
For more information about Depression research studies at the Lindner Center of HOPE
call 513-536-0707 or visit https://lindnercenterofhope.org/research/
https://redcap.research.cchmc.org/surveys/?s=YKW8CE4FRF
References
Firth J, Teasdale SB, Allott K, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019;18(3):308-324. doi:10.1002/wps.20672
Martínez-Cengotitabengoa M, González-Pinto A. Nutritional supplements in depressive disorders. Actas Esp Psiquiatr. 2017;45(Supplement):8-15.
Feeling Blue vs. Being Depressed: What Is the Difference?
Almost everyone has felt “down in the dumps” at times or had a case of “the blues.” In this state, you may have referred to yourself as feeling depressed. But is this really clinical depression?
An estimated 25 percent of Americans suffer from major depression. So what distinguishes the common “down” feelings felt by most of us with true depression? Actual depression is different from “the blues” in several key ways.
Symptoms of Feeling Blue vs. Being Depressed
Feeling “blue” or being down in the dumps” are ways we describe feelings of sadness or melancholy. True depression has a host of other symptoms in addition to sadness. They may include: significant weight loss or gain, insomnia, loss of interest in daily activities, feelings of guilt, helplessness or hopelessness, fatigue/loss of energy, and poor concentration.
Causes of Feeling Blue vs. Being Depressed
Brief periods of feeling “blue” are usually caused by life events that leave us feeling discouraged. From a broken date to the loss of a loved one, the causes can range from minor to major events. Depression can be triggered by a stressful life event, but research indicates that depression is also associated with a variety of genetic and biochemical factors. Some individuals appear to be more “hard-wired” to get depression. The “blues,” on the other hand, are feelings with which almost everyone can relate.
Duration of Feeling Blue vs. Depression
To be considered depressed, an individual must be experiencing significant symptoms for at least two weeks on an ongoing basis. Individuals who are feeling a bit “down” usually shake off these feelings in a few days, if not hours. The “down in the dumps” sensation we’ve all had is noteworthy for being temporary. Without treatment, true depression, on the other hand, can last for months or years, or it can re-occur frequently.
Intensity of Depression Symptoms
In addition to being longer lasting, true clinical depression is also more intense than a case of the “blues.” Usually, individuals who are feeling “blue” or “down” manage to perform their regular daily activities. Individuals experiencing an episode of depression often are unable to function normally. The depression interferes with work, relationship, and daily activities. In extreme cases, depression can lead to feelings of complete hopelessness and suicidal thoughts or acts.
If you or a loved one frequently feels “down in the dumps” or “blue,” consider whether the condition may actually be depression. A physician or mental health professional can conduct an assessment to determine if depression is present and recommend appropriate treatment.
Understanding the difference between feeling “blue” and being depressed can make a difference in the quality of life for an affected individual. With proper treatment, depression can be managed, and individuals can live more enjoyable and productive lives.
Psychological Disorders and Their Impact on Cognition
Fortunately, our culture has recently seen a gradual erosion of the stigma regarding emotional disorders, along with an increased understanding of such conditions. However, a less well-understood aspect of emotional disorders is the impact that they have on the cognitive functioning of those who are afflicted. Disorders such as Major Depression, Bipolar Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, and Schizophrenia all tend to interfere with one’s ability to access the full extent of their cognitive abilities, adding to the burden that these conditions create.
Regarding Major Depression, it is the one disorder that the DSM-V lists cognitive difficulties as one of the diagnostic criteria (diminished ability to think or concentrate, or indecisiveness, nearly every day). As a neuropsychologist, I routinely encounter patients who are all too aware that their depression impacts their ability to think clearly, to focus, and to recall everyday interactions. Part of the reason for this is that depression causes a reduction in processing speed, as well as the energy that it takes to attend to conversations and events. Difficulties with maintaining attention, and “keeping up” with things going on around them, these patients experience troubles recalling information, sometimes so profoundly that they begin to fear that they may have dementia. However, as their depression is more effectively treated, they regain full access to their cognitive skills and abilities.
Anxiety disorders also are accompanied by significant cognitive difficulties, for a couple of reasons. First, when the mind is anxious, most of the brain’s resources (blood flow, oxygen, glucose, etc.) are redirected to the emotional centers of the brain (the limbic system), and away from parts of our brain that mediate higher-level thinking and logic. Secondly, those who are anxious tend to be rather “internally-oriented” in their thinking, and so they are not as attentive to external events. In other words, because they become preoccupied with their fears and worries, the ordinary events of the external world can be largely overlooked. As a result, these ordinary events are not well-encoded into the memories of anxious patients, and therefore they cannot easily be recalled. As with depression, as anxiety becomes better managed, these cognitive issues largely resolve.
Two other diagnoses have profound implications for cognitive functioning. Bipolar disorder has a well-established pattern of cognitive difficulties, including diminished attention, verbal memory, and executive functioning abilities (planning, anticipating, problem-solving, emotional regulation, staying focused and attentive to personal goals, etc.) These difficulties, fortunately, are typically limited to times that these patients are actively experiencing a mood episode, whether it be depression or mania. Regarding those with schizophrenia, they experience similar cognitive difficulties. However, they often continue to experience such cognitive difficulties even when their symptoms of schizophrenia have been well-controlled with treatment. This is why the DSM-V lists “associated features” of schizophrenia specific to these difficulties, explaining that, “Cognitive deficits in schizophrenia are common and are strongly linked to vocational and functional impairments.”
Fortunately, over the past 20 years there have been treatments and interventions to address such cognitive difficulties. Cognitive Enhancement Therapy, or CET, has been developed and implemented for the mentally ill for whom cognitive problems are getting in the way of living independently, maintaining employment, and sustaining meaningful relationships. It has proven to be an effective means to address such difficulties, and for providing a much higher quality of life. It is anticipated that, as the benefits of CET become more evident to those working with the mentally ill, its positive impact will widen in both its breadth and depth.
Managing Suicidality During Isolation
In the United States, suicide is the 10th leading cause of death. The rate increased 33% from 1999 through 2017 according to the Centers for Disease Control and Prevention. The American Foundation for Suicide Prevention states that “suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair.” For some, the COVID-19 pandemic could create this experience. The pandemic has produced a condition that has increased many of the risk factors for suicide: feelings of depression and anxiety, increased alcohol and substance use, serious physical health conditions, unemployment, financial crisis, illness or death of a loved one, isolation, and decreased access to care.
Social distancing and isolating at home have limited access to coping skills and reduced suicide protective factors. People no longer have in person contact with behavioral health providers, there is decreased connectedness to support systems, and no access to gyms, art studios, massage therapy, beauty salons, barbers, etc. With fewer physical and creative outlets, healing therapies, and self-care that improves self-esteem, people can feel lost. They also no longer have physical access to places of worship where the social connection was as important as the message or music. It important to remember that we need to maintain physical distancing rather than social distancing – it is necessary to maintain physical separation to not contract the virus but other ways of maintaining social connections are still very important.
Another risk factor that staying at home can bring is closer proximity to abusers. Children of abusive parents who are no longer in school are now with their abusers all day and adults with abusive partners are also with their abusers more often. Adverse childhood experiences are associated with 2 to 3 times more suicide attempts later in life and victims of intimate partner violence are twice as likely to attempt suicide.
Staying at home also increases access to lethal means so it is imperative to either remove guns from the home or ensure they are locked securely and reduce access to other lethal means (such as large amounts of extra medications, excess amounts of alcohol, ropes/cords) in the home for people who are high risk for suicide. For homes with large amounts of prescription medications due to multiple health conditions, a medication safe is recommended.
For people with loved ones who have risk factors for suicide, it is important to know the warning signs. Warning signs include talk of: killing themselves, feeling hopeless, having no reason to live, being a burden, feeling trapped, and unbearable pain; behavior: increase use of alcohol and drugs, looking for a way to end their lives (including internet searches), withdrawing from activities, isolation from family and friends, too much or too little sleep, saying goodbye to people, giving away possessions, aggression, and fatigue; and mood: depression, anxiety, loss of interest, irritability, humiliation/shame, agitation/anger, and relief/sudden improvement. If you notice these warning signs, it is important to ask a person directly if they are having thoughts of suicide and if they are, get them help by contacting their mental health providers, calling a crisis line, taking them to an emergency department, or calling 911. Visit take5tosavelives.org or bethe1to.com to learn how to talk to your loved ones about suicide. Due to COVID-19, people have tried to avoid emergency departments and hospitals but if someone you love is unsafe do not hesitate to get them the help they need.
What are ways to increase coping skills and protective factors in our current climate? Take advantage of telephone or video appointments offered by your mental health providers. If you do not already have mental health providers, now is a good time to seek treatment – practices are still accepting new patients and insurances are covering telephone and video appointments. To reduce worry and fear, limit media consumption about COVID-19. Stick to a routine, stay physically active, get outside with appropriate physical distancing, get enough sleep, limit alcohol, and eat healthy. If you feel you have a problem with alcohol, substances, overeating, or other addictive behaviors – there are online support groups. Connect with loved ones by phone, social media apps, video apps, or writing. Consider safe altruistic ways to connect with others – making masks, running errands for vulnerable loved ones, donations, etc.
How can you get help? Crisis Text Line: text HOME to 741741, they can also be messaged on Facebook messenger.
National Suicide Prevention Lifeline 1-800-273-8255
YouthLine answered by trained teen peer support from 4 pm – 10 pm and by adults from NSPL during other hours 877-968-8491 or text teen2teen to 839863
Childhelp National Child Abuse Hotline text or call 1-800-422-4453
National Domestic Violence Hotline 1-800-799-7233 or text LOVEIS to 22522
Mental Health America Support Group Directory www.mhanational.org/find-support-groups
Lindner Center of HOPE 513-536-HOPE
Danielle J. Johnson, MD, FAPA Lindner Center of HOPE, Chief Medical Officer
Living with Anxiety During Times of Stress
Times are uncertain. The world feels scary. Our normal day to day life has been turned upside down. Let me just start by saying this, if you are feeling anxious, scared, overwhelmed, frustrated… you are allowed to feel these emotions, it makes total sense why you feel this way, you are not alone, and you are not weak. Remember, pain in life is unavoidable, but suffering is a choice. Meaning, we are going to experience stress in our life, every person on this planet will, but it is ultimately how we respond to that stress that influences exactly how much pain we will experience. Let’s walk through some ways we can live with anxiety during times of stress.
Mindfulness of Emotions. When it comes to managing our anxiety during times of stress, an important first step that we tend to overlook is mindfulness. In order to reduce anxiety, we must first acknowledge that it is there. Allow yourself to pause and put a name on what you are feeling, notice if you feel it physically in your body, observe what thoughts are running through your mind. Try using the stem “I am aware of the emotion of ______, I am aware of the thought that _______.” By bringing mindful awareness to our anxiety in this way, we are bravely choosing to face our discomfort while also seeing it as something that we are experiencing in that given moment, not who we are or the way things will always be.
Self-Compassion. Now that you are observing your anxious mind in action, practice some self-compassion by normalizing the experience, validating its’ presence, being “kind to your mind.” We tend to create more suffering for ourselves when we judge ourselves for our emotions, when we tell ourselves we should not be feeling that way, or try to just “suck it up.” You are an amazing human doing the best you can with some really hard human things right now!
Changing Emotional Response. While part of our goal is accepting the anxiety through mindfulness and self-compassion, we also have the ability to create change in our emotional state and our response to it. First, we need to “check the facts” and get a good look at what our mind is telling us. Our minds tend to be great storytellers, mind readers, and fortune tellers. While these seem like super powers, these are actually mind tricks and traps that create more suffering. Checking the facts is seeing if your emotion and its’ intensity actually match reality (i.e., are valid), or if you are responding to a mind trick.
Next, ask yourself if the action urge associated with the emotion you are feeling is effective? For example, is being angry with your partner because they did not clean the house then throwing a shoe at them actually helpful here?? If the emotion is invalid and/or ineffective, we want to act opposite to what the emotion is telling us to do. So instead of avoiding work responsibilities because we are stressed, make a specific schedule to complete tasks. Instead of spending hours reading the news because we are scared, watch one news program then spend the rest of the day playing with the kids or watching movies.
Acceptance. Consider what is and what is not in your control. If there is a stressor that is in your control, practice problem solving. For stressors we cannot control, accept that we cannot change that reality and focus instead on what in the here and now is in your power. Remember, rejecting reality does not change reality. Instead of dwelling on how terrible it is to be stuck at home, make plans for a game night, clean out that room you have been avoiding, soak up the springtime outdoors.
Practice Gratitude. Lastly, practice gratitude every day. Spend some time thinking about what you have that you are grateful for rather than hyper-focusing on what you don’t have or what has been taken away, which tends to just create more stress. Be specific, instead of just saying you are grateful for your family, say “I am grateful that today my kids helped clean the kitchen and cuddled with me on the couch.”
We as humans are under an incredible amount of stress right now, but remember, as humans we are also incredibly strong and resilient. Importantly, please know you do not have to struggle with this alone. Sometimes the strongest thing we can do is ask for help. If your anxiety is persistent and intense and/or is significantly interfering with your life, please reach out to a mental health therapist. Telehealth services are being offered across the region, including at the Lindner Center of HOPE, who has a whole team of providers eager to help guide you through this.
By Allison Mecca, PsyD
Lindner Center of HOPE, Staff Psychologist, Harold C. Schott Foundation Eating Disorders Program