Young Adults, Latinos and Low-Income Households Feeling Psychological Distress

By Pat Anson, PNN Editor

The COVID-19 pandemic appears to be taking a heavy toll on America’s mental health. A new survey conducted by researchers at the Johns Hopkins Bloomberg School of Public Health found that psychological distress among U.S. adults tripled — from 3.9 percent in 2018 to 13.6 percent in April 2020.

Psychological distress was even more acute among young adults aged 18­–29. Nearly one in four (24%) had symptoms of anxiety and depression.

Distress was also high among Latino adults (18.3%) and adults living in low-income households (19.3%) making less than $35,000 a year.

Nearly 1,500 adults were surveyed about their mental health between April 7 to April 13, when much of the country was still under a coronavirus lockdown. Researchers say their findings, recently published in JAMA, suggest the U.S. will face a wave of mental health problems even after the pandemic ends.

“We need to prepare for higher rates of mental illness among U.S. adults post-COVID,” said lead author Emma McGinty, PhD, associate professor in the Bloomberg School’s Department of Health Policy and Management. “The study suggests that the distress experienced during COVID-19 may transfer to longer-term psychiatric disorders requiring clinical care.

“It is especially important to identify mental illness treatment needs and connect people to services, with a focus on groups with high psychological distress including young adults, adults in low-income households, and Hispanics.”

Older adults seem to be handling the emotional challenges of the pandemic better, with only 7.3% of Americans aged 55 and older reporting psychological distress in April. So are people in households making over $75,000 a year. Only about 8% of Americans in that category reported distress.

Surprisingly, the survey found only a slight increase in feelings of loneliness, from 11 percent in 2018 to 13.8 percent in 2020, suggesting that loneliness is not driving the psychological distress people are feeling.

Zoloft Shortage

Increased demand for antidepressants during the pandemic has led to shortages of Zoloft and its generic version, sertraline. The Food and Drug Administration recently added the antidepressant to its list of drug shortages. Drug manufacturers say they “cannot support monthly demand” for sertraline, in part because of low supplies of its active ingredient. The shortages are expected to continue for the next few months.   

Sertraline is a selective serotonin reuptake inhibitor (SSRI) and the most commonly prescribed antidepressant. Over 49 million prescriptions for sertraline were written in 2018, according to the IQVIA Institute, making it the 11th most dispensed drug in the United States.

In the early stages of the pandemic, pharmacy benefit manager Express Scripts reported a spike in prescriptions for anti-anxiety medications such as Xanax and Valium, as well as antidepressants and anti-insomnia drugs.

Why We Need Connections

By Dr. Lynn Webster, PNN Columnist

On a recent "Hidden Brain" podcast, Shankar Vedantam interviewed former U.S. Surgeon General Dr. Vivek Murthy about the need for human connection.

Dr. Murthy is promoting his book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” which is especially timely given the fact that so many people are currently experiencing social isolation.

I encourage everyone to listen to the podcast and, perhaps, to buy the book. Murthy comes across as a sensitive, intelligent physician who offers an empathetic perspective.

To state the obvious, the COVID-19 pandemic has created distance between most of us and isolation for many of us. To some degree, it has traumatized nearly all of us.

It is important to recognize many people will be seeking ways to heal from the experience. A desire to feel connected is primordial. To have a sense of belonging is on our hierarchy of basic needs. It is also important to healing.

Rachel’s Story

I want to share a short, true story to illustrate the power that connection plays in wellness and healing. 

Debra Hobbins was a nurse practitioner who worked with me in our clinic. She had a unique capacity to connect with patients and make them feel they were important. It was genuine; she was a compassionate and empathetic clinician. 

Debra and I had a patient, whom I will call "Rachel," who had developed an opioid addiction. After several years of fighting the addiction, Rachel tried to get help, but the barriers and rules created by treatment centers and the government prevented Rachel from seeking the care she needed. One day, Rachel found her way to our clinic, where Debra became her primary provider.

Since we were treating Rachel with Suboxone for an opioid addiction, I was included in Rachel’s treatment team. (This happened at a time before nurse practitioners could prescribe Suboxone for addiction.) However, it was Debra who took the lead role in offering a powerful sense of caring and connection for Rachel.

Debra was uniquely qualified to understand Rachel's pain, because she had lost her son to a heroin overdose many years earlier. She knew what Rachel needed to begin healing. Debra gave her what no one had given her before: understanding, compassion and nonjudgmental, unconditional love.

The connection Debra offered Rachel was essential to Rachel’s healing. But there are all sorts of support, and people in pain need various types of help at different times.

Religion and Spirituality Can Help Us Heal

Sometimes, people need help that no human can provide, and they seek healing and comfort from the divine or through spiritual practices.

Researchers are especially interested in how effective religion and spirituality are in helping people deal with physical or emotional pain. Time and again, studies have shown a correlation between a religious or spiritual orientation and improvements in pain or health.

In a 2011 study of 60 depressed patients, researchers found that “hopelessness and suicidal intent correlated negatively with the level of religiosity." In other words, people in pain who are religious or spiritual tend to feel better than those without belief. They are more likely to have "better psychological well-being."

Seeking Connections During the Pandemic

For many of us, our sense of isolation has been heightened by the pandemic. Some people who typically feel connected to others may have temporarily lost the ability to participate in activities that provided them with a sense of belonging, such as going to church or the gym.

There are alternatives, such as using Zoom to visit with friends and family, but all forms of connection are not equal. Some options work better for some people than for others. Those who are lucky enough to be able to participate in video calls may find them inadequate. According to Psychology Today, the technology may leave some people feeling exhausted and depleted rather than satisfied.

Tapping into their faith or joining video conferences may help some people feel connected. But for others, that may barely scratch the surface of their loneliness.

As Murthy points out, a "dark thread of loneliness" can cause physical health problems, including drug abuse. Physical distancing may keep many of us safe from the coronavirus—but without human connections, the richness of life can be elusive.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

How to Cope with Anxiety During the Pandemic

By Ann Marie Gaudon, PNN Columnist

Some folks do not cope well when anxiety comes for a visit. They don’t consider anxiety a normal emotion or call to action, but rather as something bad that must be gotten rid of.

There is no fault here, we live in a “feel good” society bombarded by messages that if we feel distress of any kind, we must do or take or buy something to get rid of it.

I explained how emotions contain a message in my column about loneliness during the coronavirus lockdown. The message is that you must make an effort to end your loneliness by changing your behaviour. Expand your world. Talk with people, laugh with people and cry with people. Find ways to interact.

Anxiety is another emotion. The research is very clear. If you try to deny, dismiss, avoid or overreact to anxiety, it is very likely to get worse. This in turn, can wreak havoc on your overall health.

Consider for a moment that you have a “struggle switch” for anxiety (or any emotion). If you overreact to anxiety or try to avoid it, your struggle switch is flipped “ON.” 

The message during a pandemic is loud and clear: There is something serious going on and we must take action to protect ourselves and others. That anxious feeling you have is trying to protect you, not harm you. It’s a very old evolutionary response. Very good copers have learned how to make peace with their anxiety, realizing it is there in an attempt to keep them safe.

Here are ways to flip that struggle switch to “OFF.”

Pay attention on purpose. Slow down, notice and name what you are feeling. For example, “I am feeling anxious. My heart is pounding fast, and my stomach has knots in it.”

Let these bodily sensations be just as they are, without judging or evaluating them. Just breathe, slow down, and let go of the urge to do anything at all with this feeling of anxiety.

Again, this is a normal response to an abnormal situation and your body is wise to this, so just be still and observe. If you need help with this, there are endless mindfulness activities online that allow you to have your experience without trying to escape from it. Here is one you can try.

Make an intention. Ask yourself, “What will I do with this feeling of anxiety? My mind sees this as something that makes me weak and vulnerable, however I choose not to get hooked by this. I accept this anxiety as mine. What will I do with it now that it is here?”

How you respond will be clear if you remember what is important to you. Even in a world that is fearful, you can be in touch with your values. Ask yourself, “What do I want to stand for in the face of this pandemic?”

You can hold this anxiety gently, as you would a nervous puppy, and change your behaviour -- with puppy in tow.

Expand your experience. Rather than running away from anxiety, learn from it. Anxiety tells us that we are alive and there is work to be done to protect ourselves. Even in times of fear and uncertainty, there is opportunity. Necessary life changes are not all negative. You can use this anxiety as a wake up call.

In addition to protective measures such as social distancing, are there other behaviours you can take that reflect how you want to be in this world? Can you commit to actions that improve the way you treat yourself and others?

Infectious disease, like any life stressor, presents a major challenge to our coping skills. I speak about this on my website. Binge eating and zoning out on Netflix will not improve your coping skills. They are just ways to try to escape from anxiety. Hoarding toilet paper or panic buying will also not accomplish this. They are signs of over-reacting to anxiety.

Instead, focus on what you can do in this moment. Worry is normal and natural, and can help us to eliminate threat. However, worry cannot get all of our troubles to take a hike. Once we have taken our protective actions, we can focus on how to make our lives better and to nurture and enjoy our relationships and all that is important to us.

Once that struggle switch is turned “OFF,” you will see that you can commit to your values – even with anxiety coming along for the ride. 

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

I’m Lonely. Are You Lonely Too?

By Ann Marie Gaudon, PNN Columnist

We are born for connection and being socially separated is bad for our physical and emotional health. From altering our immune systems to creating more inflammation to increasing the risk of heart disease and stroke, the health consequences of loneliness are significant.

Being a chronic pain patient can put you at even greater risk of being lonely. On the one hand, we know that social isolation is unhealthy, but on the other hand, we don’t have a choice as we must practice social distancing and self-isolation to protect ourselves and others from the coronavirus.

I’m lonely, you’re lonely – now what?

Don’t Do This

Do not attempt to run from your loneliness by zoning out for hours on end with Netflix or video games, consuming too much alcohol or other substances, or over-eating.  Trying to escape loneliness that way might give you some reprieve in the short-term, but those strategies will suck the life out of you in the long-term.

Trying to avoid or suppress feelings actually has a rebound effect in that they become stronger and more invasive in our lives. Avoidance is not a benign strategy and can have catastrophic results.

Do This Instead

Pay attention on purpose. Slow down, notice and name it. For example, “I am feeling lonely. It feels heavy and sluggish in my heart.”

Can you let this feeling be there just as it is, without judging or evaluating it? Without reacting to it? Can you just slow down and let your body feel what it is feeling? Can you let go of the urge to do anything at all with this feeling of loneliness? This is a normal response to an abnormal situation and your body is wise to this, so let it be.

Make an intention. Ask yourself, “What will I do with this feeling of loneliness now? My mind sees this as something that makes me weaker, unlovable and sad. But I choose not to buy into this. I accept that this loneliness is mine. What will I do with it now that it is here?”

The way out of this suffering is to behave your way out of it. Changing your behaviour will change the way people interact with you and will also change the way you interact with yourself. Make an intention to change your behaviour while holding the loneliness lightly, as you might hold a butterfly on your hand.

Expand your experience. You’re not going to shrink away from your experience of loneliness, but rather learn from it. We hurt where we care. Loneliness tells us that we care deeply about relationships. If we didn’t, we wouldn’t feel anything at all.

You will learn that your experience cannot bring you to your knees or ruin your life. You will learn that you can go through hell on earth and still treat yourself in a non-judgmental, non-reactive way. You will learn to wrap yourself in the warmth of self-kindness – even in moments of loneliness – and expand out into life to be part of this world.

Stay Connected

If you are reading this, you already have at least one technology that you will use to move forward with a new meaning. How you take control over what you do have control over – your behaviour – will be up to you, so choose something that you value.

People all over this planet are getting creative with ways to connect with each other. Stay connected to those you love. Use your phone or software such as Skype or Zoom. Use whatever floats your boat, just remain consistently connected.

There’s a virtual world out there for everyone. You can access therapy, support groups, entertainment of all kinds, exercise of all kinds, and even stream from your local library. How about taking that online course right now that you’ve been putting off? The great thing is that you can connect with a resource anywhere in the world.

The take-away message is this: Feel what you feel and make an intention to change your behaviour. Expand your world even if has to be online right now. Talk with people, laugh with people and cry with people.

The point is to emotionally connect during these especially lonely times. Texting, emailing, speaking, video-conferencing – the sky's the limit. Change your behaviour and change your life. Self-isolation need never mean emotional isolation.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.