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Impact of the COVID-19 Pandemic on Adolescent Mental Health

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Even before the COVID-19 pandemic began, concerning mental health trends and major treatment gaps were noted among adolescents in the United States. According to data from the National Survey on Drug Use and Health, an estimated 13.3% of US adolescents aged 12-17 experienced at least 1 episode of major depressive disorder in 2017, yet 60.1% of these individuals did not receive treatment for their illness.1

In addition, survey results from the Centers for Disease Control and Prevention demonstrated increasing rates of US high school students experiencing persistent sadness or hopelessness (from approximately 26% in 2009 to 37% in 2019), serious contemplation of suicide (from 14% to 19%), suicide planning (from 11% to 16%), and suicide attempts (from 6% to 9%). The highest risk levels were observed for White, female, and sexual minority students compared with non-White, male, and heterosexual students.2

Early findings indicate that these issues are being further exacerbated by the current crisis, with an especially high risk of worsening mental health among individuals with pre-existing psychological problems. These results have shown increased symptoms of depression, anxiety, and post-traumatic stress disorder among youth of various age groups.3,5 “The number, severity and duration of these symptoms are influenced by age, history of trauma, psychological status before the event, hours spent watching media coverage of the event, having a family member who died and the presence or absence of social and economic supports,” wrote Hertz and Barrios in a paper published in February 2021 in Injury Prevention.2


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They noted that school closures may reduce access to mental health screening and care for vulnerable students, considering the large number of adolescents — nearly 3.5 million in 2018 — receiving such services in educational settings.2 These settings represent the only source of mental health services for many adolescents, particularly those from low‐income households and racial and ethnic minority groups. The authors thus emphasized the heightened importance of collaboration between schools and community health professionals to address the growing mental health needs of students.

Adolescents and other youth are also affected by the impact of the pandemic on their caregivers, including unemployment, financial and emotional stress, and fear of infection, highlighting the need for adults to receive adequate care and support as well.6,7 Some youth have been forced to spend more time in abusive or otherwise dysfunctional homes due to quarantine requirements.

“Assessing the relative safety of a child at home is one of the major challenges posed to mental health professionals during a pandemic,” according to a November 2020 paper co-authored by Cécile Rousseau, MD, researcher, psychiatrist, and professor in the division of social and transcultural psychiatry at McGill University in Montreal, Canada.6 “Fueled by parental stress and in the absence of the benevolent gaze of the school or daycare, the risk of maltreatment is increasing as the rate of cases reported to youth protection is decreasing.”

Providers at hospitals across the US are reporting alarming increases in rates of attempted and completed suicides among youth — especially teenagers. One school district in Las Vegas has lost 19 children to suicide since the pandemic began. Regarding the increasing number of pediatric patients presenting to hospitals nationwide with suicidal ideation, clinicians have described them as having “worse mental states” compared to similar patients typically seen before the pandemic.8

Such trends underscore the vital importance of youth outreach and creative intervention and support during these times. Mental health providers “must continue to advocate to ensure that families and children get the mental health support that they need to support resilience, to decrease family conflict and child maltreatment, and to decrease risk-taking, unsafe, and dangerous behaviors,” as stated in the November 2020 article.6

We recently interviewed Dr Rousseau to further discuss these issues and potential solutions.

Cécile Rousseau, MD

What are believed to be the reasons for the generally low rates of mental health treatment among adolescents even pre-pandemic?

I believe there are 2 main reasons: First, MH services are overall difficult to access and often not very user-friendly for youth. Although some emerging models are addressing this, they are not generalized. Second, there is a widespread tendency to confound psychological distress and its expression — through sadness, anxiety, and anger — and mental disorder.

The first is associated with life being hurtful, which is very common, while the second is associated with more individual vulnerabilities. Of course, the 2 phenomena overlap, but in past times, distress was not medicalized or an object of treatment. Rather, it was addressed through interpersonal networks, spirituality, and so on. In the past decades there has been a shift in paradigm.

How has the pandemic affected and exacerbated mental health issues in this population?

The pandemic has generated first an acute stress response — which is normal, with fear and panic reactions, among others. To a certain extent, this has supported adherence to public health measures. As time passes, this becomes a chronic stress reaction with predominant avoidance symptoms such as denial and minimization of the pandemic risk. Frustration and anger regarding constraints have also increased, leading to scapegoating through conspiracy theories, and to legitimation of violence.

These are widespread reactions, which are not within the disorder range. For many people with vulnerabilities, however, the pandemic has exacerbated their symptoms, except for some cases of phobia — particularly school phobia — or cyberdependence, as these individuals may enjoy the confinement.

What are the relevant recommendations for clinicians about how to address these issues in practice and advocate for their adolescent patients?

Clinically, outreach to our patients to maintain continuity of care is crucial. In cases of frequent family conflict, virtual care should be used cautiously as it may not provide the needed confidentiality and safety and may aggravate the family conflict in some cases.

For new cases, management should include decreasing the impact of the collateral consequences of the pandemic — most commonly from social isolation and lack of stimulation — on adolescents’ development.

What are some of the broader, longer-term solutions that are also warranted?

Schools and colleges should be at the forefront of prevention. In Canada, pediatricians have advocated for the return of youth to school and the preservation of their social network (not partying, of course!). Youth need their peers to pursue their individuation-separation task, and this has been made impossible during confinement. We need to find a balance between the security of the elderly and the fulfillment of adolescent developmental needs.

References

  1. Major depression. National Institute of Mental Health. Updated February 2019. Accessed online February 7, 2021. https://www.nimh.nih.gov/health/statistics/major-depression.shtml
  2. Hertz MF, Barrios LC. Adolescent mental health, COVID-19, and the value of school-community partnerships. Inj Prev. 2021;27(1):85-86. doi:10.1136/injuryprev-2020-044050
  3. Rogers AA, Ha T, Ockey S. Adolescents’ perceived socio-emotional impact of COVID-19 and implications for mental health: results from a U.S.-based mixed-methods study. J Adolesc Health. 2021;68(1):43-52. doi:10.1016/j.jadohealth.2020.09.039
  4. Liang L, Ren H, Cao R, et al. The effect of COVID-19 on youth mental healthPsychiatr Q. 2020;91(3):841-852. doi:10.1007/s11126-020-09744-3
  5. Ma Z, Zhao J, Li Y, et al. Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiol Psychiatr Sci. 2020;29:e181. doi:10.1017/S2045796020000931
  6. Rousseau C, Miconi D. Protecting youth mental health during the COVID-19 pandemic: a challenging engagement and learning process. J Am Acad Child Adolesc Psychiatry. 2020;59(11):1203-1207. doi:10.1016/j.jaac.2020.08.007
  7. Chatterjee R. Make space, listen, offer hope: How to help a suicidal teen or child. NPR. Published online February 2, 2021. Accessed online February 7, 2021. https://www.npr.org/sections/health-shots/2021/02/02/962185779/make-space-listen-offer-hope-how-to-help-a-child-at-risk-of-suicide
  8. Chatterjee R. Child psychiatrists warn that the pandemic may be driving up kids’ suicide risk. NPR. Published online February 2, 2021. Accessed online February 7, 2021. https://www.npr.org/sections/health-shots/2021/02/02/962060105/child-psychiatrists-warn-that-the-pandemic-may-be-driving-up-kids-suicide-risk

This article originally appeared on Psychiatry Advisor

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Source: https://www.medicalbag.com/home/medicine/adolescent-mental-health-issues-are-further-exacerbated-by-the-covid-19-pandemic/

Covid19

June 18 Web Event: Asian Immigrant Experiences with Racism, Immigration-related Fears, and the COVID-19 Pandemic

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While the country has collectively experienced health and economic difficulties with the COVID-19 pandemic, certain groups have experienced a disproportionate impact. The Asian American community has had to cope with the burden of pandemic-related racism and, as one of the fastest growing immigrant communities in the nation, immigration-related fears due to policy and regulatory action of recent years. Yet, there is often limited data and focus on the experiences of the expanding Asian immigrant community. KFF is hosting a June 18 public web event to highlight and discuss the complex set of challenges facing Asian immigrants and strategies to address them.

The one-hour interactive web event begins at 12 p.m. ET on Friday, June 18, featuring remarks from U.S. Congresswoman Judy Chu, who has been a leading voice on many of the issues to be discussed and chairs the Congressional Asian Pacific American Caucus. Findings from a new KFF survey of Asian American patients from four community health centers will be released at the event with a panel discussion and audience questions to follow.

Welcome and Keynote Remarks

  • KFF Executive Vice President for Health Policy Larry Levitt (moderator)
  • U.S. Congresswoman and Chair of Congressional Asian Pacific American Caucus The Honorable Judy Chu
  • Chief Program Director of Blue Shield of California Foundation Carolyn Wang Kong

Presentation of Survey Findings

  • KFF Vice President and Director of the Racial Equity and Health Policy Program Samantha Artiga

Panel Discussion

  • Director of Policy and Advocacy at the Association of Asian Pacific Community Health Organizations (AAPCHO) Adam Carbullido
  • Vice President of Strategic Initiatives at International Community Health Services Sunshine Monastrial
  • Chief Deputy of Administration at Asian Health Services Thu Quach

The one-hour event will conclude with a question-and-answer session.

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Source: https://www.kff.org/racial-equity-and-health-policy/event/june-18-web-event-asian-immigrant-experiences-with-racism-immigration-related-fears-and-the-covid-19-pandemic/

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G-7 Leaders Are Set To Pledge 1 Billion Coronavirus Vaccines To Other Countries

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President Biden and British Prime Minister Boris Johnson speak during a bilateral meeting ahead of the G-7 summit on Thursday in Carbis Bay, England. Patrick Semansky/AP hide caption

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Patrick Semansky/AP

World leaders of the Group of Seven are expected to announce today a commitment to share 1 billion of their COVID-19 vaccine resources with the lower income countries struggling to control the spread of the virus.

On Thursday, President Biden announced plans for the U.S. to donate 500 million doses of the Pfizer COVID-19 vaccine globally. The first 200 million are expected to be distributed this year and the rest will follow in 2022.

“Our values call on us to do everything that we can to vaccinate the world against COVID-19,” Biden said of the decision. “It’s also in America’s self-interest. As long as the virus rages elsewhere, there’s a risk of new mutations that could threaten our people.”

Canada, France, Germany, Italy, Japan, the United Kingdom and the U.S. make up the G-7.

The move by the wealthy democracies to share their vaccine stockpiles comes as high vaccination levels in those countries have led to a decline in infections, hospitalizations, and deaths. Enough improvements have been made in the U.S. and U.K. for coronavirus-related protocols to ease.

But in South Asia and Latin America, countries are still struggling to contain the virus.

In late May, the World Health Organization urged wealthier countries to contribute more to COVAX and requested at least 1 billion excess doses by the end of 2021. The COVAX program distributes mass quantities of vaccines to countries based on their populations.

“By donating vaccines to COVAX alongside domestic vaccination programmes, the most at-risk populations can be protected globally, which is instrumental to ending the acute phase of the pandemic, curbing the rise and threat of variants, and accelerating a return to normality,” WHO said in a statement in May.

Biden and the other G-7 leaders are in the U.K. for the first meeting in about two years. The meeting is set to open today at Carbis Bay, a seaside resort in Cornwall in southwest England.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/06/11/1005437511/g-7-leaders-to-pledge-1-billion-vaccines-to-countries-struggling-with-covid-19

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COVID-19 and heart attack risk

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COVID-19 and heart attack

Does a positive diagnosis of COVID-19 increase the risk of heart attacks for those with pre-existing atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH)?

It has been shown that higher rates of COVID-19 deaths can be associated with hypertension, heart failure, and cardiovascular disease. However, there were fewer patients reporting acute myocardial infarction (AMI), or heart attacks, when visiting hospitals during the pandemic.

Researchers from across the United States gathered the data from approximately 55 million individuals for this study. They were divided into six categories based on the information available, which included combinations of diagnosed FH, probable FH, diagnosed ASCVD, and none of the above. Differences amongst individuals were examined, and included variables such as sex, age, ethnicity, and education levels. Other diseases or medical conditions, cholesterol prescriptions, and any history of cardiac issues were all taken into account to develop a baseline for the study.

Establishing these factors and taking them into consideration accounted for any baseline differences among the participants. Those conducting the study were then able to compare the six groups, and more effectively compare who tested positive for COVID-19 among the groups, and who did not.

When testing positive for COVID-19, it was found that there was a higher risk of AMI for those individuals with both diagnosed and probable FH and those with pre-existing ASCVD. There was also a higher risk of AMI observed when compared to other COVID-19 positive patients without ASCVD or FH.

The complete medical history wasn’t available for all of the participants included in this study, resulting in some notable limitations. Individuals that had a history of ASCVD or FH may have not been placed in the correct group for comparison due to missing data.

Although many variables were taken into account to establish baseline difference amongst group members, other factors such as obesity were not considered. The researchers also investigated whether there were any correlations between lipid lowering therapies (LLT) and people with FH who did and did not test positive for COVID-19. There wasn’t a significant relationship between people taking LLT and those not, as the analyses lacked statistical power.

These findings may encourage those with ASVD and FH to receive a COVID-19 vaccination due to the increased risk of AMI. Additionally, this highlights the importance of diagnosing familial hypercholesterolemia, which could help to improve the health of the individual and providing proper treatment.

Source:

Myers, K, D., et al. (2021) COVID-19 associated risks of myocardial infarction in persons with familial hypercholesterolemia with or without ASCVD. American Journal of Preventive Cardiology. doi.org/10.1016/j.ajpc.2021.100197.

Image by PIRO4D from Pixabay 

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Source: https://medicalnewsbulletin.com/covid-19-and-heart-attack-risk/

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Hey Washingtonians! Get A Vaccine. Smoke A Joint.

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Washington is offering free, pre-rolled joints to adults who get the COVID-19 vaccine. Here, a person smokes a joint in The Netherlands. Robin Van Lonkhuijsen/AFP via Getty Images hide caption

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Robin Van Lonkhuijsen/AFP via Getty Images

Still anxious about getting the COVID-19 vaccine? Washington state is offering adults a relaxing new incentive — marijuana joints.

The program, launched by the state’s Liquor and Cannabis Board and named “Joints for Jabs,” runs until July 12 and allows state-licensed dispensaries to give qualifying customers one pre-rolled joint at an in-store vaccination clinic.

Eligible participants must be 21 years old or older and have to have received their first or second dose during that visit.

This is only the latest among Washington’s abundant vaccination incentives, which include free tickets to sports events and a lottery totaling up to $1 million. Just a few weeks ago, the Liquor and Cannabis Board announced an incentive that allows breweries, wineries, and restaurants to offer free drinks to vaccinated adults.

Washington’s newest promotion reflects a multitude of unique vaccination incentives being offered across the country, and the state isn’t the first to offer weed.

In exchange for proof of vaccination, an Arizona dispensary’s “Snax for Vaxx” campaign provides free joints and edibles. In Washington, D.C., cannabis advocacy group D.C. Marijuana Justice distributed joints at vaccination sites on April 20.

As of June 9, nearly 49% of Washington residents have been fully vaccinated.

Josie Fischels is an intern on NPR’s News Desk.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/06/09/1004752026/washington-offers-marijuana-cannabis-vaccine

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