Depression & Mental Health Issues Re: Covid 19

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Re: Depression & Mental Health Issues Re: Covid 19

Post by trader32176 »

Researchers provide new evidence that fear and anxiety reflect overlapping brain circuits

10/19/20 ... cuits.aspx

Anxiety, the most common family of mental illnesses in the U.S., has been pushed to epic new heights by the COVID-19 pandemic, with the Centers for Disease Control and Prevention estimating that nearly 1 in 3 U.S. adults and a staggering 41% of people ages 18-29 experienced clinically significant anxiety symptoms in late August. Now, the findings of a recent UMD-led study indicate that some long-accepted thinking about the basic neuroscience of anxiety is wrong.

The report by an international team of researchers led by Alexander Shackman, an associate professor of psychology at UMD, and Juyoen Hur, an assistant professor of psychology at Yonsei University in Seoul, South Korea, provides new evidence that fear and anxiety reflect overlapping brain circuits. The findings run counter to popular scientific accounts, highlighting the need for a major theoretical reckoning. The study was published last week in the Journal of Neuroscience.

"The conceptual distinction between 'fear' and 'anxiety' dates back to the time of Freud, if not the Greek philosophers of antiquity," said Shackman, a core faculty member of UMD's Neuroscience and Cognitive Science Program, and 2018 recipient of a seed grant award from UMD's Brain and Behavior Initiative, "In recent years, brain imagers and clinicians have extended this distinction, arguing that fear and anxiety are orchestrated by distinct neural networks.

However, Shackman says their new study adds to a rapidly growing body of new evidence suggesting that this old mode is wrong. "If anything, fear and anxiety seem to be constructed in the brain using a massively overlapping set of neural building blocks," he said.

Prevailing scientific theory holds that fear and anxiety are distinct, with different triggers and strictly segregated brain circuits. Fear--a fleeting reaction to certain danger--is thought to be controlled by the amygdala, a small almond-shaped region buried beneath the wrinkled convolutions of the cerebral cortex. By contrast, anxiety--a persistent state of heightened apprehension and arousal elicited when threat is uncertain--is thought to be orchestrated by the neighboring bed nucleus of the stria terminalis (BNST). But new evidence from Shackman and his colleagues suggests that both of these brain regions are equally sensitive to certain and uncertain kinds of threats.

Leveraging cutting-edge neuroimaging techniques available at the Maryland Neuroimaging Center, their research team used fMRI to quantify neural activity while participants anticipated receiving a painful shock paired with an unpleasant image and sound--a new task that the researchers dubbed the "Maryland Threat Countdown".

The timing of this "threat" was signaled either by a conventional countdown timer--i.e. "3, 2, 1..."--or by a random string of numbers--e.g. "16, 21, 8." In both conditions, threat anticipation recruited a remarkably similar network of brain regions, including the amygdala and the BNST. Across a range of head-to-head comparisons, the two showed statistically indistinguishable responses.

The team examined the neural circuits engaged while waiting for certain and uncertain threat (i.e. "fear" and "anxiety"). Results demonstrated that both kinds of threat anticipation recruited a common network of core brain regions, including the amygdala and BNST.

These observations raise important questions about the Research Domain Criteria (RDoC) framework that currently guides the U.S. National Institute of Mental Health's quest to discover the brain circuitry underlying anxiety disorders, depression, and other common mental illnesses. "As it is currently written, RDoC embodies the idea that certain and uncertain threat are processed by circuits centered on the amygdala and BNST, respectively. It's very black-and-white thinking," Shackman noted, emphasizing that RDoC's "strict-segregation" model is based on data collected at the turn of the century.

"It's time to update the RDoC so that it reflects the actual state of the science. It's not just our study; in fact, a whole slew of mechanistic studies in rodents and monkeys, and new meta-analyses of the published human imaging literature are all coalescing around the same fundamental scientific lesson: certain and uncertain threat are processed by a shared network of brain regions, a common core," he said.

As the crown jewel of NIMH's strategic plan for psychiatric research in the U.S., the RDoC framework influences a wide range of biomedical stakeholders, from researchers and drug companies to private philanthropic foundations and foreign funding agencies. Shackman noted that the RDoC has an outsized impact on how fear and anxiety research is designed, interpreted, peer reviewed, and funded here in the U.S. and abroad.

" Anxiety disorders impose a substantial and growing burden on global public health and the economy. While we have made tremendous scientific progress, existing treatments are far from curative for many patients. Our hope is that research like this study can help set the stage for better models of emotion and, ultimately, hasten the development of more effective intervention strategies for the many millions of children and adults around the world who struggle with debilitating anxiety and depression."

- Alexander Shackman, Associate Professor of Psychology, UMD


University of Maryland

Journal reference:

Hur, J., et al. (2020) Anxiety and the Neurobiology of Temporally Uncertain Threat Anticipation. Journal of Neuroscience.
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Re: Depression & Mental Health Issues Re: Covid 19

Post by trader32176 »

Initial phase of COVID-19 lockdown decreased sleep, exercise and mental health

10/23/20 ... ealth.aspx

A first-of-its-kind global survey shows the initial phase of the COVID-19 lockdown dramatically altered our personal habits, largely for the worse.

" The stay-at-home orders did result in one major health positive. Overall, healthy eating increased because we ate out less frequently. However, we snacked more. We got less exercise. We went to bed later and slept more poorly. Our anxiety levels doubled."

- Leanne Redman, PhD, Associate Executive Director, Scientific Education, Pennington Biomedical Research Center

The global survey evaluated the inadvertent changes in health behaviors that took place under the pandemic's widespread restrictions. Researchers found that the lockdown's effects were magnified among people with obesity.

"Overall, people with obesity improved their diets the most. But they also experienced the sharpest declines in mental health and the highest incidence of weight gain," Dr. Redman said. "One-third of people with obesity gained weight during the lockdown, compared to 20.5 percent of people with normal weight or overweight."

The online survey study ran during the month of April. More than 12,000 people worldwide took a look at the survey and 7,754 completed the detailed online questionnaire. The majority of the respondents were in the United States, with half from Louisiana. Residents of Australia, Canada, the United Kingdom, and more than 50 other countries also responded.

Those who took the survey reacted to the pandemic in largely the same way whether they live in Louisiana, elsewhere in the United States or abroad.

"This study is the first to survey thousands of people across the globe on lifestyle behavior changes in response to stay-at-home orders. Groundbreaking research like this is part and parcel of Pennington Biomedical's mission.

The study demonstrates that chronic diseases like obesity affect our health beyond the physical," said Executive Director John Kirwan, PhD. "Dr. Redman's study is just one of many initiatives the center launched to help understand COVID-19's impact and to slow its spread."

The research team would like physicians and scientists to modify the way they manage patients with obesity in two ways, said Emily Flanagan, PhD, lead author of the study and a postdoctoral researcher in Dr. Redman's Reproductive Endocrinology and Women's Health Laboratory.

By increasing the number of mental health screenings during and after the pandemic.
By remaining connected to patients/study participants through remote visits and telehealth to prevent irreversible health effects from the pandemic. So-called virtual visits can assuage patients' concerns about the safety of in-person visits.


Pennington Biomedical Research Center

Journal reference:

Flanagan, E. W., et al. (2020) The impact of COVID‐19 stay‐at‐home orders on health behaviors in adults. Obesity.
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Re: Depression & Mental Health Issues Re: Covid 19

Post by trader32176 »

For each critically ill COVID patient, a family is suffering, too

10/28/20 ... g-too.aspx

The weeks of fear and uncertainty that Pam and Paul Alexander suffered as their adult daughter struggled against COVID-19 etched itself into the very roots of their hair, leaving behind bald patches by the time she left the hospital in early May.

Tisha Holt had been transferred by ambulance from a smaller hospital outside Nashville, Tennessee, to Vanderbilt University Medical Center on April 14, when her breathing suddenly worsened and doctors suspected COVID-19. Within several days her diagnosis had been confirmed, her oxygen levels were dropping, and breathing had become so excruciating that it felt like her "lungs were wrapped in barbed wire," as Tisha describes it.

Vanderbilt doctors put the 42-year-old on a mechanical ventilator, and the next few weeks passed in a blur for her parents, who waited helplessly for the next update about the eldest of their three children.

"That's when it got really, really bad," Pam said. "We were not allowed to see her, to go, to talk to her — not anything. I would call. And I might get somebody, and then again I might not." Later that first week after Tisha arrived at Vanderbilt, Pam reached a nurse. "She said, 'Ms. Alexander, in all probability your daughter will die today.' Me and my husband both, we just cried and cried."

It "was probably more than likely the worst day of my life when the nurse told us that," Paul said. "She was our first baby, and the first person that I've held that was part of me."

The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can't sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

Studies show that about one-fourth of family members, and sometimes more, experience at least one symptom of PICS-Family, including anxiety, depression, post-traumatic stress disorder or "complicated grief" — grief that is persistent and disabling — when their loved one has been hospitalized, according to a 2012 review article published in the journal Critical Care Medicine. Dr. Daniela Lamas, a critical care physician at Boston's Brigham and Women's Hospital, believes relatives and friends of coronavirus patients may be particularly vulnerable.

Hospital rules designed to prevent the spread of the virus have robbed them of the opportunity to sit with their loved ones, watching clinicians provide medical care and gradually processing what's happening between physician updates, Lamas said. In pre-pandemic times, a nurse "would explain what they had heard [from the doctor] and help them come to terms with unacceptable realities," she said.

Life becomes a daze

The Alexanders could reach a doctor or nurse on most days. But not always, said Pam, acknowledging that "they had a lot to do." Pam described trying to cope minute to minute, day to day, waiting for the next report from the hospital, wandering from room to room. "You just walk around sort of in a daze. You can't think about anything else but that."

Paul struggled with feelings of depression, often retreating to his workshop. "I wouldn't do anything but sit there and cry, wouldn't work on nothing, just sit there with my head in my hands."

Meanwhile, they had become temporary parents to their grandsons, two teenagers who had homework and laundry and kept asking about their mom. Pam tried to shield them as much as possible. "There are a lot of things I just didn't tell them until it got really bad," she said.

Being physically cut off from their daughter was the hardest, Pam and Paul said. "I don't care if I had to put on 40 layers of clothes," Pam said. "Just to have gotten to go in and touch her and see her would have made a huge difference."

Even though family members are typically barred from visiting during the pandemic, they can wrestle with guilt that they let a loved one down in his or her time of need, said Jim Jackson, a psychologist and assistant director at Vanderbilt's ICU Recovery Center.

Without any visual sense of what's going on, "people often move to worst-case scenarios; they move to catastrophic thinking," he said. "And why wouldn't they, because it's already a hugely serious situation, right? It's a five-alarm fire and they're not able to be engaged."

Seeking healing

Doctors and nurses can ease the strain on loved ones by updating a designated family member at least once a day, said Judy Davidson, a nurse scientist at the University of California-San Diego and an author of the 2012 Critical Care Medicine review article. Arrange video calls, she suggested, so the family can see their loved one and better picture the room, clinicians and broader hospital environment.

"If we don't protect them and keep them strong while the person is in the ICU," Davidson said, "they won't be strong enough to do the caregiving that's necessary once the person comes home."

After a patient does return home, family members may shy away from discussing what they have been through, so as not to burden their still recovering loved one, Jackson said. The ICU survivor may remain silent for similar reasons, he said.

"What tends to happen is they both sort of passively agree not to talk about the elephant in the room, when that's exactly the best thing to do," Jackson said.

Tisha — who finally left the hospital May 3 — was stunned by her parents' appearance the first time she saw them. "They both looked exhausted and I was shocked at the amount of hair that they'd lost," she wrote in an email. Treatment and damaged lungs have made it difficult for her to talk by phone.

Since then, her parents' bald spots have begun to fill in, but they haven't released their worry. Tisha can breathe from only the top of her lungs and needs 24-hour oxygen, Pam said. She's not strong enough to return to work as a nurse, a job she loved. She no longer has health insurance and can't afford even the cheapest plan on the Affordable Care Act exchanges. To this day, Tisha doesn't know where she contracted the virus.

Her parents spend virtually all waking hours at Tisha's home, about a 10-minute drive from their house, and check on her a few times daily, sometimes more often if she's feeling poorly, Pam said. "I think, 'Am I going to come over here and she's going to be dead from her heart not working?' It scares me to death because she has bad days and good days."

Tisha keeps her cellphone handy in case they text or call. "If they call and I don’t answer, it sends them into a panic and they are apt to drive over here to make sure everything is alright," she wrote.

She's been attending a virtual ICU survivors support group at Vanderbilt that Jackson helps lead. It's open to relatives, but Pam was unsure she could handle hearing others' painful stories as she's still processing her own. "I don't mind talking to you about it," she said, "but sometimes talking about it just sort of gets you in a funk."

Their church community has provided solace, calling when Tisha was in the hospital and leaving food on the porch. Pam and Paul credit a myriad of prayers from loved ones near and far with bringing their daughter home. "Even the doctors, they really didn't know why she was still here either, to be honest with you," Paul said.

He hasn't stopped fretting about his eldest child. "I still can't turn it off — it hasn't turned off," Paul said. "But every day is a blessing, though."
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Re: Depression & Mental Health Issues Re: Covid 19

Post by trader32176 »

Pandemic worsened older adults' mental health & sleep; others show long-term resilience

Nearly 1 in 3 express reservations about seeking help if they need it, suggesting need for more screening and reducing stigma on seeking care

5/4/21 ... 050321.php

Nearly one in five older adults say their mental health has gotten worse since the pandemic began in March 2020, and an equal percentage say their sleep has suffered in that time too. More than one in four say they're more anxious or worried than before the COVID-19 era, according to a new poll of people age 50 to 80.

Women, people in their 50s and early 60s, and older adults who have a college degree or higher were more likely than others to report worse mental health than before the pandemic, according to the new findings from the National Poll on Healthy Aging. Older adults who say their physical health is fair or poor were most likely to report worse mental health, with 24% saying this.

And when asked about the last two weeks before they were surveyed, the percent who said they had concerning mental health symptoms was even higher, with 28% saying they felt depressed or hopeless in that time, 34% saying they'd been nervous or anxious, and 44% saying they'd recently felt stressed.

Just under two-thirds (64%) said they had had trouble falling asleep or staying asleep at least once in the past week, twice the percentage who said this in a 2017 poll of a similar group of older adults.

The poll is based at the University of Michigan's Institute for Healthcare Policy and Innovation and receives support from AARP and Michigan Medicine, U-M's academic medical center. It draws from the answers of a national sample of more than 2,000 adults aged 50 to 80 to a poll in late January, when COVID-19 case rates were high across the nation and vaccination of older adults had just begun.

The poll also reveals hopeful signs that many older adults are showing long-term resilience. Two-thirds say their current mental health is excellent or very good. Just over 80% say their mental health is as good as, or better than, it was 20 years ago.

Just under half (46%) of the respondents say they feel isolated, which is down from 56% in a similar poll taken in spring 2020, but up from 28% before the pandemic. Nearly one in three (29%) say that they have made a lifestyle change to improve their mental health since the start of the pandemic such as exercise, diet, and meditation.

"As we enter a new phase of the pandemic, with most older adults getting vaccinated, it's important to ensure adequate access to mental health screening and care to detect and address any lingering effects of this prolonged period of stress," says Lauren Gerlach, D.O., M.Sc., a geriatric psychiatrist at Michigan Medicine who worked with the poll team. "This is especally important to those who might have a harder time accessing mental health care, including those with lower incomes and worse physical health."

The data also suggest that older adults are more open to seeking mental health help than past research might suggest, with 71% saying they wouldn't hesitate to see a mental health professional in the future, and 13% saying they had talked with their primary care provider about a new mental health concern since the pandemic began.

Poll director Preeti Malani, M.D., a Michigan Medicine infectious disease physician also trained in geriatrics, notes that primary care physicians play a key role in identifying, monitoring and treating the mental health concerns of older adults.

"It's encouraging to see that nearly one-third of the older adults rated their primary care provider as the person they'd most want to talk with about mental health concerns, and that 19% said they'd actually done so in the last two years," she says. "Health systems and insurers should support this role, and efforts to reduce stigma around seeking help for the patients who still feel this way."

Among the 29% of older adults who said they would hesitate to see a mental health professional for treatment in the future, common reasons were that they thought it wouldn't help, that they'd feel embarassed or that they had worries about the cost.

"Older adults have been hit hard by the COVID-19 pandemic, and it has impacted mental health for many," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We are seeing bright spots of resiliency in some during such a difficult time, but we must continue to provide support as we emerge from the pandemic and cope with the aftermath."
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Re: Depression & Mental Health Issues Re: Covid 19

Post by trader32176 »

Uncertainty during first COVID-19 lockdown had negative impact on mental health

5/4/21 ... ealth.aspx

Many people in Switzerland experienced considerable psychological distress during the first COVID-19 lockdown from mid-March to the end of April 2020.

Researchers from the Department of Child and Adolescent Psychiatry and Psychotherapy at the University Hospital of Psychiatry Zurich (PUK) and the University of Zurich in collaboration with the La Source School of Nursing have now examined the most common sources of stress among children, adolescents, their parents and young adults. For their study, the researchers used representative samples in Switzerland of 1,627 young adults aged 19 to 24 as well as 1,146 children and adolescents between the ages of 12 and 17 and their parents.
Uncertainty, disruption, postponement

" Uncertainty during last year's lockdown was considerable and had a negative impact on mental health."

- Meichun Mohler-Kuo, Professor, La Source and University Hospital of Psychiatry Zurich

Children and adolescents felt most stressed by having to change, postpone or cancel important plans or events and being unable to participate in social activities and normal routines during leisure time and at school. The main sources of stress for adults were not knowing when the pandemic will end, coping with the massive disruptions to social life and having to reorganize work and family life.

Mental health problems of young adults

The study found that many young adults, and young women in particular, experienced symptoms of mental illness during the first lockdown. More than half (54%) of young women and 38% of young men reported mild to severe symptoms of depression. Almost half of young women (47%) and one-third (33%) of young men experienced mild to severe anxiety. "In general, these results are quite similar to the results from a representative study carried out in 2018," Mohler-Kuo says. "It's notable, however, that monthly risky alcohol use decreased dramatically during lockdown, from 34% to 21%. This decrease was more pronounced in women than in men."

Mental health problems in over one-third of kids

Overall, more than one-third of the children and adolescents screened positive for one of the mental health problems assessed in the study. More than 20% of boys and girls showed symptoms related to attention deficit hyperactivity disorder (ADHD). 18% of girls and 11% of boys displayed unruly and angry behavior and thus symptoms of what is known as oppositional defiant disorder (ODD).

"This came as a surprise, since these symptoms had previously been observed less frequently overall, but significantly more often in boys than in girls," says Susanne Walitza, last author of the study. In addition, 14% of girls and 13% of boys experienced anxiety symptoms, while symptoms of depression were reported by 10% (girls) and 5% (boys). "Our findings show that children and adolescents are particularly at risk of developing mental disorders," says Walitza.
One-fifth with problematic internet use

For both children/adolescents and young adults, the median time spent on the internet per day was 240 minutes during lockdown. More than 40% of men and 35% of women used the internet for more than 4 hours per day, while about 8% of children, adolescents and young adults were online for more than 6 hours a day. Overall, 30% of children and 21% of young adults met the criteria for problematic internet use.
More help for kindergartens, schools and sports clubs

The findings demonstrate how important it is to maintain routines, schedules, social contacts and support structures during lockdown. The authors of the study thus recommend that health and education authorities should provide more support to institutions, such as kindergartens, schools, and sports organizations, to avoid the detriments of lockdowns.


University of Zurich

Journal reference:

Mohler-Kuo, M., et al. (2021) Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland. International Journal of Environmental Research and Public Health.
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