Category: Mental Health

Quicksand

The school year’s end tends to be accompanied with deadline crunches and stress. So as with the closing of last semester, I would like to end on a reflective note. The concept of quicksand was brought up in casual conversation and I got to thinking about how my mental schematic was entirely informed by action films of the ‘70s, ‘80s, ‘90s (and today!). This couldn’t be rooted in science, it’s too cinematic. So of course I Googled if quicksand is real, don’t judge me, and the kind I was imagining—that kind does not exist. Remember that scene in the Princess Bride? A total lie.

Then I began thinking about the metaphoric possibility that is quicksand. This passage is pulled from the BBC article “Can quicksand really sink you to your death?” and not only is it educational, it’s actually really beautiful and strangely reassuring:

Quicksand usually consists of sand or clay and salt that’s become waterlogged, often in river deltas. The ground looks solid, but when you step on it the sand begins to liquefy. But then the water and sand separate, leaving a layer of densely packed wet sand which can trap it. The friction between the sand particles is much-reduced, meaning it can’t support your weight anymore and at first you do sink. It is true that struggling can make you sink in further, but would you actually sink far enough to drown?

Beautiful and reassuring—because the answer is no. The quicksand itself won’t fully cover you because you’re buoyant. What can kill you is staying in their too long (tides, the elements, pressure making it difficult to breathe). With dry quicksand, you’ll need help from someone on solid ground. In the sludge that is wet quicksand, stay calm and allow your buoyant self to float back up to the surface.

Have a wonderful summer.

California: The Robin Hood of Mental Health

This week’s blog post was inspired by a reading from my health policy and management course about California’s tax on the wealthy and using the revenue to fund community based services for mental health. The state of California is acting as Robin Hood for mental health to take from the wealthy to help those who need the most. According to the article published by Kaiser Family Foundation, The Mental Health Services Act (or formerly known as Proposition 63) taxes 1% of California citizens whose annual income exceeds $1 million. It was passed into law in January 2005. Annually, this tax generates around $2 billion and since its inception has raised around $16.53 billion. The two major initiatives that are funded by this endeavor include prevention and early intervention for young adults and outcome improvement in individuals with severe mental health conditions. Results have shown that this tax has had a positive effect on the outcomes of individuals with mental health conditions. Hopefully we start to see more results come out of California and the positive outcomes that may encourage other states to adopt similar policies and move towards a culture of prevention instead of treatment of mental health.

To learn more about the law here is a link to the bill: http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx

References

https://khn.org/news/californias-tax-on-millionaires-yields-big-benefits-for-people-with-mental-illness-study-finds/

 

Discrimination and Health Part I: LGBTQ+ Americans

Past research has suggested that discrimination can impact health outcomes – perhaps through vehicles such as stress of daily interactions and negative experiences with the healthcare system. One group whose experiences with discrimination can be linked to negative health outcomes is LGBTQ+ Americans. A study found that over half of LGBTQ people have experience slurs and offensive comments, and over half have been sexually harassed or experienced violence, or had an LGBTQ friend or family member experience such trauma.

We can make the connection between discrimination and trauma through various factors. One is through microaggressions –  seemingly harmless daily interactions with others who express, in this case, homophobic or transphobic views. These have been found to negatively impact health. Another is through discrimination within the healthcare system that lead LGBTQ Americans to seek healthcare less frequently. 18% of this population has avoided necessary medical care. Various forms of discrimination they face at the hands of medical professionals, police, and community members are much worse for those of color and those who are transgender.

Unfortunately, we can already see the health outcomes of discrimination to this population – they have higher rates of psychiatric disorders, substance dependence (including higher tobacco use), and suicide; lesbian women are less likely to get preventative services for cancer, and gay men are at higher risk for certain STIs.

How can we work to eliminate these gaps, even when interpersonal discrimination may take longer to tackle as our culture continues to evolve? HealthyPeople2020 provides several recommendations. First, healthcare providers should discuss sexual orientation and gender identity (SOGI) respectfully with patients, and collect data on it. Medical students should be trained in LGBTQ culturally-responsive care. In addition, we must be spokespeople against legal discrimination of this population in social services such as employment, housing, and health insurance.

Sources:

https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

https://www.npr.org/documents/2017/nov/npr-discrimination-lgbtq-final.pdf

https://www.centerforhealthjournalism.org/2017/11/08/how-racism-and-microaggressions-lead-worse-health

https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race

http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/pdf/nihms134591.pdf

Khat: Dangerous drug, cultural pastime, or self-medication?

Khat is made from young leaves from the khat tree that are commonly chewed in the Horn of Africa and the Arab Peninsula. The drug produces stimulating effects and is said to make the chewer animated, energized, and social. Chewing can be done individually or as a social activity – in these gatherings, a communal tobacco pipe is placed at the center of the circle and passed around in addition to the khat. Khat chewing has become an extremely popular practice in the Horn of Africa – an estimated 90 percent of Somali men partake. Research suggests that this practice is associated with physical, psychological, and social risks, and the Somali diaspora is already one that faces high rates of PTSD and other mental health issues. Khat chewing may worsen these issues in the long run, but can also serve as a source of self-medication for those without resources for dealing with trauma.

There is controversy over khat in the countries where Somali refugees are resettling. Abukhar Awale, a Somali TV talk show host, suffered khat addiction himself and became a proponent of the ban. He called khat “the biggest barrier to our integration…segregating Somali youngsters from wider society…they do not contribute, they don’t speak English, they don’t feel they are part of the society.” On the other side, many argue that khat itself is not the problem, but the symptom of a society ravaged by war and trauma. They point to over-policing of people of color and the fact that the ban was associated very little support for those who were made to quit.

Sources:

http://www.itv.com/news/wales/2015-06-24/communities-criticise-lack-of-support-in-year-since-herbal-stimulant-khat-was-banned/

https://www.aljazeera.com/indepth/features/2015/03/somaliland-abuzz-ethiopia-khat-convoys-150325100843701.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075009/

Image retrieved from: TripSavvy

Are you processing or are you ruminating?

I am a self-described over-thinker.  From a young age, my family often complained that I over analyzed everything.  While this has served me well in many pursuits, I recently read that it may not be so great for my health.

According to a recent article by U.S. News and World Report, rumination over stressful or negative events may lead to prolonged psychological recovery time along with increased blood pressure and heart rate (1).  While I’m still an advocate for processing difficult situations, rumination is different.  Rumination typically leads to repeatedly and cyclically thinking about the same situation while creating moods that spiral downward (1).   People often end up ruminating without realizing it; they think they’re attempting to problem-solve instead (1).  I know this speaks to the analytical “Ms. Fix-it” in me.

According to the article, people can identify if they’re in rumination mode by asking themselves if their thoughts are unproductive, creating feelings of being overwhelmed, or causing distractions from their surroundings (1).  Suggestions to get past this include distraction by taking a walk or enjoying a hobby (1).

Now, all of this is said with a giant caveat-  if you feel like you need mental health help, get it.  Rumination often happens when people are dealing with something traumatic in their lives.  I am by no means telling you to shove your feelings down and avoid them.  What I am encouraging you to do is stop and ask yourself if you’re having the same negative thoughts over and over again.  If you feel like it’s something minor, you may want to stop and distract yourself to break the cycle.  If it’s something that’s a big deal to you, then you may need to enlist the help of a mental health professional.

Thinking about situations is helpful, but if three days have passed, and you’re still thinking about how the coffee-shop barista spelled your name wrong, you may be ruminating and hurting your health in the process.

 

Reference

  1. Colino, Stacey. The Hazards of Rumination for Your Mental and Physical Health. U. S. News and World Report. [Online] March 14, 2018. https://health.usnews.com/wellness/mind/articles/2018-03-14/the-hazards-of-rumination-for-your-mental-and-physical-health.

 

Study confirms grad students have higher rates of anxiety and depression

I’m currently in my second semester of grad school, and I have heard many people talking positively about mental healthcare since I’ve been here.  Within the first few days of classes in August, we were informed where and how to get mental health help on campus.  I know plenty of people who have sought assistance with their mental health, and they speak about it without any sort of stigma.  All of this talk got me wondering, what’s behind this positivity?  Is it:

A) My department is super supportive

B) We’re a bunch of public health enthusiasts who want to dismantle stigma in every way we can

C) There’s a huge need for mental healthcare among graduate students

It turns out that the answer is likely: D) all of the above.

According to a recent study published in Nature Biotechnology the prevalence of both moderate to severe and anxiety and moderate to severe depression is over six times higher in graduate students than in the general population (1).  The good news is that the study also found that a good work-life balance helps improve mental health (1).  This means the next time someone tells you to take care of yourself, they’re not just repeating trite advice.  It really is important.

If you’re one of the many grad students (or anyone for that matter) who feels overwhelmed, know that you’re not alone.  Many of us are there with you, and it’s OK if you need to enlist the help of a professional.  Personally, I view this as a sign of strength instead of weakness.

 

Reference

(1) Pain, Elisabeth. Graduate students need more mental health support, new study highlights. ScienceMag.org. [Online] March 6, 2018. http://www.sciencemag.org/careers/2018/03/graduate-students-need-more-mental-health-support-new-study-highlights.

Celebrities, Social Media, and Mental Illness

By Jacob Rohde

Earlier this month, Selena Gomez opened up to Harper’s Bazaar magazine about her struggles with mental illness [1]. When asked about her upcoming plans for the new year, Gomez responded:

“I will always start with my health and my wellbeing. I’ve had a lot of issues with depression and anxiety, and I’ve been very vocal about it, but it’s not something I feel I’ll ever overcome… I think it’s a battle I’m gonna have to face for the rest of my life…”

Gomez is joined by several other celebrities, from Gina Rodriguez to Kid Cudi, who have spoken out about the realities of their mental illnesses and have used social media to publicly vocalize their related experiences [2]. For example, Gomez recently used Instagram to talk about her lupus diagnosis, which she has linked to her depression and anxiety [3]. All too often, celebrities are viewed as immune to such circumstances when, in reality, they share many of our own battles with mental illness. Social media allows celebrities, like Gomez, to connect with their audiences who may also struggle from mental illness, or to those who do not fully understand the complexity of mental illness symptoms.

Fifty percent of Americans will experience some form of mental illness in their lifetime [4], yet public perceptions about mental illness remain highly stigmatized, especially among young adults and college students [5]. In my own experiences, I have witnessed several students express their reluctance to seek mental health services as to avoid being “outed” by peers and stereotyped.

Efforts to reduce mental illness stigma can benefit from the stories and experiences shared by celebrities through their social media accounts. Indeed, a recent study found that college students exposed to celebrity narratives about mental disorders were far less likely to stigmatize mental illness overall and had fewer negative perceptions about those who seek help for mental illness than students in control conditions [6]. Given this, celebrity use of social media as a platform to talk about mental illness may have a positive effect on how the public perceives mental illness.

Of course, I am not advocating for celebrities to share deeply personal experiences. However, if they choose to address certain issues pertaining to their mental health, it may serve to reduce the taboo culture currently surrounding depression, anxiety, and other mental illnesses. At minimum, doing so shows that celebrities, like Gomez, are not so different than ourselves.


Mental illness is a serious concern. If you are struggling, please seek professional help or reach out to the 24/7 suicide prevention hotline: 1-800-273-8255

If you are a UNC student, free support is available through the Counseling and Psychological Services program (CAPS). Information available here: https://caps.unc.edu/


References:

  1. Langford, K. (2018). Selena Gomez’s Wild Ride. Harper’s Bazaar. Retrieved from http://www.harpersbazaar.com/culture/features/a15895669/selena-gomez-intervi ew/
  2. Yang, L. (2017). 23 celebrities who have opened up about their struggles with mental illness. Retrieved from http://www.thisisinsider.com/celebrities-depression-anxiety-mental-health-awaren ess-2017-11#cara-delevingne-struggled-with-depression-as-a-teenager-8
  3. Chiu, M. (2016). Selena gomez taking time off after dealing with ‘anxiety, panic attacks and depression’ due to her lupus diagnosis. People Magazine. Retrieved from http://people.com/celebrity/selena-gomez-taking-a-break-after-lupus-complication s/
  4. Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R. O. N., Demyttenaere, K., Gasquet, I., … & Kawakami, N. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6(3), 168.
  5. Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522-541.
  6. Ferrari, A. (2016). Using celebrities in abnormal psychology as teaching tools to decrease stigma and increase help seeking. Teaching of Psychology, 43(4), 329-333.

Teens for Gun Reform Make Their White House Appearance

The events that occurred at Marjory Stoneman Douglas High School in Parkside, Florida last week have sparked the gun control debate yet again in the United States. To me the past week has felt a little like déjà vu: Sandy Hook, Route 91 Festival and Pulse nightclub shootings. Thinking even farther back to Columbine shooting in 1997 when a school shooting seemed unthinkable and how that has changed to be almost a predictable occurrence today. Each shooting seems to spark the same cycle of outcry among our nation with folks pressuring change from policymakers. Yet each time there is no change from the people in power. A few weeks go by and there is another story that captives our attention and it is pushed to the back of our minds until the next shooting occurs and the cycle begins again. However one group is attempting to stop this hopeless cycle: Teens for Gun Reform.

Teens for Gun Reform is a student run group that appeared in front of the White House on Monday. They prepared a “silent lie-in” demonstration of 17 members lying down for three minutes in the streets in front of the White House (the amount of time it took the gunman to take the lives of the students and teachers). Around a hundred students and other advocates rallied and protested following the demonstration. These students are standing up for what they believe needs to be changed since policymakers aren’t listening to anyone else. It’s their lives that are in danger and hopefully protests and pressures from this group will lead to change regarding gun control.

To learn more about this group and the protest visit the following sites:

http://www.independent.co.uk/news/world/americas/us-politics/gun-control-lie-in-white-house-parkland-florida-shooting-donald-trump-protest-students-a8218686.html

https://www.npr.org/sections/thetwo-way/2018/02/19/587089773/teens-lie-in-at-white-house-to-protest-for-stronger-gun-control

Are Mobile Mental Health Apps User-Friendly?

by Kat Caskey

Currently, only about half of those affected by mental illness in the United States will receive any kind of treatment[1]. In the past few years, however, experts have begun to look to remote healthcare options that could improve access to mental health treatment. Perhaps most promising is the growing consensus that mental health apps, or mHealth apps, “have unprecedented potential for improving quality of life and public health outcomes” for the tens of millions of people affected by mental health conditions in the U.S. each year.[2]

Mobile apps have the unique potential to reduce many of the traditional barriers to mental health treatment. For example, mHealth apps can be significantly less expensive than traditional treatment and may be accessed anytime, including during times of crisis, without an appointment. In addition, apps can reduce cultural barriers to care as they provide a “discrete mobile environment” free from social stigma.[3]

Evidence-based mHealth apps have been proven effective at treating a variety of mental health conditions, including posttraumatic stress disorder[4], anxiety[5], depression[6], obsessive compulsive disorder[7], bipolar disorder, borderline personality disorder, and substance abuse[8]. Unfortunately, however, although patients frequently download any of the myriad of mental health apps available in the App store, many are deleted after only a few uses, and a staggering 26% are used only once. One study that surveyed mental health app users found that among the most common reasons for deleting mental health apps included “not engaging” and “not user friendly,” with “ease of navigation” being the top feature that makes eHealth apps for mental health favorable.[9]

What good are evidence-based mental health apps if people won’t use them? These results indicate trouble in the realm of user experience, which considers “user emotions, affects, motivations, and values” as well as “ease of use, ease of learning and basic subjective satisfaction.”[10] Understanding user experience has been identified as “a key step in realizing the role of mental health apps”[11] and reminds us that it is not enough to understand the clinical basis of new health technologies; equally significant is consideration of the best ways to design and implement apps for people with mental health conditions. Ideally, user experience and usability testing evaluations should involve all relevant stakeholders, including patients and providers.[12]

Especially considering the wide reach of mHealth apps, “even minor efforts to further refine the usability and utility of the app” have the potential to decrease app attrition rates and increase user exposure to evidence-based treatment recommendations.[13] As apps designed to improve mental health continue to proliferate, app designers and researchers should continue to investigate how an emphasis on user experience can improve mHealth tools for mental health.

[1] National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/index.shtml.  Accessed February 4, 2018.

[2] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[3] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[4]Rodriguez-Paras, C., Tippey, K., Brown, E., Sasangohar, F., Creech, S., Kum, H. C., … & Benzer, J. K. (2017). Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR mHealth and uHealth5(10).;
Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

[5] Sucala, M., Cuijpers, P., Muench, F., Cardoș, R., Soflau, R., Dobrean, A., … & David, D. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and anxiety.

[6] Lattie, E. G., Schueller, S. M., Sargent, E., Stiles-Shields, C., Tomasino, K. N., Corden, M. E., … & Mohr, D. C. (2016). Uptake and usage of IntelliCare: a publicly available suite of mental health and well-being apps. Internet interventions4, 152-158.

[7] Ameringen, M., Turna, J., Khalesi, Z., Pullia, K., & Patterson, B. (2017). There is an app for that! The current state of mobile applications (apps) for DSM‐5 obsessive‐compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders. Depression and anxiety.

[8] Rizvi, S. L., Dimeff, L. A., Skutch, J., Carroll, D., & Linehan, M. M. (2011). A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behavior therapy42(4), 589-600.

[9] Smith, D. Motivating Patients to use Smartphone Health Apps. Consumer Health Information Corporation. http://www.consumer-health.com/motivating-patients-to-use-smartphone-health-apps/. Published 2014. Accessed February 4, 2018.

[10] Abrahão, S., Bordeleau, F., Cheng, B., Kokaly, S., Paige, R. F., Störrle, H., & Whittle, J. (2017, September). User Experience for Model-Driven Engineering: Challenges and Future Directions. In 2017 ACM/IEEE 20th International Conference on Model Driven Engineering Languages and Systems (MODELS) (pp. 229-236). IEEE.

[11] Lemon, Christopher. “The User Experience: A Key Step in Realizing the Role of Mental Health Apps.” Psychiatric Times, 7 Feb. 2018, www.psychiatrictimes.com/telepsychiatry/user-experience-key-step-realizing-role-mental-health-apps.

[12] Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014). mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical psychology & psychotherapy21(5), 427-436.

[13] Owen, J. E., Jaworski, B. K., Kuhn, E., Makin-Byrd, K. N., Ramsey, K. M., & Hoffman, J. E. (2015). mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR mental health2(1).

Love is all you need (that, and chocolate)

Hypothetically speaking of course, if one had no plans at all for this Wednesday and/or if that same someone muttered, “What’s this Wednesday,” one might recommend a day of self-care. Hallmark be darned! Regardless of plan status (or, you know, relationship status), self-love can be every day. I’m talking about healthy, happy choices.

Take a soak in the tub of love

Sprinkle some rose petals and rose water in there for some antibacterial, anti-inflammatory, and moisturizing action. Or pour in a glass of red wine! The polyphenols soften skin and antioxidants give you a boost.

Flavonoids

Get you some dark chocolate. It’s high in iron, magnesium, and feel-good phenylethylamine. One to two ounces should do the trick.

Hit some zzz’s right in the bullseye with Cupid’s arrow

Pro tip: Sleeping naked helps the body regulate its temperature, which in turn helps decrease the stress hormone cortisol and balance melatonin.

 

If that’s not a romantic evening of self-care, I don’t know what is. Enjoy!