Diving Deep into Postpartum Depression

Pregnancy is a beautiful thing that shows how strong, resilient, and capable a woman’s body is. Not only does having a child put a physical toll on someone’s body, but it can also have a mental and psychological strain. Postpartum depression is one of the most common difficulties encountered after having a child and it affects about 13% of women after delivery. The onset is usually four weeks to three months after delivery and the symptoms are like those of depression unrelated to childbearing. Women who experience postpartum depression often experience a diminished interest in activities, dysregulation of sleep and eating, and increased agitation among other symptoms correlated with depression (Winser et al., 2002). Since postpartum depression can be detrimental to a mother’s physical and mental health, its effects can trickle down to the child as well, potentially leading to cognitive and behavioral problems.

There are two types of postpartum depression: 1) nonpsychotic and 2) psychotic. The symptoms of postpartum nonpsychotic depression include sleep and appetite disturbances, the inability to concentrate, feelings of inadequacy as a parent, and dispirited moods (Miller, 2002), and it affects about 10% to 20% of women in the United States. Women can be at greater risk for it if they had a history of major depression, psychosocial stress, and inadequate support from others around them. There are many studies that show how social support for mothers can help prevent them from having postpartum depression. With a good support system, a mother can be aided with their childcare which can significantly reduce their stress.

Unlike postpartum nonpsychotic depression episodes, postpartum psychotic depression episodes involve more emotional lability which is rapid and exaggerated changes in mood in relation to strong emotions. Also, if a mother who is suffering from this kind of postpartum depression has thoughts of hurting her child, she is more likely to act on them (Miller, 2002). The severity of this form of depression is due to a mix of manic and depressive features coupled with mood disorders such as depression or bipolar disorder. Proper treatment such as taking selective serotonin reuptake inhibitors (SSRIs) and therapy, needs to be done in order to reduce the likelihood of recurrence, even after the postpartum period. It will greatly benefit the mother and child alike.

The question of what causes postpartum depression is still ongoing, and there are many possible reasons why some women are afflicted by it and others are not. One hypothesis may be the sudden drop in hormones after birth. During pregnancy, estrogen and progesterone levels increase significantly, then drop quickly back to the levels before pregnancy 24 hours after delivery. This is only one of many possible reasons women experience this kind of depression, but there are many other external factors that can potentially perpetuate it such as environmental stressors and psychiatric history.

Unfortunately, stigmas are seen in all cultures, and they can have extremely debilitating effects on the individual. Mothers are not spared from the stigmas that society puts on mental illness. In a study done by Dennis and Chung-Lee in 2006, it was found that the fear of labeling and shame were the main factors that prevent mothers from seeking out postpartum help. The idea of “mother blaming” which is shaming the mother for unfortunate incidents that are out of her control, has been embedded in many cultures and in the minds of people, thus making it difficult for mothers to reach out for help and assistance (Pinto-Foltz & Logsdon, 2008).

Postpartum depression is a common illness that plagues millions of mothers globally. There needs to be an increase in education in order to staunch the stigma that comes along with mental illness. Moreover, mothers should also be given proper and adequate support before, during, and after delivery, no matter their socioeconomic status. Education and equal treatment are what are necessary to help mothers all over the world, and it will provide them with the support necessary to raise their child(ren) to become balanced and healthy people.

References

Miller LJ. (2002) Postpartum depression. JAMA. 287(6):762–765. doi:10.1001/jama.287.6.762 

Wisner, K. L., & Piontek, C. M. (2002). Postpartum depression. The New England Journal of Medicine, 6. DOI: 10.1056/NEJMcp011542 

Pinto-Foltz, M. D., & Logsdon, M. C. (2008). Stigma towards mental illness: A concept analysis using postpartum depression as an exemplar. Issues in Mental Health Nursing, 29(1), 21–36. https://doi.org/10.1080/01612840701748698 

Pinto-Foltz, M. D., & Logsdon, M. C. (2008). Stigma towards mental illness: A concept analysis using postpartum depression as an exemplar. Issues in Mental Health Nursing, 29(1), 21–36. https://doi.org/10.1080/01612840701748698 

Image from: https://alohabehavioral.com/2019/04/16/the-roller-coaster-ride-of-postpartum-depression/

Seasonal Depression

Although our species is considered to be incredibly advanced, we often fall victim to our own emotions. This question has been asked many times, but it has not been resolved. One of the possible answers to this issue could be found within the seasons. During the winter season, some of your friends might seem to be very down or out of their usual social behavior. This could be caused by seasonal affective disorder; which is “a mood disorder in which there is a predictable occurrence of major depressive episodes, manic episodes, or both at particular times of the year” and this pattern is correlated with major depressive episodes during the fall or the winter months (APA, 2022). For some, this means that they feel depressed during the winter months due to its gloomy feel and lack of sun all the time, while in the summer, they feel exceedingly happy and sometimes manic due to the presence of good weather, as well as increased presence of the sun in the daytime. This condition is very important to people; however, it is not talked about enough. It is also not widely understood by those around the person suffering from it. 

It is also important to note that a condition that is not widely known can lead to the failure of people around the person with it to understand them. A good example of this could be someone suffering from seasonal depression as they are going through something that gravely affects their daily lives (during specific seasons) and as such, leads the people who were friends with them to feel off-put with their current attitude and potentially not want to be friends with them anymore. This effectively isolates the person from their social environment, leading them to believe that they are the problem which, in turn, leads them to internalize their feelings in order to receive positive feedback from those who surround them. This is precisely the issue with this type of logic; as they are not the problem, but due to their surroundings they believe that they are and alter who they really are to appease those around them. If we were to provide a source of information or increase the amount of public awareness about disorders such as seasonal depression i.e. seasonal affective disorder, then this type of event would never occur and those suffering from disorders might feel more inclined to be true to themselves in social settings. In doing so, they not only free themselves from their current shackles, but they are also allowing themselves to trust in others and to trust that they will both assist them in their day-to-day life (if needed) and treat them the same way they would treat anyone else. 

As humanity continues to progress, it is important to realize that we are not perfect. Although we try our best, we can never be completely satisfied with what we have. Even though we sometimes struggle with our daily activities and moods, we can still be perfectly fine in our own way. This is why it is important that we try to understand other people's points of view and not only agree with them, but also acknowledge that there are times when a person may be suffering from a condition that is not widely known. In order for this to occur, we must enlighten the public on disorders and the social stigma that surrounds them. Currently, much of society attributes the flaws we see in others as “defects” or issues that you don’t wish to surround yourself with and our own flaws as something that occurs due to external factors such as a professor not teaching you the proper material therefore, you performed poorly on your exam and feel sad as a result. The problem with such logic is that it fails to see other points of view and it fails to accept people for who they are. Only when society changes its way of seeing and accepting others' points of view, will we see progress be made. 

References

American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological Association. Retrieved October 25, 2022, from https://dictionary.apa.org/seasonal-affective-disorder

Stress and Trauma Impacts OCD

Obsessive-compulsive disorder (OCD) is a long-term disorder where an individual experiences obsessions and or compulsions (U.S. Department of Health, 2022). Obsessions can be characterized as recurring and unwanted thoughts, urges, or fears (U.S. Department of Health, 2022). Commonly reported obsessions include: fear of contamination, harmful thoughts towards other individuals or themselves, and needing items to be in a symmetrical/perfect order (U.S. Department of Health, 2022). According to the U.S. Department of Health and Human Services compulsions are repetitive behaviors that the individual feels the need to perform in order to make the obsessions go away. Many feel the urge to excessively wash their hands or clean, arrange belongings in a specific order, or constantly check on items (U.S. Department of Health, 2022). These symptoms typically affect an individual's day-to-day life in terms of their work, relationships, and school. While the causes of OCD are still unknown, risk factors such as brain function, genetics, and environmental factors appear to be associated with OCD. However, recent studies have shown that stress and trauma have a significant impact on the onset of OCD. 

Stress has been found to influence the onset associated with OCD in many individuals. Childbirth complications, marriage, socioeconomic struggles, bodily injuries, and age-related reproductive changes have all been identified as stressors that can contribute to OCD (Murayama et al., 2020). Self-reported studies by individuals with OCD have shown that 25-67% of OCD patients have reported stressful incidents occurring prior to their onset of their OCD symptoms (Adams et al., 2018). Another study containing 281 OCD participants recorded that 172 (61.2%) of the participants expressed they experienced stressful life events prior to their diagnosis (Murayama et al., 2020). It has also been reported that individuals with OCD experience stressful events occurring 6 months and 12 months prior to their onset of the disorder (Adams et al., 2018). Similarly, those individuals who vocalized their experience with stress prior to their diagnosis also experienced cleaning and contamination-related obsessions related to those stressful events  (Murayama et al., 2020).

Trauma has also been identified as a factor which intensifies the severity and onset of OCD symptoms (Adams et al., 2018). Traumatic events may include: war combat, sexual assault, and violence. Other potential traumatic events, which are commonly associated with childhood-related trauma, include neglect, physical, sexual, or emotional abuse (Pinciotti et al., 2022 ). Individuals who have experienced traumatic events during their childhood were found to be 5 to 9 times more likely to meet the criteria for OCD in their adulthood. These childhood-related traumas have been associated with higher suicide risk, as well as more severe OCD symptoms (Pinciotti et al., 2022 ). There is also a correlation between expressed childhood trauma and other mental health-related disorders including; anxiety, depression, impulsivity, and attention deficit hyperactivity disorder (Pinciotti et al., 2022 ). In addition, in a study with 954 OCD patients, leaving a relationship was identified as a stressor that accelerated the progression of OCD (Murayama et al., 2020). Furthermore, there are findings that suggest that lifelong trauma is linked with a higher obsession with checking items and ordering/symmetry symptoms, while sexual trauma is related to higher rates of contamination and washing compulsions (Pinciotti et al., 2022 ).

Although extensive research is being performed to better understand the neurological mechanisms that are associated with OCD, there should also be more focus on understanding the relationships between OCD symptoms, stress, and trauma. Insight into these OCD-related factors can allow for more treatment options to be provided to OCD patients. More importantly, prevention methods can be developed to prevent the early onset of OCD and the development of this disorder when not associated with genetic factors. 

References

Adams, T. G., Kelmendi, B., Brake, C. A., Gruner, P., Badour, C. L., & Pittenger, C. (2018). The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder.   Chronic stress (Thousand Oaks, Calif.). Retrieved October 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841259/

Murayama, K., Nakao, T., Ohno, A., Tsuruta, S., Tomiyama, H., Hasuzawa, S., Mizobe, T., Kato, K., & Kanba, S. (2020, December 3). Impacts of stressful life events and traumatic experiences on onset of obsessive-compulsive disorder. Frontiers in psychiatry. Retrieved October 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744562/

Pinciotti, C. M., & Fisher, E. K. (2022, April 6). Perceived traumatic and stressful etiology of obsessive-compulsive disorder. Psychiatry Research Communications. Retrieved October 23, 2022, from https://www.sciencedirect.com/science/article/pii/S2772598722000253

U.S. Department of Health and Human Services. (n.d.). Obsessive-compulsive disorder. National Institute of Mental Health. Retrieved October 23, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd 

Photo: Spratt, A. (2021, May 6). White and Brown Cat Print Textile Photo. Unsplash. Retrieved October 23, 2022, from https://unsplash.com/photos/4BwcmbExs5c 

Grief: An Inevitable Aspect of Life

Death is one of the few things in life that are guaranteed. At some point in time, every single one of us will lose a person or an animal who we love and care for so much. And with that loss, comes immense overwhelming feelings of sadness that are known as grief. Grief presents itself differently from person to person. Dealing with grief is a very individual experience dependent on many factors, including your personality, your coping skills, past life experiences, your faith, and how significant the loss was in your life (HelpGuide, 2022). Due to the individuality of grief, there is no set timeframe in which someone should be “healed” from it. I think it is fitting to put the word healed in quotation marks because, for many of us, the grief that comes from a loss of a loved one can last our whole lives.

Psychiatrist Elisabeth Kübler-Ross founded the concept of the “five stages of grief” in 1969 (HelpGuide, 2022). The stages are denial, anger, bargaining, depression, and acceptance. The first stage, denial, is characterized by feelings of disbelief and shock. Some common thoughts an individual can experience at this time are, “How could this happen to me?” and “It can’t be true” (Mind, 2019). Anger is the second stage, which includes blaming yourself or others for the loss and general hostile feelings and behaviors. “Why me?” or “Why them?” and “This isn’t fair” are some typical anger responses people have in this stage (Mind, 2019). Next comes the bargaining stage which is filled with guilt. Here, someone may have thoughts along the lines of, “Make this not happen, and in return, I will _____” (HelpGuide, 2022). The next stage, which is arguably the most commonly associated with grief, is depression. When one is in the depression stage, they experience feelings of hopelessness, intense sadness, and the sense that they are lost in life. “I’m too sad to do anything” is most likely a recurring thought that someone in this stage may face (HelpGuide, 2022). Finally, the last stage of grief, there is acceptance. Acceptance is about coming to terms with what happened: “Acceptance does not mean that somebody likes the situation or that it is right or fair, but rather it involves acknowledging the implications of the loss and the new circumstances, and being prepared to move forward in a new direction” (Mind, 2019).

It is important to note that not everyone experiences grief in these exact stages. Some people may go through the stages in a different order, skip some stages, or just not experience them at all. Even Kübler-Ross, who introduced this concept, acknowledges that healing from grief is not linear and that these stages are not one-size-fits-all. In her last book, about the stages of grief, she declares, “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives” (HelpGuide, 2022). 

While grief is typically associated with the significant loss of a loved one, that is not the only instance from which grief can stem. A loss of any kind can provoke grief in someone. These losses include a divorce or a breakup, loss of a job, a miscarriage, diagnosis of an illness for you or a loved one, retirement, loss of a friendship, loss of safety after a trauma, changing careers, graduating, or even moving to a new place (HelpGuide, 2022). Regardless of the situation you are grieving from, it is immensely important to make sure you are taking care of yourself emotionally and physically during this tough time.

References

HelpGuide. (2022, October 13). Coping with Grief and Loss. Retrieved October 24, 2022, from https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm 

Gautam, P. (n.d.). Unsplash. Retrieved from https://unsplash.com/@pgauti. 

Mind. (2019, July). Bereavement. Retrieved October 24, 2022, from https://www.mind.org.uk/information-support/guides-to-support-and-services/bereavement/experiences-of-grief/ 

Going Beyond the Baby Blues: Examining the Characteristics and Treatment of Perinatal Depression

Historically, it has been wrongfully believed that pregnancy and the puerperal period, also known as the postpartum period, serve as protective factors against mental health issues in women (Kerr, 2017). In recent years, this myth has been largely disproven as more women and mental health professionals are sharing their experiences and expertise on the matter of how pregnancy and the puerperal period are two areas of high concern where increased risk of developing mental health issues has been observed. One such critical mental health concern is perinatal, formally postpartum, depression which refers to the onset of depression or related symptoms beginning in pregnancy and/or following childbirth. The former term, postpartum depression, is limited to the period when the body is returning to its nonpregnant state, however it fails to acknowledge that depression during this time often begins during pregnancy (National Institute of Mental Health, 2022). Individuals with perinatal depression may experience extreme sadness, indifference, anxiety, and fatigue which makes it more difficult to care for oneself and the child (National Institute of Mental Health, 2022). 

Oftentimes, pregnancy and the time period following delivery can be a vulnerable and sensitive experience, as there is a multitude of changes occurring in one’s body to prepare for pregnancy and delivery. Physiological changes relating to the high and rapid variation in reproductive hormones, estrogen, and progesterone both during pregnancy and after delivery may lead to potential mood changes and emotional distress (Torres, 2020). Emotional stress may be heightened due to financial and social changes, such as the high expenses associated with keeping up with physician visits, medications, and postpartum care. Considering the range of potential triggers which may interfere with a new mother’s well-being, approximately 70% of women experience a short onset of emotional anguish following the delivery of their child (Torres, 2020). Colloquially referred to as the “baby blues”, this period of emotional stress is characterized by negative feelings of anxiety, sadness, or irritability, with the added responsibility of caring for a baby, sleep deprivation, and lifestyle changes. While “baby blues” may appear to be similar to perinatal depression, it is important to acknowledge that these are two very different conditions in their severity and duration. “Baby blues” are defined to be short-term and do not disrupt or impair an individual’s ability to carry out their daily activities. After a couple of days, patients will see an improvement in their mood without needing medication attention or treatment. However, perinatal depression is usually a longer-lasting condition paired with intense symptoms that can be emotionally and physically debilitating to an individual (Torres, 2020). 

Perinatal depression must be diagnosed by healthcare professionals, and although it is not a separate illness classification in the DSM-5 manual, patients must meet the provisions for a major depressive episode with the criteria of a peripartum-onset specifier (American Psychiatric Association, 2022). For a depressive episode to be classified as such, patients must experience at least five out of nine symptoms nearly every day for a two–week period: depressed mood, loss of interest or pleasure, change in appetite or weight, insomnia or hypersomnia, psychomotor retardation or agitation, fatigue, worthlessness or guilt, reduced concentration or indecisiveness, or suicidal ideation or attempt (American Psychiatric Association, 2022). These symptoms may increase or decrease in severity throughout the depressive episode and may result in additional shame or guilt concerning motherhood. 

Evidently, perinatal depression can have dire consequences for the pregnant individual in question by hampering their quality of life. However, these consequences can also impact the baby’s well-being and sense of attachment and bonding with the mother. This can induce sleeping and feeding issues, which can introduce a host of new concerns for the child and mother (Van Niel & Payne, 2020). With the severity of perinatal depression, treatment is usually needed to resolve the depressive episode. Treatment options include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and the use of medications such as antidepressants. CBT and IPT are two evidence-based psychotherapy approaches that revolve around improving one’s ability to challenge negative situations (National Institute of Mental Health, 2022). CBT is a more structured therapy approach in which an individual may work to identify and tackle harmful thought patterns, behaviors, and emotional responses by substituting them with realistic and positive ways of thinking about one’s challenges and situations (Cleveland Clinic, 2022). IPT allows one to better their communication and relationship skills to develop stronger support networks and realistic expectations and outlooks on their respective situations. This allows an individual to have more resources and control over their circumstances to deal with their issue (National Institute of Mental Health, 2022). Whether an individual chooses to use therapy, medications, or both, it is no doubt that these options should be available to any individual undergoing a pregnancy. While pregnancy is commonly viewed as a time to rejoice, we, as a society, need to acknowledge the social and biological difficulties that pregnancy may introduce to the individual. 

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text rev (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

Cleveland Clinic. (2022, August 4). Cognitive behavioral therapy (CBT). https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt

Kerr, M. (2017, June 26). Perinatal depression. Healthline. https://www.healthline.com/health/depression/perinatal-depression#causes

National Institute of Mental Health. (2022). Perinatal depression. https://www.nimh.nih.gov/health/publications/perinatal-depression

Torres, F. (2020, October). What is Peripartum Depression (formerly Postpartum)? American Psychiatric Association. https://psychiatry.org/patients-families/peripartum-depression/what-is-peripartum-depression

Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic Journal of Medicine, 87(5), 273-277. https://doi.org/10.3949/ccjm.87a.19054

Reforms in Education: Attention Spans

The average attention span of a human is now less than that of a goldfish. In the age of smartphones and social media, it’s no surprise that students tend to lose concentration. Bombarded with constant stimulation, young brains are unable to focus on a certain task for long periods of time without craving distractions. 

One clear example of these short attention spans comes from the idea of TED talks. TED talks are a series of talks where speakers present their ideas on a wide range of topics. The maximum amount of time these talks can be is 18 minutes; with the idea that 18 minutes is the longest amount of time a person can hold another's attention. However, even with this multitude of research that limits the average student’s ability to be productive in a time period, lectures are still 50 minutes long (perhaps longer in many institutions). While lecture times cannot actually be as short as the recorded attention span of 8s (partially because of its ridiculous infeasibility), it should be noted that curriculum should change to reflect this new age of technology and its consequences. 

According to the book “Tools for Teaching”, the narrator dictates that “most students are paying attention for only about 10 minutes.” So if students are only paying attention for 10-15 minutes, why not change lesson plans? Another drawback with the 50 minute traditional lesson is that note-taking drops exponentially over the course of a lecture. However, some have noted that this could be due to mental or physical exhaustion rather than an attention deficit. In addition, recall is greatly affected over the course of a long period. It was found that over the course of 50 minutes, a student was unable to remember information past 10-15 minutes from the first part of the lecture. It can be noted though that attention spans are not the same as memory (but are tightly linked). 

It is of course difficult in large institutions to have classes that only last 10-15 minutes. However, small breaks in between those 10-15 minutes can improve this. It was seen that students' attention did not completely leave in a 50 minute lecture after the first 10-15 minutes. Rather, a student would go in and out of paying attention to the lecturer. Therefore, if something were implemented so that every lecture would have a 1 minute break every 10-15 minutes, attention spans would be able to reset and could last longer. 

References

Bradbury, N. A. (2016). Attention span during lectures: 8 seconds, 10 minutes, or more? Advances in Physiology Education, 40(4), 509–513. https://doi.org/10.1152/advan.00109.2016 

McSpadden, K. (2015, May 14). Science: You now have a shorter attention span than a goldfish. Time. Retrieved October 25, 2022, from https://time.com/3858309/attention-spans-goldfish/ 

Do we have a healthy relationship with the news?

The accessibility of news and media has never been higher, than in today's world. Between our mobile devices and streaming platforms, we are never more than a few clicks away from the news. Much like many other facets of our life, this increase in access comes with both a handful of rewards and consequences, with the primary benefit of a higher percentage of the public able to stay up-to-date on events on a micro and macro scale. In the same breath, it can be hard to determine how much news is too much news. This thought led to a recent study that looked into the increasingly unhealthy relationship between the news and a portion of the anxious public (McLaughlin B. et al, 2022).

Led by Texas Tech University, this study aimed to look at the interconnectedness of individuals deemed to have “problematic news consumption“ and mental/physical ailments via survey. It should be noted that this study did not attempt to find a cause-and-effect relationship between the symptoms listed and problematic news consumption, rather to understand if there is a notable association between news consumption and physical, mental, and emotional symptoms. Secondly, it did not look at other mental health disorders, such as depression, or if the individuals in the study have been previously diagnosed with a mental health disorder (McLaughlin B. et al, 2022).The researchers classified problematic news consumption as: compulsively checking the news, constant state of worrying about news, and experiencing interference in everyday life stemming from being absorbed in news content. Of the 1,100 randomly chosen adults surveyed, just under half of them had moderate or severe problematic news consumption, with 16.7% of them stating that their consumption has negatively impacted other aspects of their life. The study further goes on to state how the individuals who had problematic news consumption also reported feeling increased levels of stress, anxiety, fatigue, sleep, problems, poor concentration, and gastrointestinal issues. 

Problematic news consumption is an issue that needs to be evaluated on multiple fronts. The way in which the media has disseminated information has been a topic of debate since the printing press. What is considered sensationalism and fear-mongering? The public undoubtedly has faced immense hardship over the past two years which is reflected in the 25% increase in diagnosis of anxiety and depression in people under the age of 50 (World Health Organization, 2022). One study looked to find a connection between this increase and the way COVID was covered in the media, by surveying 175 random adults and placing them into one of three groups; exposure to positive, negative, or neutral-worded news regarding COVID. What was found is that the use of negative language/frightening language resulted in higher percentage of participants noting negative emotions and decreased feelings of emotional resilience (Giri, 2021). Not only does high media access come with potential detriments to one’s mental health, an increase in Internet usage has also shown to have a correlation with increased feelings of anxiety (Caplan et al, 2010). 

The world is certainly an unpredictable place and with an increasing amount of people feeling as though the world is falling apart around them, only feeds into an overwhelming feeling of anxiousness. Part of this can be attributed to the never-ending pipeline of information we have, but a balance needs to be struck so that individuals are properly informed of recent events impacting society and preserving their mental health in the process. 

Other than the use of pharmacological methods to treat anxiety and depression, one effective way to reduce screen time and in turn reduce stress and anxiety is to practice mindful meditation. This practice of training to focus your attention on achieving “calm concentration and positive emotions” has been used in conjunction with cognitive behavioral therapy to help treat depression and anxiety (APA, 2019).  

Problematic news consumption is most likely a concept that will only become more and more prevalent in the general public. It is imperative that news outlets make a more conscious effort to report the facts as they are presented, without the need to consistently push a theme of despair with it. As for what can be done on the individual level, it is not as simple as “stop worrying about things outside of your control“. This is a situation that needs to be monitored closely with more research hopefully leading to more targeted cognitive therapies for problematic news consumption.

References

Caplan, S. E. (2010). Theory and measurement of generalized problematic Internet use: A two-step approach. Computers in Human Behavior, 26(5), 1089–1097. https://doi.org/10.1016/j.chb.2010.03.012 

McLaughlin B., Gotlieb M R. & Mills D J. (2022, August 23). Caught in a Dangerous World: Problematic News Consumption and Its Relationship to Mental and Physical Ill-Being. Health Communication. https://www.tandfonline.com/doi/full/10.1080/10410236.2022.2106086 

Giri, S. P., & Maurya, A. K. (2021). A neglected reality of mass media during COVID-19: Effect of pandemic news on individual’s positive and negative emotion and psychological resilience. Personality and Individual Differences, 180(110962), 110962. doi:10.1016/j.paid.2021.110962

World Health Organization. (2022, March 2). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. Who.int; World Health Organization: WHO. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide 

(N.d.). Retrieved October 25, 2022, from Apa.org website: https://www.apa.org/topics/mindfulness/meditation

Nurturing Sleep and Mental Health

Mental health is a broad term that encompasses a large array of factors concerning the well-being of one’s psychological state. The state of our mental health determines our everyday function and our capacity to learn and work, handle stress and contribute to our society and others (Tahir, M. S. et al., 2022). It is often difficult to handle both the responsibilities required from family, school, and work, along with the self-care required to take care of one’s mental well-being, and often, it is the latter that is neglected. There are many factors in mental health that can affect productivity, mood, stress, and anxiety. Sleep has been shown to be one of the contributing factors to psychological health and can greatly impact how well one functions on a day-to-day basis. The quality and amount of sleep one gets often varies and depends on whether one has a present psychological disorder such as insomnia, or it can vary due to work, school, and socioeconomic status. Sleep is a large part of mental health and there are multiple studies that show its importance in maintaining one’s well-being. 

The amount and quality of sleep in undergraduate students often vary due to workload and social life, often affecting their mental health. A study was done with 71 undergraduate students to examine whether sleep duration and frequency of disruptions during sleep were predictive of mental health outcomes, along with whether sleep quality was associated with self-report mental health in undergraduate students who claim they have healthy sleeping patterns (Milojevich, H. M., & Lukowski, A. F., 2016). It was found that poorer sleep quality is correlated to increased externalized problems such as aggression and rule-breaking issues, as well as increased internal problems like anxiety. Not only were there internal and external repercussions reported, but there were also clinically relevant problems such as anxiety, attention deficit/hyperactivity, and depression. This demonstrates that although these students reported they have healthy sleep patterns, poor quality of sleep is indicative of reduced mental well-being.  

Additionally, work hours can have a causal relationship with reduced sleep duration and quality, thus minimizing an individual’s psychological health. Although there has been work done worldwide to create a 48-hour per week maximum limit, it is reported that about 22% of workers worldwide are still working more than 48 hours per week (P. Afonso, et al., 2017). This can be due to an individual’s economic status and responsibility to support one’s family, which can lead to a decline in physical health, as well as mental health. Overworking often leads to sleep disturbances which can impact the quality of life, and job performance, and can also lead to an increase in healthcare and in absenteeism. In a study examining two groups Long Working Hours Group (LWHG) and Normal Working Hours Group (NWHG), a relationship between weekly working hours and sleep quality was found. It was recorded that in the LWHG workers reported higher sleep disturbances, and depression and anxiety symptoms than those in the NWHG (P. Afonso, et al., 2017). Although work and having a source of income is essential to maintain livelihood and independence, it is not worth the toll it can take on mental and physical health.  

The balance of the responsibilities of life and sleep is crucial to maintaining a healthy body and psyche. If the mind is not working optimally then that will reflect on the body as well and vice versa. Schools and workplaces need to emphasize the importance of sleep quality and duration since they can affect the output of scores and productivity. Everyone struggles with mental health and thus, having a good sleeping routine is one of the key ways to help improve quality of life.  

References

Milojevich, H. M., & Lukowski, A. F. (2016). Sleep and mental health in undergraduate students with generally healthy sleep habits. PLOS ONE, 11(6), e0156372. https://doi.org/10.1371/journal.pone.0156372  

P. Afonso, M. Fonseca, J. F. Pires, Impact of working hours on sleep and mental health, Occupational Medicine, Volume 67, Issue 5, July 2017, Pages 377–382, https://doi.org/10.1093/occmed/kqx054 

Tahir, M. S., Ur Rehman, M. E., Fazal, F., Murtaza, H., Noor, A., Kamran, A., Tanveer, U., & Mustafa, H. (2022). Curbing and preventing psychiatric disorders through healthier eating and sleeping habits. Annals of Medicine and Surgery, 82, 104614. https://doi.org/10.1016/j.amsu.2022.104614

Illustration by: kbeis Strategies to Aid Sleeping Habits - (health.harvard.edu)  

The Hidden Sickness

The world we live in is filled with people of all types of races, ethnicities, genders, and cultures; yet we still find it acceptable in our society to judge others based on one, two, or even all of these. Take the perspective of someone who is suffering from a disorder such as schizophrenia, they may act in a manner that may be seen as strange or outside of what we would call societal norms; but do they deserve to be judged based on how they act in public? The answer to this should always be no; however, due to the stigma attached to mental disorders, such as schizophrenia and depression, it is not always possible to completely separate people with these conditions from those without them. Most people believe that mental disorders are typically caused by a person's mental strength. They also believe that those suffering from these conditions lack the will to overcome their condition. This logic is not supported by the evidence. Many people find it hard to accept a diagnosis of schizophrenia or other psychological disorders due to their nature. Also, these conditions have a stigma attached to them that makes it hard to talk about them in public. Research proves the opposite as it explicitly shows that although sometimes it is caused by issues surrounding their mental health, it is often the product of a chemical imbalance within the brain. As a byproduct of not being talked about enough, not enough has been done to help people who suffer from these disorders, leading to the problem not being solved, and the cycle still repeating. In order to break this cycle, we must assess how a disorder such as schizophrenia can be made more mainstream and how we can change the narrative to match that of what we hope to achieve.

Understanding schizophrenia can help people change their minds about the condition. It is a serious mental illness that can be caused by delusions or hallucinations, as well as incoherent or illogical thoughts. The age of onset is typically between the late teens and mid-30s” (APA, 2021). These delusions and hallucinations may take a form or present themselves as a sound, a whispering voice in the back of your head telling you to perform certain actions or do specific requests in order to satisfy the voice. Symptoms such as these take their toll on the person suffering from them and as such, may exhibit social withdrawal or simply overall social issues therefore, it may be harder for them to engage in prosocial behavior and to fit within the current confines of what our society deems normal. An example of this can be stated from a study investigating nonverbal behavior in face-to-face social interactions where they found “inpatients with schizophrenia displayed a reduction in nonverbal behaviors designed to invite social interaction, particularly prosocial facial expressions” (Lavelle, Healey, and McCabe, 2014). This furthers the thought that people with schizophrenia may suffer socially and may be judged unfairly for something that lies outside of their control. Educating the public about schizophrenia is also important to help break the current stigma surrounding this condition. If the public is educated about schizophrenia, then eventually change will be made in a way that will allow people with this condition to get the help they need. This will also help those who used to be judgemental. Accepting that everyone is different and that there are certain characteristics that make people unique will help decrease the stigma surrounding mental disorders.

The concept of mental disorder is a controversial one, as it can either be something to fear or something to learn. Understanding it can help improve the way society views mental disorders. Destigmatization at this level can only occur through enlightenment, in the form of knowledge, allowing for the public to be better informed that psychological disorders are not something to hide thus, allowing for a more significant number of people who suffer from these disorders to get the help that they need or the friendships that they deserve. Every person experiences a point in their life where they have suffered from some form of mental disorder. It is important to remember that one day, you may be the one who tries to hide this condition from society due to how it makes you feel.

References

Schizophrenia. (2021). Apa.org. https://www.apa.org/topics/schizophrenia

Lavelle, M., Healey, P. G. T., & McCabe, R. (2014). Nonverbal Behavior During Face-to-face Social Interaction in Schizophrenia. Journal of Nervous & Mental Disease, 202(1), 47–54. https://doi.org/10.1097/nmd.0000000000000031

Impact of Sex and Gender on Mental Health

The prevalence of mental health disorders greatly varies between men and women. Mental health disorders are known to impact an individual's quality of life in terms of their emotions, behaviors, mood, and thought processes (Otten et al., 2021). Although mental illness can impact anyone, studies have shown that there are higher rates of specific disorders found in one sex compared to the other. In addition, it has been challenging for scientists to determine the true causes of the vast differences in prevalence rates between sexes.

The disorders that are more commonly identified in women are often related to the internalization of emotion while men are diagnosed with disorders that externalize emotions (Eaton et al., 2012). The National Comorbidity Survey has identified that women are approximately twice as likely to be diagnosed with anxiety disorder, social phobia, major depression, and panic disorder in comparison to men (Eaton et al., 2012). The survey has also indicated that men have higher prevalence rates for alcohol and drug dependence, as well as antisocial personality disorder when compared to women (Eaton et al., 2012). Moreover, dementia as well as mood and neurotic disorders are found more in women (Suanrueang et al., 2022). Intellectual disability, schizophrenia, along with mental and behavioral disorders are better detected in men (Suanrueang et al., 2022). In addition, each sex experiences different severities of the diagnoses. For instance, adverse symptoms related to schizophrenia are more commonly reported in men while there are worse anxiety symptoms present in women (Otten et al., 2021). Men have also reported having experienced more traumatic incidents in their lives, yet women are more likely to develop post-traumatic stress disorder after traumatic events (Otten et al., 2021). Additionally, suicide performed by men occurs more frequently while women have higher numbers of suicide attempts (Otten et al., 2021).

Although the origins of the prevalence rate differences between the two sexes have not been made clear, many factors that impact the rates have been determined (Otten et al., 2021). Seeing as sex refers to the biological construct of an individual at birth, factors including hormone production of sex-specific hormones may explain differences in relation to psychiatric and stress disorders (Otten et al., 2021). Gender refers to the self-identity of an individual and relates to the behavior associated norms and power distribution that society has assigned to men and women (Otten et al., 2021). Gender-related factors include; self-esteem, gender-related violence, and family-related factors (Otten et al., 2021). Socioeconomic positions and social interactions vastly differ among men and women depending on their culture, and where they live. Furthermore, disparities in education, family, and lifestyle-related factors are being studied as characteristics that impact differing mental health diagnoses in men and women (Otten et al., 2021).

All individuals regardless of sex and gender should be provided with fair mental health treatment options. The various differences in prevalence rates can change the future of mental health assistance. For instance, improved prevention options can be discussed with the respective sex (Suanrueang et al., 2022). Enhanced mental health evaluations can be performed and risk factors are more likely to be identified (Suanrueang et al., 2022). In addition, new medications can be formulated and more tailored treatment options can be provided. Ultimately, these unique prevalence rates can aid in the implementation of better mental health resources for men and women.

References

Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S. (2012, February). An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample. Journal of abnormal psychology. Retrieved October 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402021/

Otten, D., Tibubos, A. N., Schomerus, G., Brähler, E., Binder, H., Kruse, J., Ladwig, K.-H., Wild, P. S., Grabe, H. J., & Beutel, M. E. (2021, February 5). Similarities and differences of mental health in women and men: A systematic review of findings in three large German cohorts. Frontiers in public health. Retrieved October 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892592/

Suanrueang, P., Peltzer, K., Suen, M.-W., Lin, H.-F., & Er, T.-K. (2022). Trends and gender differences in mental disorders in hospitalized patients in Thailand. Inquiry: a journal of medical care organization, provision and financing. Retrieved October 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9019317/          

Photo: Nhân, D (n.d). People Wearing Sneakers. Pexels. https://www.pexels.com/photo/people-wearing-sneakers-1021145/

Severe Symptoms of Borderline Personality Disorder Lead to Misdiagnosis of Bipolar Disorder

CW; Suicide 

As many individuals go to college to seek a higher form of education for their future careers, several of them suffer from one or more mental disorders. The prevalence of mental disorders among college students is higher than the general population (Limone & Toto, 2022). For example, Borderline Personality Disorder prevalence amongst the general population is only 1.6% while college students have a higher rate of being BPD symptomatic, up to 17.1% to be exact (Meaney & Hasking & Reupert, 2016). One would assume that with the high prevalence amongst college students, a proper diagnosis would be established. But, unfortunately, Bipolar Personality Disorder is often misdiagnosed(Porr, 2017). The severity of Borderline Personality Disorder can lead individuals into depressive episodes that lead 10% of individuals with Borderline Personality Disorder to commit suicide (Porr, 2017). The symptoms that are associated with Borderline Personality Disorder often overlap with more common disorders, such as Bipolar Disorder (Ruggero & Chelminski & Young, 2009). People are commonly misdiagnosed with a mood disorder rather than Borderline Personality Disorder. 

Many of these symptoms can be seen in several other disorders as well, specifically mood disorders.  The symptoms are as follows: greatly afraid of abandonment and take extreme actions to avoid what they fear; an unstable ideology of the individuals’ relationship with others; dissociating from reality for minutes and/or hours at times and paranoia associated with stress; “impulsive and risky behaviors”; suicidal ideation, behavior, and/or threats in response from fear of abandonment; “wide mood swings” that can last for hours and/or days; endless feeling of emptiness; “inappropriate, intense anger” (Mayo Foundation for Medical Education and Research, 2019). 

According to Ruggero & Chelminski & Young, the likelihood of individuals being misdiagnosed with Bipolar Disorder, increases with the number of Borderline Personality Disorder symptoms (2009). This means the more symptoms an individual exhibits of Borderline Personality Disorder, the more likely they will be diagnosed with Bipolar Disorder. This reinforces the assumption that the symptoms of Borderline Personality Disorder and Bipolar Disorder are very similar to one another, leading to a greater number of people to be misdiagnosed.

Misdiagnosis can lead to detrimental effects, such as suicide attempts and completions (Porr, 2017). The misdiagnosis of individuals with Borderline Personality Disorder accounts for 40% of individuals misdiagnosed with Bipolar Disorder (Ruggero & Chelminski & Young, 2009). Misdiagnosis can lead to incorrect treatments that may lead symptoms to worsen over time. Comorbid diagnoses often occur with Borderline Personality Disorder (Porr, 2017). This means there is a high prevalence of individuals with  Borderline Personality Disorder that have one or more co-occurring mental disorders. Co-occurring mental disorders may lead to a longer period of misdiagnosis. More symptoms affiliated to Borderline Personality Disorder lead to an incorrect diagnosis, thus even more symptoms affiliated to other disorders may lead to several misdiagnoses until a proper diagnosis is done. 

The stigmatization of Borderline Personality Disorder is very prevalent considering the continuous misdiagnosis of Bipolar Disorder instead. Thus it can be concluded that many clinical professionals often diagnose individuals with more common disorders without taking into account the existence of less common mental disorders. Luckily training was established to educate clinical professions with the proper diagnosis techniques for Borderline Personality Disorder (Ruggero & Chelminski & Young, 2009). 

Misdiagnosis of Borderline Personality Disorder, and many other mental disorders alike, is still prevalent today. But as more awareness and factual knowledge about different mental disorders is spread, the chance for proper diagnosis to occur in the future is greater.

References

Limone, P., & Toto, G. A. (2022). Factors That Predispose Undergraduates to Mental Issues: A Cumulative Literature Review for Future Research Perspectives. Frontiers in public health, 10, 831349. https://doi.org/10.3389/fpubh.2022.831349

Mayo Foundation for Medical Education and Research. (2019, July 17). Borderline personality disorder, Mayo Clinic. https://doi.org/10.1037/e555352011-001

Meaney, R., Hasking, P., & Reupert, A. (2016). Borderline Personality Disorder Symptoms in College Students: The Complex Interplay between Alexithymia, Emotional Dysregulation and Rumination. PloS one, 11(6), e0157294. https://doi.org/10.1371/journal.pone.0157294

Porr, V. (2017). Real life consequences of stigmatization, misdiagnosis, misunderstanding, and mistreatment of borderline personality disorder. European Psychiatry, 41(S1), S259–S260. https://doi.org/10.1016/j.eurpsy.2017.02.065

Ruggero, Zimmerman, M., Chelminski, I., & Young, D. (2009). Borderline personality disorder and the misdiagnosis of bipolar disorder. Journal of Psychiatric Research, 44(6), 405–408. https://doi.org/10.1016/j.jpsychires.2009.09.011

Fall is Here, Why Do I Feel So SAD?: What is Seasonal Affective Disorder and How Can it Be Treated?

The best time of the year can sometimes bring out the worst of our feelings. The transition into the fall season has many things we can look forward to such as the holidays, fall festivities like pumpkin and apple picking and much more. However, along with the positives of fall come the negatives: As the seasons change, the weather becomes colder and the days become shorter. These factors can lead to some individuals developing seasonal affective disorder (SAD), also known as seasonal depression.

Seasonal affective disorder is a specific type of depression that is linked to the changes of the seasons (Mayo Clinic, 2021). For most people diagnosed with SAD, the symptoms begin during the fall and usually last throughout the winter months, resolving in the spring. Another less common form of SAD is developed during the spring and summer months and settles down during the fall. Some of the symptoms of fall and winter SAD include hypersomnia, or oversleeping, overeating (with a craving for carbohydrates), weight gain, and social withdrawal when one feels like “hibernating” (NIMH). The causes of these symptoms, and SAD in general, are not yet fully understood by professionals. Although, research suggests that individuals with seasonal depression may have reduced activity of the neurotransmitter serotonin. Serotonin's role in our brains is to regulate our moods. When an individual has normal levels of serotonin, they tend to feel happier and more emotionally stable. Therefore, if an individual is experiencing low levels of serotonin, they are more inclined to feel depressed (Cleveland Clinic). It has also been suggested that sunlight plays a part in controlling the levels of molecules that help regulate serotonin levels. In people with SAD, the maintenance of serotonin levels does not function properly. As a result, there is a decrease in serotonin for them during the colder and darker months of fall and winter (NIMH). The drastic decrease in sunlight also affects vitamin D production in the body. Vitamin D is believed to be important in boosting serotonin levels. Thus, lower levels of vitamin D will contribute to lower levels of serotonin activity in the brain, making us feel more melancholy than in other times of the year that have more hours of sunlight (NIMH). 

While the symptoms of SAD may lead one to feel hopeless or overwhelmed, there are different treatment methods that can be used to help relieve them. Since SAD is a type of depression, some of the treatments are the same as that of Major depressive disorder (MDD). One of these treatments is psychotherapy, specifically cognitive behavioral therapy (CBT).  CBT is a form of talk therapy in which an individual works with a licensed counselor or other mental health professional to talk through and learn how to cope with difficult thoughts and feelings. CBT for patients with SAD may focus primarily on shifting the negative thoughts they have surrounding the winter season to a more positive light. This can be achieved through a process called behavioral activation. Behavioral activation helps individuals to identify and create a schedule of enjoyable indoor and/or outdoor winter activities that they can engage in to fight the loss of interest brought on by this time of year (NIMH). Another kind of treatment for SAD, which is also used for MDD, is antidepressant medication. Since serotonin dysregulation is common in people with SAD, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to increase serotonin levels and thereby regulate mood (NIMH).

A treatment that is specifically geared towards healing SAD would be light therapy, also known as bright light therapy (BLT). Light therapy, which has been around since the 1980s, works to expose individuals with SAD to artificial light that mimics natural outdoor light. BLT is administered in the form of light boxes with suggested exposure time of 30-45 minutes a day, preferably in the morning. Psychologist Adam Borland recommends using the light box as early in the day as possible. Dr. Borland specifies that one should not be looking directly at it,  but rather using it as a nearby passive light source in their indoor space (Cleveland Clinic, 2021). Another SAD-specific form of treatment is taking vitamin D supplements. As mentioned earlier, many individuals with SAD may experience some sort of vitamin D deficiency due to the lack of sunlight during the fall and winter months. Therefore, taking these vitamin D tablets may help improve symptoms for some (NIMH).

Just because SAD season is upon us, doesn’t mean that those of us who struggle with it should spend all of the colder months feeling sad. All of the treatments mentioned above have been found to be effective in relieving the symptoms of SAD. Of course, like any other condition, everyone is different and what works best for one person might not be what works best for another. Regardless, finding a form of SAD treatment that benefits you is a great way to enjoy the fall and winter season for all of its unique joys and festivities!

References

Cleveland Clinic. (2021, December 2). How light therapy helps SAD. Cleveland Clinic. Retrieved October 5, 2022, from https://health.clevelandclinic.org/light-therapy/ 

Mayo Foundation for Medical Education and Research. (2021, December 14). Seasonal affective disorder (SAD). Mayo Clinic. Retrieved October 5, 2022, from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651 

Photograph: https://www.science.org/do/10.1126/science.caredit.aax2505/full/WL_LightH.jpg

Serotonin: What is it, Function & Levels. Cleveland Clinic. (n.d.). Retrieved October 12, 2022, from https://my.clevelandclinic.org/health/articles/22572-serotonin#:~:text=Mood%3A%20Serotonin%20in%20your%20brain,serotonin%20are%20associated%20with%20depression. 

U.S. Department of Health and Human Services. (n.d.). Seasonal affective disorder. National Institute of Mental Health. Retrieved October 5, 2022, from https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder 

Caring for Our Caregivers: Physician Suicide Awareness and Prevention

The conclusion of September brings the end to National Suicide Awareness month, a topic often shunned by public discussion. Awareness regarding this issue should not be limited to just one month, rather year-round conversations are necessary to examine systemic issues and barriers regarding suicide prevention with additional emphasis on high-risk groups. Physicians are one such high-risk group who on average face a higher death-by-suicide rate than other professions, with studies estimating the suicide of 300-400 practicing physicians yearly (Yaghmour et al., 2017, p. 976). It is estimated that “The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is…2.27 times greater than the general female population” (American Foundation for Suicide Prevention, 2022). A fundamental problem exists that perpetuates the crisis seen in medical professionals. 

Not often viewed as the byproduct of an individual event, suicide is commonly the aggregated result of multiple risk factors, with the highest occurrence being mismanaged mental health conditions (American Foundation for Suicide Prevention, 2022). Following the completion of medical school, physicians enter a formative period of residency training for three to seven years to become specialized in their respective fields. Residency training is labor intensive and highly demanding of a physician's time, as individuals may work between 60-80 hours per week depending on their specialty and rotation by standardized working conditions. In 2003, The Accreditation Council for Graduate Medical Education (ACGME) imposed an 80-hour weekly work limit, averaged over four weeks, and 24-hour shift limit guidelines for residents (Accreditation Council for Graduate Medical Education, 2004). Though these regulations were created to combat overwork and sleep deprivation for residents, studies have shown it is a common occurrence to underreport or falsify one’s hours worked to comply with ACGME. Through an anonymous survey completed by 6202 residents at ACGME-accredited medical programs, “Nearly half of residents (42.9%) responded that they falsely reported their duty hours at some time, including 18.6% who reported falsely at least once or twice per month” (Drolet et al., 2013). Although legal limitations are established for resident working conditions, physician training generally applauds a visible dedication and commitment to maturing in one’s field. This may encourage residents to stay longer to observe more patients, take on more cases, and commit to more educational or academic tasks at home or in the hospital (on their own time). Thus, to fit national compliance, trainees might be more flexible in logging false hours. Long hours translate to fewer hours for oneself, whether it be doing leisure activities or spending time with loved ones.  

Amongst long hours and competitive, high-stress training environments, “... trainees often learn to ignore signs and symptoms of burnout, depression, and suicidality” (Kalmoe et al., 2019). A meta-analytic review of multiple studies examining suicide amongst physicians and healthcare workers found “... between 20.9% and 43.2% of trainees screened positive for depression or depressive symptoms during residency” (Mata et al., 2015). It is important to note that a significant increase in the onset of depressive symptoms lies at the start of residency, which supports the finding that training experience across all specialties is commonly distressing to the individual’s mental health  (Mata et al., 2015). In a study cohort of 740 first-year U.S. residents across 13 institutions and multiple specialties, it was examined that suicidal ideation escalated by 370% over the first several months of their training year (Guille et al., 2015). 

While physician training applauds fortitude and passivity from its residents, it is no doubt that the profession demands for its trainees to forgo themselves to be more devoted to their training. Though physicians routinely check for their patient's mental health concerns, medical culture routinely stigmatizes mental health treatment and support for its own. Lacking an adequate support network can further amplify the dehumanizing experience faced by medical trainees leading them to isolation in combating their mental health issues. Similar to the barriers faced by many others, resident physicians may also come across financial and social barriers in seeking mental health treatment. With medical educational debt having an average of $200,000-$300,000 and resident salaries being around $50,000-$60,000, residents may struggle to obtain affordable care or therapy combined with their other living expenses and continuing medical education. With finances not being a concern, even finding adequate time to schedule appointments may be difficult with the long shifts and on-call hours. 

While it is advised for physicians, particularly residents, to address their mental health conditions through treatment, it is vital to recognize this issue not as a personal conflict, but as a systemic crisis. Individual actions may fall short of the larger issue at hand, which is a large burden placed on physicians during their training to constantly be more and do more. It is crucial for medical training to become humanized to combat depressive symptoms faced by physicians and remind them they are not alone. 

References

Accreditation Council for Graduate Medical Education. (2004). The ACGME’s Approach to Limit Resident Duty Hours 12 Months After Implementation: A Summary of Achievements. ACGME Home. https://www.acgme.org/globalassets/PFAssets/PublicationsPapers/dh_dutyhoursummary2003-04.pdf

American Foundation for Suicide Prevention. (2022). Facts about Mental Health and Suicide Among Physicians. https://www.datocms-assets.com/12810/1578319045-physician-mental-health-suicide-one-pager.pdf

Drolet, B. C., Schwede, M., Bishop, K. D., & Fischer, S. A. (2013). Compliance and falsification of duty hours: Reports from residents and program directors. Journal of Graduate Medical Education, 5(3), 368-373. https://doi.org/10.4300/jgme-d-12-00375.1

Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial. JAMA psychiatry, 72(12), 1192–1198. https://doi.org/10.1001/jamapsychiatry.2015.1880

Kalmoe, M. C., Chapman, M. B., Gold, J. A., & Giedinghagen, A. M. (2019). Physician Suicide: A Call to Action. Missouri medicine, 116(3), 211–216.

Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio, E., & Sen, S. (2015). Prevalence of depression and depressive symptoms among resident physicians. JAMA, 314(22), 2373. https://doi.org/10.1001/jama.2015.15845

Yaghmour, N. A., Brigham, T. P., Richter, T., Miller, R. S., Philibert, I., Baldwin, D. C., & Nasca, T. J. (2017). Causes of death of residents in ACGME-accredited programs 2000 through 2014. Academic Medicine, 92(7), 976-983. https://doi.org/10.1097/acm.0000000000001736

ALS: The Silent Killer

Amyotrophic Lateral Sclerosis, commonly referred to as ALS, is a disease that affects neurons involved in voluntary muscle movement. Voluntary muscle movement features any movement not triggered by a reflex or internal mechanisms such as heart rate and blood pressure. The word "Amyotrophic Lateral Sclerosis" can be broken up into two meanings: muscle atrophy and hardness of the lateral columns of the spinal cord (Rowland & Shneider, 2001). Symptoms typically begin with hand or leg weakness, followed by slurred speech and dysphagia (difficulty swallowing). Eventually, the disease worsens into significant weakness in muscle activity and for some, eventual paralysis (Rowland & Shneider, 2001). 

ALS is a heartbreaking illness to live with, particularly since it has the ability to affect people as young as 30. Early diagnosis is vital to prevention of the progression of the disease (Priest, 2015)). In recent years, medications such as the drug Rilutek, have been found to delay this progression. Rilutek is a glutamate blocker. Glutamate is an excitatory neurotransmitter in the central nervous system and is vital in the firing of action potentials in a functioning neuron, which signals for the muscles to constrict or relax, resulting in normal bodily movement when working properly. However, excessive stimulation of glutamate receptors has been found to cause neuronal death, resulting in muscles no longer being able to move, leading to the paralysis patients with ALS suffer from (Foran & Trotti, 2009). By Rilutek functioning as a glutamate blocker, it aims to prevent abnormal glutamate activity that negatively impacts muscle movement. As of early 2020, Rilutek was the only medication that has been found to have a long-term effect on ALS progression. 

Fortunately, as medicine continues to advance, so do new forms of treatment for existing diseases. Recent studies have begun studying AMX0035 (Relyvrio). Relyvrio is a combination of sodium phenylbutyrate and taurusodiol aimed to prevent cellular stress and stop the progression of the disease before its progression. This medication was found to result in a slower functional decline by extending life an average of 10 months for patients treated with it (Paganoni et al, 2020). It was accepted by the FDA in September of 2022 and is awaiting more clinical trials to assess long-term symptoms (als.org). 

Being such a devastating illness, it is crucial that research involved in ALS continues to be funded for future studies to test new, hopefully, more effective treatments, and those with ALS have options to assist in their care and well-being. It is treated as a necessity to the care and well-being of those who live with ALS. 

References

AMX0035 (RELYVRIO). The ALS Association. (n.d.). Retrieved October 6, 2022, from https://www.als.org/navigating-als/living-with-als/fda-approv ed-drugs/amx0035#what-is 

Foran, E., & Trotti, D. (2009). Glutamate transporters and the excitotoxic path to motor neuron degeneration in amyotrophic lateral sclerosis. Antioxidants & Redox Signaling, 11(7), 1587–1602. https://doi.org/10.1089/ars.2009.2444 

Paganoni, S., Macklin, E. A., Hendrix, S., Berry, J. D., Elliott, M. A., Maiser, S., Karam, C., Caress, J. B., Owegi, M. A., Quick, A., Wymer, J., Goutman, S. A., Heitzman, D., Heiman-Patterson, T., Jackson, C. E., Quinn, C., Rothstein, J. D., Kasarskis, E. J., Katz, J., … Cudkowicz, M. E. (2020). Trial of sodium phenylbutyrate–Taurursodiol for amyotrophic lateral sclerosis. New England Journal of Medicine, 383(10), 919–930. https://doi.org/10.1056/nejmoa1916945 

Priest, A. (2015). Living with ALS. Canadian Medical Association Journal, 187(3), 210–211. https://doi.org/10.1503/cmaj.141517 

Rowland, L. P., & Shneider, N. A. (2001). Amyotrophic lateral sclerosis. New England Journal of Medicine, 344(22), 1688–1700. https://doi.org/10.1056/nejm200105313442207