You’re listening to a press conference from the Harvard School of Public Health with Archana Basu, a research scientist in the Department of Epidemiology. This call was recorded at 11 a.m. Eastern Time on Thursday, December 17th.
MODERATOR: Dr. Basu, do you have any opening remarks?
ARCHANA BASU: Thank you for having me. I guess I’ll just add a little bit more information to what you said. Just to note that I do clinical work. I’m a psychologist, so I work with children and families at MGH on supporting children and families, coping with issues of grief and bereavement, a range of traumatic events, and of course, coping with the pandemic and do research. So I can share a little bit about, you know, what we’re hearing clinically and contextualize that in terms of what we know about what is helpful, what’s the science on supporting children’s resilience during these trying times. So I’ll just pause there and thank you for that brief summary.
MODERATOR: Great, thanks, Dr. Basu, and go ahead.
Q: Well, I have to keep my old hat status, so I just want to start with something simple. What stressors are traditionally associated with the holidays and what new ones are we experiencing this year?
ARCHANA BASU: That’s a really good question, because you’re absolutely right. Holiday season, as much as we all look forward to it, it also comes with its set of stressors. And, you know, I think traditionally, as we can all relate, what we hear about are typically sort of daily hassles and stressors in terms of travel and getting together and sort of family dynamics being challenging. When you’re spending a lot of time together with family, you might be meeting after a long time. But generally speaking, people often look forward to this as a period of rest and reprieve and getting together as a family, even though there are sort of all the typical stressors around traveling and getting together with family. I definitely I think we can all relate. This year is incredibly different. We are now several months into the pandemic, there are public health guidelines around travel restrictions, around in-person get togethers. And while these are pretty variable right now, the key themes that we’re hearing about is there’s certainly a very sort of sense of pandemic fatigue. I mean, we’ve been sort of in this for a long time together. So I think that’s a big part of this as a sense of burnout and fatigue, a lot of decision fatigue. People have had to make a lot of tough choices around whether or not to travel, who to see, how to celebrate, whether to celebrate. This doesn’t feel as joyous, perhaps as it typically does. So I think there’s a lot of decision fatigue and sort of emotional burnout. And then, you know, I think there is also a piece around the losses, and these are both big and small. Many of us are forgoing traditional get togethers and rituals as families. And so those are important losses. But there are bigger losses in terms of families may have lost a loved one or someone who’s sick, but also changes for families in terms of employment changes or maybe just the economic impact that families are feeling. One thing that I think has been really striking, we’ve been reading about the statistics, about the growing rates of food insecurity across the country. And this is something that we’re hearing about a lot right now is just the sense of the really high need in the communities that families and particularly families with children who are reporting higher rates of food insecurity, especially young kids. So I think there is a sense of loss and bereavement, which is particularly pronounced during a time that families typically get together to celebrate.
Q: Thank you. And if I may ask a follow up, how do we get through the holidays in not only a healthy way, so what strategies can we use, but are there ways that we can find joy in holidays to make up for all this extra stress?
ARCHANA BASU: That’s another really good question. And I think you highlight a key distinction, which is part of this is about coping and survival. And you’re sort of asking, like the part of this is how you get through it and on the part of how do you really find joy? And so, I would say one thing that I have been hearing a lot about is the holiday season, you’re really starting from, I think, Thanksgiving. It’s also a season of giving back and really connecting with the community. I mean, it’s about connecting with families, but we also get together as communities in terms of, you know, maybe as part of religious congregations, for example, or other communities. You know, there’s lots of food banks or winter charity drives during this time. And this is something that for families and for people who can afford to give in some way, we know that the need is really high. And I think a sense of giving back actually makes us feel good about ourselves, but it also makes us feel more connected as a community. So I think there is a way in which that sense of community is very pronounced and I think is a source of comfort and even joy. The second thing I would say, you know, for kids in particular, this is a really common question for parents and grandparents, like caregivers of kids, how do I, even in the midst of all the stress, keep some of that joy that I really want to share with my family and my kids in particular. And I think in my conversations and experience, it helps to think about what it is in our family rituals that we really value the most. And for each of us, that’s different. So I’m thinking about a young family with young kids that I work with. You know, they describe in very vivid detail sort of this very specific tradition they have about the Christmas Day and the day after, where it’s about the opening of the gifts and a brunch together with very specific family members and neighbors. And they are not meeting the people with whom they typically celebrate. But it was the doing it together. You know, they have a countdown system. And so I think what they narrowed down, which I think is a great example, is what it is in the traditional ritual that’s most meaningful for them. And so if we can figure out what it is for each of us that feels that we can protect or preserve from our traditions, but find a safe way this year to do it. And so for this family that I mentioned, you know, they are doing it over Zoom and through remote calls, as they typically do, they added scavenger hunt because they have young kids and a home where they can do this. But they felt that even though there were a lot of changes, they were able to preserve some of that ritual which they feel, you know, brought them something that kids are looking forward to. So I would say community connectedness is a big part of it. And then thinking about our own unique rituals that we can maybe preserve in some way.
Q: Thank you very much.
ARCHANA BASU: Thank you.
MODERATOR: Next question.
Q: My question is relating to children’s mental health during the pandemic. We had a doctor here locally saying last night that things are reaching disastrous proportions as it relates to children’s mental health and seeing more behavioral and mental health cases in their E.R. and general practice. What can you say about that and why we are seeing those higher numbers during this time in the pandemic?
ARCHANA BASU: Thank you for that question. You know, we’ve been talking about this pandemic as in terms of feeling the impact in waves, so the viral disease impact was sort of the first wave. There’s been the sort of economic impact as another wave. And I think the mental health impact is sort of yet another wave in terms of the impact of this pandemic. And I think what you’re highlighting is something that we’re all seeing. And the CDC actually released some data recently. I think you mentioned that the physician you were referencing works in the emergency department. And CDC did release some data recently showing that there has been an increase since, I believe, April, to where there’s been a huge increase in terms of children seeking psychiatric emergency evaluations. So that is one data point that we know are very available. But I will just step back to say that, you know, given all the range of stressors and losses that children and just lifestyle changes that children have experienced, that parents and families have experience, that communities have experienced, I mean, there’s really layers and layers. And it’s now been going on for many months. There’s sort of a cumulative effect over time. And this, you know, the holiday season is around the corner. We are certainly sort of feeling our losses, maybe, you know, thinking about them a bit more. There’s an impact of this cumulative effect over time. I think there’s the impact of the number of different stressors and losses that we’ve been hearing about and experiencing and all of those could be playing a part. The second thing I would say is that there have been some upsides to the fact that mental health services have become more readily accessible through virtual or phone based, basically remote mental health services. But the fact of the matter is that this it’s not a one size fits all model. We know this type of telemedicine model is not going to meet the range of needs of all kids. And there are certainly children who need more comprehensive care as well as in-person care. And the fact is that not everyone can easily access telemedicine. There are digital disparities that are well-established. So I think community based and in-person services, which are much more limited right now, are not as accessible in each of these factors, could definitely be playing a role in terms of what you are seeing and describing.
Q: Thank you so much.
ARCHANA BASU: And do you have the CDC report that I mentioned? I’d be happy to send you a link if you’d like.
Q: That would be great. I was going to just Google it.
ARCHANA BASU: I think you should be able to find it if you Google it. But if you don’t, I’d be happy to send you a link.
MODERATOR: Next question.
Q: Hi. I wonder if you’re going to address the capacity of the mental health care system to meet this surge? You know, I hear about difficulty getting appointments and things like that. I mean, can our mental health system handle it?
ARCHANA BASU: Another really good question. So I will tell you, I work part time at MGH and I will tell you what I know from our most recent sort of departmental statistics. For example, our total number of visits this year, and this was in September, October, when we got the most recent update. I think we were like a hundred and fifteen percent of what we typically do relative to last year. So the demand is definitely up. And I think the answer to your question is not everyone is going to need sort of the same level of care. And I think even before the pandemic, we know that mental health resources and services were essentially inadequate or there were certainly shortages in school-based systems, in clinics and outpatient clinics and so forth. So, you know, in a system that was already stretched a little thin, I do think that this is going to place inordinate demands. And I think the answer is we will need capacity building in terms of outpatient care. But this is also an opportunity and a really important one, I will say, to do more mental health, education and social emotional sort of curriculum-based opportunities in school-based settings and community based settings. Those are more sort of universal intervention models where we can really support teachers and schools or even in routine care like pediatric practices, integrating mental health into schools and pediatric practices like places where children are seen on a routine basis are also opportunities, valuable opportunities for interventions, because so many children are going to need some level of support but may not need long term outpatient therapy or inpatient therapy. So I think there’s a scope for capacity building in many settings and in many different ways.
Q: Just to clarify, the statistic you gave is that one hundred, one hundred and fifteen percent over a year to that point, or is that over the previous year?
ARCHANA BASU: I believe it was year to that point.
Q: So just 15 percent up?
ARCHANA BASU: Yes.
Q: Is there a danger as we look towards the end of this pandemic with vaccine starting to be distributed, that once everybody gets vaccinated, people will kind of go, OK, that’s over and ignore what may be a long tail of mental health issues.
ARCHANA BASU: You know, I’ll just comment that I think that is a danger or that is certainly being discussed widely. What does it really mean to have this vaccine? As far as we know, there’s a couple of different doses. There’s a phased plan. And I think one thing we know very clearly is that public health messaging around what it means to have the vaccine, there’s a lot of work to be done around that. Is your question more specifically about what this means for kids?
Q: When we talk about the vaccine in the pandemic, are we focusing too much on the physical impacts of the pandemic as opposed to the mental impact? And I’m wondering if we can expect there to be sort of lingering mental health issues even after everyone’s been vaccinated?
ARCHANA BASU: Got it. OK, thank you for clarifying that. So what I would say to that is we can extrapolate a little bit from previous data from mass disasters in terms of kind of the longer term impact on children and youth, but with the caveat that the COVID-19 pandemic is a very different communal stressor relative to other mass disasters that have generally been geographically located and also to say we’re still in the midst of the pandemic, you know, the horizon is still unclear. So I do think while the vaccine gives people hope and we can extrapolate from prior data, we won’t know. I think data on children will still be forthcoming. And what we know from prior data is essentially, you know, for example, if you look at Hurricane Katrina studies following children and youth two to four years post Hurricane Katrina, about two to four years out, the majority of kids were not showing sort of clinically significant mental health concerns of the sort that would require ongoing weekly therapy or pharmacological intervention. And this is a common pattern that we see with adults and with children, which is that as the stressor sort of abates over time, we see that more than half and the majority over time tend to show fewer mental health sort of related distress and concern. There are studies, including from Hurricane Katrina, showing that in some communities, I mean, this particular study, you looked at children who were served in a mobile mental health clinic about four years out in a primary care pediatric facility and found that about 30 percent of children in a primary pediatric care service needed mental health services. And so I think that there will be a substantial subgroup of children and youth that will continue to need mental health services, even two to four years after. And so I do think that there will be lingering effects for a subset of children.
Q: Thank you very much.
MODERATOR: Next question.
Q: Yes, I’m back, I have a follow up question in that same vein, if I’m a parent, how do I know when to really seek help for my child as it relates to the mental health, anxiety and depression? How do I know if they really need the help to bring them into a doctor or if they’re just being dramatic?
ARCHANA BASU: So the couple sort of core things to keep in mind, you know, one of the things we look for is sort of persistence in the types of problems that you’re seeing because some level of distress or like when we adapt to stress and children adapt to stressors, sort that we’re experiencing now, you’re likely to see maybe some difficulty in staying motivated with school, some behavioral concerns, maybe increased crying. It’s common for children to show what we call somatic symptoms, which are sort of more physical symptoms. They might complain of aches and pains like bellyaches, sleep problems. These are very common. But kids, often with kids’ parents, report behavioral difficulties as a primary concern. So these are all sort of a constellation of concerns parents might observe. But when these are very persistent or are actively interfering with just getting through the day, you know, there’s been several days at a stretch where a child may not have been able to engage with schoolwork or your kid, who’s otherwise very social and friendly is, you know, sort of more detached and disconnected from friends. They typically want to sort of talk to or hang out, I would say, let’s say remotely. But if you start to notice changes that are both persistent but also interfering with things that you do on a day-to-day basis, whether it’s schoolwork, engagement with friends and families, or, you know, we also see sort of a loss of interest in sometimes things like play activities or hobbies or sports, whatever they can do at this time. Those are all red flags. I would look for persistence and second, for interference in things that they need to do or like to do to get through the day. A good sort of first step is always to speak with a primary care doctor. Short screening can help identify whether further screening and treatment might be helpful.
Q: Thank you.
MODERATOR: And Doctor, I know you’ve had a lot of questions come your way, so if there’s anything you would like to discuss in particular that you think would be helpful for others, feel free. This might be a question that’s outside of your expertise, so feel free to decline it. But some of the things you heard about with adults with COVID have been like brain fog and that type of thing. Have you heard about that type of effect on children as well?
ARCHANA BASU: So this is actually a question that I have, so I’ll tell you that. So the short answer, is I don’t have data on this and I don’t think I can comment on it. Actually, I’m interested in these data because of the recent sort of data that’s emerging on adults. And I was on a panel recently where a neurologist talked about their observations on what they’re seeing in terms of brain fog with adults like potential memory problems. And it made me wonder when we’re doing assessments of children. So, you know, in terms of the question that Katie asked, like one of the things we look for is, you know, if a child is having difficulty in school-based learning, which right now just feels like an extraordinary demand anyway, we are often trying to rule out how much of this is motivational. Is it about sort of the Zoom, this virtual remote learning environment? Are these genuine attentional or memory related problems? And I think the short answer is I certainly don’t know. And I am looking for those data. But I think it’s a really, really important question given what we know and what we’re seeing with adults.
MODERATOR: I know that you’ve had some other requests for information, questions asked you about long-term effects with kids, is there any difference between ages with that? Younger kids, they tend to bounce back faster than older kids? Is there a differential between kids or are they all pretty resilient up until a certain age? Is there a difference?
ARCHANA BASU: That’s a really good question. So I’ll tell you that off the available data that we have, I mean, I guess one thing I probably should’ve said this at the outset, I think it’s worth noting now, is at any time data on children is often lagging relative to adults and that’s just how it has always been. We often have more data from adult studies than we do with kids. So that’s one thing. And in this pandemic, places where we typically sort of engage children and families for sort of research and ongoing surveillance, which are like schools or routine care, like pediatricians offices, with all the distancing and stay at home orders in different places, we are not seeing kids in the places that we typically do so in this pandemic more than even others situations, I would say data on children are actually relatively as far, there’s some studies, but it’s much less than what we see typically and relative to adults. So I think in the coming couple of years, we’re going to learn a lot more in terms of the impact on children. So that was just one thing that I wanted to say. But from the available data, two sorts of groups that studies are showing me have been particularly affected, one is young children. So families with children who are young, we often think of them as being six and under, they are reporting really increased levels of stress in the family. Parents are reporting both mental health concerns for themselves, but also behavioral challenges for their kids. We suspect that a lot of this is related to the loss of kind of typical caregiving supports, because as parents, we are usually raising our kids in a village. Right? Like there’s a school system, there’s often maybe grandparents or other family members. But that sense of isolation has really cut off access or at least limited the access to our support system. And that is definitely I mean, I have to tell you, I work, and study kids and parents and parents and caregivers have always been my heroes. But in this pandemic, I have to say on a daily basis, we are asking Herculean sort of demands of our parents and caregivers and single parents in particular are my personal heroes. And what we’re learning is that young kids’ families are reporting very high levels of stress, you know, children, single parents and then young adults. So although they are legally adults, when we think of child development, we often think of young adults still about, say, twenty-four, twenty-five. Biologically, their brains are still developing, and they’re sort of the older adolescent young adult phase. So I often talk about young adults and sort of monitor research related to that. And those are two subgroups we know that are really reporting very high levels of mental health distress at this time in the pandemic.
MODERATOR: Thank you. Another question I have is about seasonal affective disorder and with the pandemic, with it getting dark outside and its winter, everybody’s cooped up. Is there anything that you can recommend people do who may be experiencing this for the first time this year because everything’s been kind of turned upside down or know that this is a pattern they’ve seen before in their lives? How could people deal with seasonal affective disorder this year? Any special recommendations?
ARCHANA BASU: Well, so I guess one thing to note about seasonal affective disorder, I think folks probably already know this, but just to mention briefly, you know, it’s a type of depression. It has a seasonal pattern. We usually see it starting more around fall and then winter with remission in spring and summer. That’s sort of a typical seasonal pattern. We see that in about, I believe, five percent of the US general population. So what we know, for one thing, is typically onset for seasonal affective disorder tends to be in young adulthood. So you might see it in some older teens. But young adulthood is sort of the typical age at which we start to see that. And, you know, if there’s a prior history of mental health concerns, particularly mood disorders, there may be an increased risk also for seasonal affective disorder. And one way to sort of know whether, at least to consider whether someone might be struggling with that is, you also hear the term kind of winter blues in the same conversation. And this is not the winter blues. This is much more, again, persistent, distressing and really gets in the way of getting through the day. There are very strong evidence-based treatments for seasonal affective disorder. You know, there is pharmacological interventions, certain types of psychotherapeutic interventions. There’s light therapy. And that really should be done. Obviously, each of these would require value. So I would evaluation and working with mental health professionals, I would recommend, you know, again, speaking at least to a primary care provider to begin with. But monitoring yourself or someone for these types of persistent impairing problems that we typically see with depression would be one way to keep an eye on it. I was just also going to send a link about that to folks in the group if they’re interested in sort of looking it up a bit more. But yeah, so there are evidence-based treatments. But the first line, I would say is recognizing the signs and then seeking an evaluation.
MODERATOR: All right, thank you. Are there any other commonly asked questions that you’ve been getting lately?
ARCHANA BASU: I think I may have sort of touched upon this. But I think one thing that folks have been asking about is there is this tremendous growing mental health need and how do we address this and how do you support children’s resilience? And I think there’s one thing that I don’t think I said this explicitly, and I think it’s worth noting is, children live like us. Children live, grow and develop in families and schools and other communities like churches and temples, among other places. And each of these communities is actually an opportunity for intervention. So, you know, in terms of thinking about the long-term impact and how to meet the needs for children’s mental health, I think that, of course, we need to do capacity building in health care systems. But I think also supporting schools, parents and also developing collaborations with community-based systems is going to be really, really key. The reason for this is partly what I said earlier, which is that, you know, not everyone is going to need the sort of type of outpatient care that folks like me and others provide in a health care setting, but also because many children are not seen in the types of health care settings where these services are available, which is also sort of stretched thin. In fact, pre-pandemic, there is data to show that I think it might be close to 30 percent of children. And I can double check and then do the research on this. But it’s about a little over 30 percent of children only, receive any mental health services in school-based settings. And this is particularly true for children who come from under-resourced communities and children who identify as racial minorities. And because we may never see them in a health care setting and because they’re neat, the needs are going to be so great. I really think that this is an opportunity for mental health capacity building at many different levels beyond just health care settings. And so when I think about resilience in kids, the way I think about it is that we can promote resilience in kids by, of course, supporting families and parents, but also by supporting these other communities like schools in their efforts to support kids. So I think resilient kids come from well-supported communities essentially. So I think the work is at many, many different levels I guess is the main thing that I would want to say, including some of the economic policies, which is not in my area of expertise. But we know that, you know, food insecurity, for example, a big issue that we’re seeing right now is related to mental health concerns. The economic policies can also affect mental health for kids. So I think this work at many different levels that can be done.
MODERATOR: Thank you. And one other quick thing, do you have any just really quick advice for parents who are trying to make it through with kids and any advice that they can help make things a little bit easier for their children and reduce their stress levels?
ARCHANA BASU: So the most important thing I will say, because parents are really bad, myself included. In a caregiving role, we are great about looking after our kids, calling our parents, you know, attending to our jobs. We are not good at prioritizing our own selves. And if there’s lots of resources and thinking about, you know, how can you stay connected to your community, practicing gratitude, mindfulness, focusing on things you can control. There’s lots and lots of resources out there that talk about these very concrete skills. And I think those are all evidence based. And I would highly recommend them. But the one thing that I will say is research time and time and time again has shown one of the best and most important predictors of children’s adjustment is parental adjustment and parental mental health. And this is something that we are not great at as parents and caregivers. So actually, I would say to myself and to parents everywhere is prioritizing your own sort of mental health and emotional well-being is not selfish. Self-care is not selfish. We really got far from an empty cup. So when we invest in ourselves, even if it’s 10 or 15 minutes, it’s a small ritual. But our self-care, our kids sort of adjustment depends on us. And we are that powerful kind of buffer. Children need responsive, emotionally available adults to help them get through this. So I would say the most important thing if I had to give one is I hope that parents will take the time to focus on their own mental health as much as they are thinking about others, including the kids.
MODERATOR: Wonderful. Thank you. If there are any other questions out there, go ahead, raise your hand or get in touch with me. Otherwise, we may be wrapping up a little bit early. I’m sorry. And as you were saying that I was just kind of chuckling to myself because it’s a snow day here in Boston. And if you have kids and they are home today, it’s a little more difficult than usual. All right. It looks like there are no questions, Dr. Basu, do you have anything else you’d like to say?
ARCHANA BASU: I just wanted to check to see if anybody needed any, I know I cited some studies, but I know I didn’t put links to all of them. I got only one link in there. So if there are particular reports of studies that I may have mentioned, but I know that you’re interested in looking up in more detail or citing, you know, if they could reach out to you, Nicole or me, I’d be happy to send them to specific studies.
This concludes the December 17th press conference.