We’re better off when kids are resilient

Are kids going to be okay when the pandemic is over? That’s the question on many parents’ minds as remote learning continues, and friends and family remain six feet apart. Better Off talks with psychologist and researcher Archana Basu about kids’ mental health and the COVID-19 crisis.

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Episode Transcript


Anna Fisher-Pinkert: From the Harvard T.H. Chan School of Public Health – this is Better Off. A podcast about the biggest public health problems we face today . . .

Archana Basu: What does it mean to have your childhood marked by these periods of great stress and uncertainty?

Anna Fisher-Pinkert: . . . and the people innovating to create public health solutions.

Archana Basu: How the system responds really matters.

Anna Fisher-Pinkert: I’m your host, Anna Fisher-Pinkert

March 2020 is going to stick in people’s minds for a long time. It’s the month WHO declared COVID-19 a pandemic, the month President Trump declared the virus a national emergency, the month states first started issuing stay-at-home orders. But for me, it’s also the month I became a mother. My daughter was born in the middle of the first wave of the COVID-19 pandemic. This is the only world my daughter knows – one where all the grown-ups wear masks and where grandparents appear via video chat.

It’s not all bad – we’re lucky to work from home and get extra time as a family. But every time we go to the park and see children playing, all spaced six feet apart – I wonder: What will these kids remember from this time? How will this pandemic influence the kind of adults they grow to be? And, most urgently: how do parents help them feel okay, even when we don’t feel okay?

Today, we’re going to talk about kids, mental health, and the COVID-19 pandemic. This week, we’re better off with psychologist and researcher Archana Basu.

Archana Basu: I used to say it’s an emotional marathon. I’m going to call it an ultramarathon now because we have no clear horizon in sight. This is for the long haul.

Anna Fisher-Pinkert: This is Archana Basu. She is a research scientist in the department of epidemiology at the Harvard T.H. Chan School of Public Health and a clinical psychologist at Mass General Hospital. Archana’s expertise is in trauma – how it affects women and children, and the potentially protective factors that may buffer the impact of trauma.

Archana Basu: I’m interested in sort of a developmental and intergenerational view of how trauma can impact people across the lifespan, but also intergenerationally.

Anna Fisher-Pinkert: Way back in March, Archana and her colleague Karestan Koenen wrote a column for one of Boston’s public radio stations, WBUR, about how to talk to kids about COVID-19. When I spoke to Archana this past fall, I realized that a lot of the advice hasn’t changed since then: Ask kids what’s on their minds as they navigate this crisis. And really listen to their concerns.

Archana Basu: One of the common themes is, you know, making the time and emotional space within families to really talk about what’s most salient in terms of their experience of the pandemic. What are they thinking about right now?

Anna Fisher-Pinkert: She also advises that parents stay on top of routines that help them feel okay – including good sleep and exercise habits – and take time away from their phone and computer screens, to sort through their own feelings about the pandemic.

Archana Basu: So I think making the time to really talk through what the pandemic looks like and feels like, the ways in which we ourselves are affected and what we’re worried about — that type of open communication, both around informational elements but also around the emotional elements, I think is really, really central to supporting children and helping them make sense of what they’re already experiencing.

Anna Fisher-Pinkert: Archana and I spoke before the U.S. approved two vaccines for COVID-19. So now that horizon line is getting a little bit clearer. But we’re still months away from most families getting access to the vaccine – and there is no specific date when everything will go back to normal. We can’t give kids that measure of certainty – and that makes the pandemic especially challenging for anyone caring for a child.

Archana Basu: The ongoing uncertainty and lack of a clear horizon is one of the very unique aspects of this pandemic. And I think providing comfort and reassurance within that context is not an insignificant challenge. And one possible way that we could think about it is first to kind of name what the worries are for each of us. You know, we, I often use this quote from Fred Rogers when talking to families, “what is mentionable is manageable.” And then, thinking of ways that, you know, there’s elements to this we can control and elements that we cannot. And thinking about what that looks like for each of us and coming up with ideas that give a sense of realistic reassurance. So it’s tempting to say it will be OK. And while we certainly hope so, it’s sort of nonspecific and unclear, and it doesn’t really take into account the worries that we have.

Anna Fisher-Pinkert: Those worries might be really specific – worrying about missing beloved friends or teachers, worries about missing family rituals and holidays – the way that many missed out on Thanksgiving and Christmas this year.

Archana Basu: I think there is an important part of this conversation is actually acknowledging the day-to-day sense of loss. But then also, you know, thinking about, well, what can we do about some of these rituals and traditions we miss? So what are some ways in which going to school or meeting friends in certain contexts can feel safe and is consistent with public health guidelines. That provides a level of detailed and realistic kind of planning and realistic reassurance.

Anna Fisher-Pinkert: We’re in month eleven of this pandemic. I can tell you that some of my early-pandemic coping mechanisms are starting to feel kind of old – and I imagine the same is true for kids. The day-to-day worries, losses, disruptions – they all add up. So what are they adding up to? I asked Archana if there were any lessons to be learned from the research that has been conducted on mental health after other traumatic events – like hurricanes and natural disasters.

Archana Basu: it is true that in the context of research examining mass disasters, both for adults as well as for children, including adolescents, the overwhelming proportion of children and individuals are unlikely to go on to have long term clinical mental health problems of the sort that would require ongoing care in, say, a hospital system or with a therapist.

Anna Fisher-Pinkert: But, researchers do expect to see – and are seeing – an increase in concerning mental health patterns among kids and adults.

Archana Basu: So we are seeing an increase in, you know, what I think of as mental distress right. So we are hearing about increased depressive symptoms, worries and anxieties. All of that is completely understandable. It’s an appropriate response to a not normal, not typical, unsafe situation.

Anna Fisher-Pinkert: The research that is out there about large-scale disasters and mental health comes from events like Hurricane Katrina – which largely affect families in just one region of the country. And while economic recovery from Katrina has taken years – the threat of the hurricane and the subsequent flooding were over in weeks, not months.

Archana Basu: What makes it hard to extrapolate completely from prior data is the fact that this pandemic, I mean, it’s not localized. It’s not quite like, you know, research from a hurricane or other mass disasters that is geographically localized, but also somewhat time bound. So I think it’s the, you know, the chronic cumulative impact. It’s the pervasive impact. It’s these other secondary effects, such as the economic recession. All of these, I think, are likely to exacerbate the risks.

Anna Fisher-Pinkert: Those chronic, cumulative impacts are what I worry about most as a parent. And I’m not alone.

Suzie Jacobson: “I worry that this pandemic will shape the personalities and morality of a generation.”

Anna Fisher-Pinkert: This is Rabbi Suzie Jacobson, speaking at Temple Israel in Boston on Yom Kippur. She’s also a parent, and she compared this pandemic to another type of long-term disaster.

Suzie Jacobson:  Many who suffered through the Great Depression or the hardships of the Second World War became excessively frugal: Rinsing and reusing plastic bags, hiding gold bars under the bed, avoiding any frivolous spending. I worry that my children’s generation will inherit a frugality of love. A fear of getting close to strangers, a reluctance to trust or engage in new relationships.

Anna Fisher-Pinkert: So I asked Archana, is this something to fear? Are kids going to carry these habits and these anxieties with them the rest of their lives?

Archana Basu: This is an observation, this particular one. There are also sort of other ones that I’ve heard in terms of sort of generational effects, for example, with millennials, their childhood, being bookended by 9/11 on the one hand and then the 2008 recession and now this. Like, what does it mean to have your childhood marked by these periods of great stress and uncertainty?

Even if there isn’t a clinically significant range of mental health concerns for a sizable portion of the population, there may still be other habit patterns and socialization patterns that might change and still affect us.

And I think the answer to that, from my personal perspective, is just that as with every other stressor, how the system responds really matters. And so within the family, we talk about when children are experiencing something worrisome and potentially stressful, parents’ sort of response really matters. And I think there’s a parallel to this at the societal level, which is that as we’re all experiencing this pandemic, how our governments and health systems and public health systems respond and how our public policies shape over time to respond to this communal crisis and trauma is going to be really important.

Anna Fisher-Pinkert: If you listened to our last episode with Howard Koh, you heard all about the government response to the pandemic – how local, state, and federal governments could work together to bring down community spread and ensure the vaccine is distributed equitably. But even if COVID-19 vanished off the planet right this very second – the total effect on our mental health wouldn’t vanish along with it.

Archana Basu: When this pandemic ends, it doesn’t necessarily mean that the mental health impact has also ended. So I think the mental health reverberations will continue for longer.

Anna Fisher-Pinkert: You can really see this in children. Kids seem to have been spared the worst of the physical impacts of COVID-19 – but that doesn’t mean they are immune to what’s happening around them.

Archana Basu: Children are affected also, by the impact of the disease on their grandparents. If they’ve lost a loved one, if they have experienced a loss of their home, their parents have had income instability or loss. All of those things still affect kids and families. So I think it’s important for us to keep in mind that the timeline for the mental health implications is different and longer-term than the sort of viral disease pandemic.

Anna Fisher-Pinkert: And those losses are not distributed equally. Archana says that if we really want to make sure that kids grow up mentally and physically healthy after we return to “normal,” we need to make sure that their parents can access food, health care, and housing.

Archana Basu: I think any meaningful policy that is designed to address the mental health needs of the pandemic for children and families must account for the existing context, the existing disparities that we started pre-pandemic. So we’ve talked about the fact that, you know, the impact of this pandemic is not the same across society. The virus is not an equalizer. It’s a magnifier. It’s an illuminator. And we know very, very clearly that the impact of this pandemic on under-resourced and minority communities has been really astounding. And so, from my perspective, I would say policies that address economic security, family-centered policies, and those that account for preexisting disparities are really critical in terms of supporting children and families.

Anna Fisher-Pinkert: The stress of sustained insecurity doesn’t just have an impact on a child’s mental health. That stress has profound physical implications.

Archana Basu: There is a lot of research already that shows that long term chronic stress, like severe stress and potentially traumatic experiences, can shape how children’s, you know, bodies develop.

Anna Fisher-Pinkert: This process is called “biological embedding.”

Archana Basu: Experiences literally can get under the skin and shape how we are developing physically.

Anna Fisher-Pinkert: The effects of trauma can show up in all sorts of unexpected ways.

Archana Basu: It sort of has a system wide impact, which means that it has been associated with, you know, multiple organ systems. So cardiovascular systems, how children’s lungs develop and, you know, risk in terms of, you know, asthma. There are changes in terms of immune system functioning and the potential implications for, you know, longer-term risk, such as inflammation, potential changes in neural functioning and brain architecture, biological aging markers. . .

What we don’t have any definitive answers on are what constitutes cumulative stress. Like, is it six months? Is it two years? We don’t know. How many stressors is too much stress?

Anna Fisher-Pinkert: It seems to me that there are no children in America or perhaps in the world who will be untouched by this particular traumatic event. So does that call for people who work with kids and parents and caregivers to change the way that we interact with kids?

Archana Basu: Yeah, I mean, how can we not, right? I think there’s approximately 74 million children in America right now. And there is many more that will grow up in the shadow of this pandemic even after it ends, because the long term reverberations are going to last for some time to come.

Anna Fisher-Pinkert: That doesn’t mean that we, as caregivers, are helpless.

Archana Basu: What are ways in which as families and as communities, we can just hold that sense of loss for each other? I do, honest – I really do believe in the power of gratitude. And the importance of it. And I think it’s important that we not be too quick or too rushed to get there and be able to simultaneously hold both the grief as well as the gratitude elements of it, because we are still mourning a lot.

In terms of what would we expect long-term, part of the picture is how we respond to it. Within a family, we often talk about feeling supported through adversities. That’s what resilience looks like. And for children, that means being buffered by responsive, attuned, caring caregivers, usually parents. And at a societal level, I would say that means how health care systems and public policies respond to this situation.

Anna Fisher-Pinkert: When I explain this time to my daughter, many years from now, I want to be able to tell her how we were resilient as a family. How I laugh-cried when I learned to use a baby carrier wrap over FaceTime. How we invented new rituals – The eight Zooms of Hanukkah is definitely coming back in a future year. How sad we were for what we lost, and how happy we were to be parents. I also hope that I can look back and say that it was also a time when people decided to make changes, big and small, to help those who need it.

Thanks for listening to this episode. If you want to read more about COVID-19 and mental health, visit hsph.harvard.edu/news – we’ll have some links up there for you.

Special thanks to Temple Israel of Boston for letting us use a clip from Rabbi Jacobson’s sermon.

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I’m Anna Fisher-Pinkert, host and producer of Better Off a podcast of the Harvard T.H. Chan School of Public Health.