COVID forced Kentuckians into a 'baseline of anxiety.' How primary care providers can help
This article discusses suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.
As the COVID-19 pandemic pushes anxiety and depression up nationwide, Kentucky primary care doctors are seeing increases in patients needing treatment.
The World Health Organization reported in March that COVID-19 pushed anxiety and depression up 25% in 2020 around the world, with Director-General Dr. Tedros Adhanom Ghebreyesus calling the data "the tip of the iceberg."
WHO found isolation, fear of the virus, death of loved ones, and financial worries were among the stressors people are facing. Additionally, the organization reported youth, women, and people with pre-existing conditions were most impacted by pandemic-induced mental health decline.
The good news is that Louisville primary care providers want to help — and they can.
Meeting people where they are: the primary care office
Dr. Katy Hopkins is the medical director for pediatric integrated behavioral health at Norton Children's. She came on four years ago to help integrate behavioral health into primary care as part of Norton's push to meet people where they are mentally and make mental health care more accessible.
"There is such a significant need for mental health services and the primary folks who are interacting with those people who need that those services are primary care physicians," said Hopkins.
A problem many providers ran into was not having the training to handle some mental health issues or, in the "vast majority" of cases, patients not following through on referrals to mental health providers.
So, Norton got to work staffing behavioral health providers across the city and eventually wants every office staffed with one. As of September, behavioral health staff was located at Fern Creek, East Broadway, Elizabethtown, Shepherdsville, Nulu, Frankfort and Shelbyville, Hopkins said.
"Mental health disorders are the predominant chronic diseases of youth ... they account for a greater lifespan morbidity and mortality than any physical disease," Hopkins said. "And 75% of kids who have those concerns are seen by a primary care provider."
The goal of embedding behavioral health with physical is that primary care providers can screen early for any potential problems and intervene early.
"We know that early intervention reduces the likelihood of developing long term significant chronic health conditions including ... depression and anxiety and long term behavioral problems," Hopkins said.
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What is COVID-19's impact on mental health?
"COVID has very much worn on us, grated on us, and increased the number of mental health symptoms that people are reporting to their primary care doctors," said UofL Health Peace Hospital’s mental health therapist, David Houvenagle.
"COVID required that we all developed a baseline of anxiety in order to stay alive," Hopkins added. "We needed to be worried about getting sick in order to avoid getting sick, in order to wear masks every day, in order to maintain social distancing, in order to accept staying home. We needed to be afraid of the virus."
More than two years into the pandemic, more is known about the virus now than in 2020 — and there are vaccines effective at fighting it. Some of that anxiety isn't as necessary now, she said. But "it's hard to just turn it off like that."
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It's been especially challenging for youth, she said, who lost support circles at school when the transition to at-home learning happened and didn't get as much time to practice social skills.
A March report from the Centers for Disease Control and Prevention said that in 2021:
37% of high school students had poor mental health during the pandemic
44% "persistently felt sad or hopeless during the past year"
55% of youth had experienced emotional abuse by an adult in the home
11% had experienced physical abuse at home
29% reported a parent or other adult in their home had lost employment
LGBTQ+ youth had higher rates of poor mental health, emotional abuse, and suicide attempts
36% of students had experienced racism before or during the pandemic, with the highest levels being among Asian students at 64% and Black students and those of multiple races at 55%
What physical symptoms could indicate depression and anxiety?
Sometimes, depression and anxiety can take the form of unexplained physical symptoms, said Norton's Dr. Michele Fass, a primary care doctor in Shepherdsville.
Those may include:
Headaches
Stomach aches
Fatigue
Insomnia
Numbness
Weakness
Vision changes
"Some of those symptoms could be a serious medical condition like a stroke," Fass added, advising patients against assuming first that such symptoms are depression or anxiety.
But, she said, "if you see your doctor, if you've talked about everything, if all the tests have been done, if nothing has shown up and your doctor feels like, 'OK, there's not really an underlying medical problem going on here,' then ... a mental health diagnosis sometimes should be considered."
How to bring up depression, anxiety with your doctor
Louisville doctors say the best way to bring up depression and anxiety concerns with your doctor is to be direct.
"If it's a problem that you're recognizing is really impacting your daily life, reaching out to a primary care physician and just saying, 'you know, I just haven't been feeling like myself lately, it's been harder to get out of the house,' or 'I'm just finding that I'm worried or more stressed than I used to be, and I'm just really struggling.' Those are conversations that physicians are really skilled at having," Hopkins said.
Sometimes people don't bring up depression and anxiety with their doctor because they don't want medicine, Fass said, but "not everyone needs medicine for anxiety, depression."
Physicians can help in other ways, too, she said, including talk therapy referrals and providing a listening ear.
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What if my friend is depressed? How do I help them?
Houvenagle with UofL said it's ok to be direct if you notice warning signs in a friend or acquaintance. Those may include, he said:
Appearing sad more often
Having less energy
Showing less interest in things they love to do
Having more irritability
Having increased anxiety
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"It does start with a conversation and the conversation is very scary for many people to have," he said. "But I do recall some research that people don't mind being asked, 'Are you OK? Are you having any thoughts of being depressed? Any thoughts of being hopeless, helpless? Or even, 'Are you have any thoughts of ending your life?' I think you can be polite, but direct with your questions as to if someone's having suicidal thoughts."
Anyone with suicidal thoughts can text or call the National Suicide Prevention Lifeline at 988 for support.
Why is there a stigma around mental health treatment?
Stigma around getting mental health treatment or help is "getting a lot better," Hopkins with Norton said, though it remains, mostly in communities that have been historically underserved. Fass has noticed the stigma also as being more present in populations 65 and older.
"Over the past seven years since I've been practicing that, it seems like there's less stigma," Fass said. "I more often do have people coming in openly saying: 'I'm having this problem or that problem' and willing to talk about it and willing to go see a therapist or talk to a psychiatrist if I think that they would benefit from them."
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Reach health reporter Sarah Ladd at sladd@courier-journal.com. Follow her on Twitter at @ladd_sarah.
This article originally appeared on Louisville Courier Journal: COVID forced a '"baseline of anxiety.' Primary care doctors can help
