Good public policy can improve mental health, part 9,645,856

There’s a new study available that shows that, for the gazillionth time, public policy can truly make a positive impact on mental health.

First, the study itself. It specifically pertains to the most recent rounds of stimulus checks. Specifically:

A new analysis of Census Bureau surveys argues that the two latest rounds of aid significantly improved Americans’ ability to buy food and pay household bills and reduced anxiety and depression, with the largest benefits going to the poorest households and those with children. The analysis offers the fullest look at hardship reduction under the stimulus aid…Among all households, frequent anxiety and depression fell by more than 20 percent.

This is a remarkable number. Direct financial aid helped to improve rates of depression and anxiety.

It’s also unsurprising. Generally speaking, wealth is not directly related to suicide rates, but subjects related to wealth are. For example, living near people who are wealthier than you may lead to increased rates of suicide. A decline in income – often one that leads to homelessness, housing insecurity, or unemployment – is correlated with higher suicide rates. Furthermore, a landmark study from a couple of years ago showed that raising the minimum wage can directly reduce suicide.

We also know that expanding access to health care can make a positive impact on suicide rates. Of course, you don’t need an advanced degree in public policy to figure out why: When you make health care easier to obtain, this usually involves mental health care, and this means people can be treated for their mental illnesses. This, in turn, can help to attack these illnesses and make someone feel better.

There are ancillary reasons why this is true, as well. One of the less-discussed causes of suicide is pain and chronic pain – I actually had a dear friend lose someone very close to her because of her partner’s pain. Medical care, of course, can treat or mitigate the impacts of countless diseases. This, in turn, can improve someone’s quality of life – and help prevent suicide.

Last, the third rail of politics: Gun control. Like it or not, means reduction policies – policies that make it harder for someone who is suicidal to get a gun – can help to reduce suicide rates. For example, there is a well-established link between gun ownership and suicide. Furthermore, states with stricter gun laws tend to have lower suicide rates. In other words, we CAN do something about suicide rates in government, we already have done quite a bit, and we can do a lot more.

Suicide is not something that just happens. It is not some magical, mystical thing that we have no control over. Yes, there are factors that are well beyond governmental control…but there are also plenty of things we can do to reduce suicide. Things we must have the courage and fortitude to do. I’ve always found mental health to be an under-tapped political issue. Many people know its pain – more than we are willing to admit. And I wish more people spoke about this issue for both the sake of politics and policy.

Okay, seriously…how is it possible that suicide numbers dropped during the pandemic?

We may be close to the end of the COVID-19 pandemic, but the scars of this battle will remain with society for a long, long time. Among the more devastating damages of COVID-19 have been the toll on mental health, with increasing signs of mental illness, greater addiction rates, increased use of mental health resources

…and a decline in suicides…

Wait, what?

Yeah. I don’t get it either. But, according to preliminary data, suicides went down in 2020:

 From 2019 to 2020, deaths by suicide declined by 5.6%, from 47,511 to 44,834, per the CDC. It was the third consecutive year of decline. Suicides [also] went down in April and May of last year, a different trend than in years past, Farida Ahmad, health scientist at the National Center for Health Statistics, tells Axios.

This is astonishing. And it defies expectations, with many predicting that COVID and the economic shutdowns would lead to a massive spike in suicide. And yet, that hasn’t been the case, despite the increase in every other category that would be a predictive factor for an increase in suicides, including mental illness, unemployment, and suicide.

This begs the question…why? What’s going on here? I’ve read a few articles on the subject, and they offer some different thoughts:

  • Telehealth played a big role. In many states, it became easier than ever to access mental health resources, as regulations were waved that enabled people to get access to telehealth. As a result, more people may have been able to seek mental health resources, thus saving their life.
  • There were huge, concentrated efforts to encourage people to get mental health help – maybe more so than ever before. Governor’s across the country spoke about it. People still do to this day. As a result, it seems possible that stigma – once a formidable barrier – was shattered. This may have put more people into mental health help.
  • Some noted that it seemed possible that a “heroism effect” was in place – similar to that which occurs at the start of a war or another catastrophe – where a sense of “we’re all in this together” kept more alive. If this is truly the case, then we need to be cautious, as it seems like that such an impact would fade over time.
  • The pandemic forced a massive reevaluation of the way we look at our lives, as more people found that they could live without certain things, and are thus able to live better lives. This is an interesting philosophical argument, one that may also be playing a role in the decline of workers across the economy.

It is also worth noting that a more advanced look at the data is needed: For example, did suicide decrease more in some groups? Did it particularly spike among teenagers and young adults, groups that were believed to be facing particular difficulties during this pandemic? Furthermore, what about differences among racial and economic demographics? What about people who could work at home versus those who could not?

My opinion? All of the above, and then some. I’d also offer this caution…there is no way, no way, that this is it, that we are now on a glide path towards a permanent reduction of suicide. I am absolutely concerned about the long-term impacts this will have on mental health, as well as how this may drive up suicide rates. There is so much more to this story that we absolutely do not understand, and I really hope that others have more insight than me!

Anything to add? Any thoughts about why suicide may have dropped as it did? Let us know in the comments below!

Depression as a Roguelike

Okay, let me say right off the bat that this entry is going to be nerdy. I mean, SUPER nerdy. Video game genre level of nerdy. That being said, even if you aren’t that level of nerd, I think this entry may have something to offer you that you can connect with.

My favorite type of genre of video games, I have finally come to realize, is a type of game called “roguelikes.” Hear me out. Stop rolling your eyes. I promise this will get to depression and mental health.

So, Roguelikes. They’re games in which you have to get to the end. My favorite all-time Roguelike – maybe my favorite all-time game at this point – is one called Enter the Gungeon. I cannot understate how obsessed I am with this one.

Games like this are designed for you to die. Like, a lot. A lot, a lot, a lot. They are typically very, very difficult games. What makes them a little extra special – and extra difficult – is that they’re never the same. The games often use a randomization procedure known as “procedural generation.” In these games, levels and bad guys will change. Layouts change. And while the game will follow the same certain pattern, it’s never the same run through the dungeon.

So, what does this Sisyphean-like task have to do with depression? Well…a lot, actually. Take Enter the Gungeon. You will die a gazillion times in this game before you make it to the final boss – and then all the secret final bosses – which is a different story. But, every time you beat a level boss, you gain these extra tokens. You use those tokens to buy better weapons for your next run. Then, you’re next time, you do a little bit better. You get a little further.

Even more importantly: The more you play, the more you learn the patterns. Like, this little bastard, who my kids call the Pinky Malinky enemy:

 

He’s blurry, but deadly

Pinky Malinky up there will fire a shotgun spread at you as you walked. The first time I ever saw him, I was totally taken aback. The second time, same. By the third time, I had it, and I rolled out of the way. 

Of course, that’s not to say that the knowledge of what he does makes me immune from screwing up. Every now and then, I’ll get distracting by dealing with another one of the little guys that shoot at me, and I’ll take a hit. But I learn. I always learn.

See where I’m going with this?

It’s kind of a weird metaphor, but it does hold. My favorite type of video game genre, Roguelikes, is very, very similar to how all of us battle mental illness. Consider the similarities:

  • No two days are ever really, truly the same – but you recognize the patterns.
  • Recognizing the patterns of a Roguelike level means you can learn how to better cope with an attack.
  • Once you learn the patterns, you have a better shot at defeating your enemies.
  • The bad guys appear in different orders, at different times, and in combination with different things, but it doesn’t mean that they aren’t different.
  • Just because you know how to kill them doesn’t mean you always will. Sometimes you have a terrible day and get a Game Over at level one. Other times, you make it to the final boss without batting an eye.
  • Randomness plays an important role – but your skill often is what makes the difference.

Look, video games are an important part of my life. They’ve given me a virtually endless source of joy or entertainment, inspired the names of my kids, and taught me some exceptionally valuable life lessons about persistence and creativity. But I do really, truly believe that there are parallels between how we fight depression and how we play some types of games. I hope this helped to provide you with a valuable metaphor, and please let us know in the comments your thoughts.

Now, please listen to this kick-ass soundtrack:

The Smallest Things Can Make the Biggest Difference

As an elected official, I tend to get captured by big ideas. That’s not a bad thing, obviously. Personally, I think this world needs more big ideas and big plans to tackle big problems, and I wish we had more energy to move in these directions.

That being said, sometimes, big ideas come with little problems. When you hear a big plan to tackle an issue like mental illness or suicide, you think that these are the ONLY things that can tackle depression or suicide. That leads to even more dangerous thoughts: You can’t do anything about it. That’s not true. That’s not true at all.

There is no question that grand gestures and big plans often work, and work well, preventing us from getting into trouble in the first place. But, on an interpersonal level, it is the little things that matter. In fact, more often than not, I’d put money down that it’s the little things that you remember. And, in the long wrong, “little things” is a misnomer. Little things can make a big blessing.

This leads to the obvious question: What are the little things that you can do – that all of us can do – that can save a life or help someone who is struggling feel better?

The Shortest Note: I always got a kick out of this study. In the 1970s, two doctors sent follow up letters to a group of patients who had just been released from the hospital, checking in, expressing concern, and saying that they wanted to stay in touch. Another group didn’t get such letters. The results? Of the group who did get the letters, which came on a regular basis, 1.8% died by suicide within two years. In the group that didn’t? 3.52%.

The conclusion? If the study’s findings are accurate, the smallest thing – the smallest little thing – can help to keep someone alive. This remarkable finding shows that people just want to know someone cares, someone values them, and someone is there if they reach out. Does this mean you can stop a suicide? Not necessarily. But it does mean that regularly checking on someone – letting them know that you value them – can help ease their pain. And yeah, maybe keep them alive.

Call Them By Their Name: The rates of suicide or suicide attempts among the transgender community are hellaciously high: Greater than 50% of transgender male teenagers reported a suicide attempt, with nearly 30% for transgender females. These rates of mental illness and suicide are tied to a few factors, including family rejection, bullying, harassment, or perceived danger. However, there is nothing inherent to being transgender that leads to higher risk of suicide, as transgener individuals who do get the support and acceptance they deserve do not have a higher risk of suicide.

So, what does that support look like? Well, accepting these people for who they are. Puberty blockers reduce the risk of suicide. So does the most simple thing: Calling a person by their chosen name and gender. Calling someone by the name they want reduces their risk of suicide and depression.

Again – it’s the little things.

Ask: There is a misnomer out there – that talking about suicide can implant the idea of suicide in someone’s head. To be clear, this isn’t true. In fact, the opposite is true: Bringing up the subject can save a life. This is because discussing the subject and asking specific questions, such as, “Are you thinking about hurting yourself? Have you been thinking about ending your life? Do you have any plans on it?” can actually check on someone. If done in a caring, compassionate matter, you can tell someone that you are concerned about them, and thus make it clear: You’re here to help. Asking someone if they are in pain or considering suicide will NOT make them more likely to make an attempt. In fact, the opposite may be true.

I need to be clear about something: Not stopping someone from dying by suicide is never someone’s fault. Suicide is a complex, complicated process that almost always involves multiple factors. It’s never just one thing, and it’s virtually impossible for it to be your fault. However, while stopping suicide may not be our fault, it is something we should all take responsibility for. Thankfully, you don’t have to be a doctor. You don’t need formal training. The smallest measures of kindness and compassion can save a life.

The debate about in-person vs. virtual school misses the point

As a parent – and as a policy-maker – it seems as if everything we do these days is related to COVID. How will we recover? How can we ensure that everyone is getting the vaccine who deserves it? How can we deal with the devastating economic and unemployment effects? How soon can we (safely) get kids back into school?

Of course, the mental health impacts of COVID are damning as well, and much of that blame – at least for our kids – has been thrown at the feet of virtual learning. There is a lot of truth in that, of course. Evidence is clear that the mental health of our kids are, on the whole, suffering, with a rise noted in self-reported rates of depression and visits to the emergency room. Some are quick to cite the idea that this is a direct result of the fact that millions of kids are in some sort of virtual learning environment now, either full-time or on a hybrid schedule.

That being said, I really, truly believe that much of this debate misses the point. Why? Because – even for kids who are in school – they’re not getting their usual experience.

If you are in the real world in any capacity, you know it: Everything is different. Wear your mask. Wash your hands. STAY MORE THAN SIX FEET AWAY FROM ME. And if you are someone who was prone to anxiety, you are nervous every time you go out, because you can, quite literally, contract a deadly disease at any moment.

Okay, fine. Now, take all those fears and all those changes, and apply them to school. What do you get? A recipe for disaster. Take this article from Wisconsin Public Radio that details the struggles of kids in the pandemic. It notes, correctly, that zoom school makes it harder for kids to get the help they need and limits social interactions and the desperately needed personal connections. But, it also notes that in-person school is not a panacea:

With the broad disruption wrought by COVID-19, though, simply bringing students back into classrooms doesn’t resolve their mental health concerns.

In the Lake Mills district, where Kisten [a school psychologist] works, students have been mostly attending school in person since the start of the year.

“There’s a lot of grief right now, but the students don’t really have the right words to express that, or they don’t even know what it is that they’re feeling,” she said.

Other evidence has buttressed this point: Kids’ mental health is suffering regardless of where they are in school.

I don’t want to miss the point: Zoom and electronic learning is a cause for mental illness. There’s no question about it. However, even among those who are in school, things aren’t normal. And this is hurting the mental health of our kids.

The debate about whether or not kids should be in school or virtual misses the point entirely. We should be concentrating on SAFELY getting all of our kids back into school, then providing them with the mental health supports that they need in order to thrive. Even kids who are in school are reporting difficulties right now. Real-life or virtual, they’re in pain.

Our Role as Parents

As I type this…damnit to hell, I was about to write something sweet about my kids, but I swear to God, my son just screamed “OW!” at the top of his lungs. I’m not sure what happened, but he’s…oh, for God’s sake, he’s upside-down now, playing on the couch. Kids are weird. 

Well, at least I got cute pictures:

IMG_0532

Kids are weird. Yup. Also, here’s my daughter, because as any parent of multiples knows, if you include one kids, you HAVE TO INCLUDE THE OTHER LEST YOU EXPOSE YOURSELF TO ACCUSATIONS OF FAVORITISM. And yes, she was in motion. She’s always in freakin motion. 

Anyway, the kiddos have been on my mind lately. No reason – they’re wonderful, and Brenna and I are very blessed. They spent about two months doing virtual school but have been able to get back to face to face. We’ve sent them to a Jewish Day School in the area for years but pulled them virtual when we were uncomfortable with the COVID numbers. 

Our experience has been blessed. Our kids are physically and emotionally healthy. That is very unlike students profiled in this Morning Call article, who have suffered mightily during the pandemic. And that is nothing compared to the issues faced by students in Las Vegas. Nevada has long been a suicide hotspot, having the 11th highest suicide ratings – and that was before the pandemic. Now? Suicides are so bad that schools are reopening as part of an effort to clamp down on a rash of suicides.

These numbers are brutal. My wife and I are lucky, and while I like to think that we’re good parents, I’m not dumb enough to think that our kids’ health doesn’t have a heaping dose of luck in it. But…I don’t want to understate the role that parents play in terms of their kids’ mental health.

Sometimes, it’s the little things, but they can be so, so meaningful for kids with certain challenges or issues. For example, take transgender kids. According to studies, suicide rates amongst transgender adults are absurdly high: One study shows that more than half of all transgender people attempt suicide. But there’s good news: Parents who are accepting and supportive of their kids can help reduce these suicide and depression risks. This involves promising unconditional love, support, and using chosen names and pronouns.

Of course, there are a million little ways that this is the case, and your kid doesn’t have to be transgender. According to a 2017 study on suicide and parental involvement, parental involvement and support can have a “significant” influence on reducing suicide. The connection is not a question – it makes perfect sense. Kids grave the love and support of their parents, and that support can help  keep them alive.

Because of my own history, I regularly worry about my kids’ mental health. I regularly think about that nightmare scenario. The only way I comfort myself at those moments is by reminding myself there are some things I can do. Loving my kids – unconditionally – and supporting them – that’s about it. That’s all any of us can ask for, and that’s all any of us can do. 

Keep that in mind in your worst moments as a parent. You matter deeply to them, even when you think you don’t.

The Connection Between Physical Appearance & Depression

I caught a post on Reddit and it got me thinking about the broader connections between physical appearance – well, really, more like self-perceived physical appearance – and depression. The results, as you can probably imagine, are not particularly pretty.

First, the study in question. A new survey shows that there is a strong correlation between rates of depression and perceived physical appearance. According to the study, 61% of people suffer from some form of body dissatisfaction. Strikingly, a study found that body dissatisfaction at the age of 14 was related to increased risk of depression as a teenager gets older. Those risks varied, but could increase depression risks by 50% – 285%. Interestingly enough, the severity of the depression was higher in women than in men, somewhat counterintuitively. The study does not that increasing body satisfaction can potentially reduce depression in teenagers.

As usual, standard disclaimer: Correlation does not equal causation, and it is very difficult to determine whether or not the body dissatisfaction causes the depression, if the reverse is true, or if there is another factor that makes these levels of depression and body dissatisfaction occur.

However, this obviously isn’t the first piece of research that makes a direction connection between body dissatisfaction and depression, and many other studies have made this connection in the past.

So, what do we do here? Of course, increasing body satisfaction is an obvious solution, but…good luck with that. I still sort of hate the way I look and I’m 37. I mean, really. How many people like the way they look?

I’m starting to veer into an area that I’ve done in the past, but again, I’d point out that this is yet another example of broader cultural connections making a big input on our mental state. Indeed, I would love to see more research on this topic. The above study, for example, took place in the United Kingdom. Other studies, like this one from Singapore, have made similar findings. This begs the question: How severe is this connection in America? Given the cultural and financial value we tend to place on issues of looks in America, I’d bet that the connections are very strong. But…what about countries that don’t culturally emphasize physical appearance the way that we do? Do they have the same level of connection between body satisfaction and depression?

I’d bet no. And if I’m right about that guess, this is even further proof: Issues of mental illness simply cannot be separated from broader cultural and societal priorities.

Is your job causing your depression? Here’s a way to find out

All of us know what it is like to have work-related stress, to have issues falling asleep because of work, or to have those periods where you just can’t bear the thought of going into the office. Thankfully, generally speaking, these are temporary periods that fade.

But, what if it’s something more?

Allow me to introduce you to what might be the most depression survey you’ve heard of in a while: The Occupational Depression Inventory, a tool designed to help, “quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression.”

Sigh.

A new survey about the ODI claims that it, “showed strong reliability and high factorial validity.” This means that it can reliably determine if someone is showing depressive symptoms as a result of workplace issues. It consists of ten statements, such as, “My work was so stressful that I could not enjoy the things that I usually like doing” and “My experience at work made me feel like a failure.” Survey takers are supposed to rate their agreement with the statements on a scale of 0-3, with 0 meaning never or almost never and 3 meaning nearly every day. A higher score means more of a chance that your work is responsible for causing your depression.

So, what do you do if you score high? Learn to cope?

Gah. I mean, look, the fact that this tool exists, and that there is enough of a demand for it, shows that we might be at a point in society where we need to reexamine our priorities. Obviously I get the need for it, and it makes perfect sense. But, as I’ve said time and time again on this blog, we have to remember that societal facets are often a huge factor in causing depression, and I worry that this is something we have lost sight of. 

I don’t mean this as a knock on the ODI or the people who developed it. It is clear there is a need for such a survey, and perhaps this survey can help people make more positive psychological changes to their lives. But what it doesn’t address is what happen when someone is at a job because they have zero financial choice and no other skills. It doesn’t deal with the fact that our society safety net, job retraining options and educational systems are all woefully inadequate. It doesn’t address the non-stop financial pressure that we all feel in order to provide for our kids, our parents, ourselves, our debt…nada. And this is why so many people stay at dead end jobs, get depressed and then take a survey like the ODI. 

For the millionth time, as a society, we have to make a choice. If we want to reduce depression, for real, we have to reduce the causes of depression, and that is often financial stress and the non-stop fear of what happens if someone loses employment. There is so, so much more to depression than mental health! This is more proof of the truth behind that statement. 

 

“…how life sometimes simply gave you a whole new perspective by waiting around long enough for you to see it.”

I recently finished the Midnight Library by Matt Haig. When I read it, I had absolutely no idea the book would have such strong mental health implications – hell, it was recommended to me by my Mom, who just thought I would like the book because it had a neat plot. That being said, it was a fantastic book, and well worth reading if you have an interest in mental health or suicide prevention.

First, the true story of why I had heard of the author, Matt Haig:

Matt Haig, as noted on his profile, his a suicide attempt survivor:

I didn’t exactly realize it when I started reading it, but the Midnight Library deals with suicide. The summary:

Somewhere out beyond the edge of the universe there is a library that contains an infinite number of books, each one the story of another reality. One tells the story of your life as it is, along with another book for the other life you could have lived if you had made a different choice at any point in your life. While we all wonder how our lives might have been, what if you had the chance to go to the library and see for yourself? Would any of these other lives truly be better?

In The Midnight Library, Matt Haig’s enchanting new novel, Nora Seed finds herself faced with this decision. Faced with the possibility of changing her life for a new one, following a different career, undoing old breakups, realizing her dreams of becoming a glaciologist; she must search within herself as she travels through the Midnight Library to decide what is truly fulfilling in life, and what makes it worth living in the first place.

From here, spoilers ahead.

Continue reading ““…how life sometimes simply gave you a whole new perspective by waiting around long enough for you to see it.””

Three symptoms of depression you may not be aware of

Depression, when you have it, can be all-consuming. I mean, all consuming. It seems to devour your life like a monster, changing your life in countless ways that you may never have anticipated. Indeed, this is one of the greatest problems with depression – it completely changes everything you knew and loved.

Most people are familiar with the basic symptoms of depression – sadness, apathy, fatigue, etc. However, you what you may not be familiar with is the other, more random symptoms of depression that can be just as problematic as the more basic ones.

To that end, here’s a look at three symptoms of depression that you may never have heard of.

Lowered memory function

There is a reason the term “depression fog” means so much to so many. When you are depressed – when you are really in it – your entire brain can feel like it is no longer functioning. As it turns out, this is more than just a perception – it’s very, very real.

Depression can cause memory loss. This has been backed up by multiple studies that show that people with depression have trouble with their short-term memory. It is also possible that certain forms of treatment for therapy – like electroconvulsive therapy or certain medications – can cause memory loss. It’s always worth checking out if you suspect it to be something else, but yes, depression can hurt your ability to store and recall things.

What can you do about it? Chalk it off. I remember being a kid and having major depressive or anxiety episodes. In my mind, I would say, “It’s a day,” and try to move on. Don’t kick yourself over it. It isn’t a sign of weakness or failure. It is a symptom of your disorder. If you treat your depression, your memory loss will fade.

Appetite changes

Here’s another very random one: When you are depressed, your appetite changes. This isn’t as random as you might think – indeed, it’s so common that unexplained weight gain or loss is actually one of the symptoms that can lead to a diagnosis of depression.

Why is this the case? If you eat less, it can be a reflection of a lack of energy or interest. If you eat more, it can be because of emotional eating – you feel emotions that make you miserable and cause you to overeat.

Ironically, and sadly, this is a huge problem. Both overeating or undereating can cause depression to get worse. That’s why appropriate diet when you are depressed is so vitally important.

And, as an aside: This is so me. I stop eating when depressed.

Irritability

So, this is a bad of a random one, and sometimes it may not make sense. It seems to strike more in men, as research shows that men are more likely to be irritable and angry when depressed. Symptoms like these, along with hostility, are more likely to appear in men, and to serve as a mask for depression.

Why is this the case? I can think of a bunch of reasons…but many come down to cultural and familial. In many cases, the way someone is raised will alter the expression of their depression, and depression can easily display itself as irritability or anger. As such, if you know someone who is more irritable than usual lately, it’s absolutely worth checking in on them.

It’s worth noting that, sometimes, these symptoms may appear before other, more severe ones. There have been times I’ve lost my appetite, not been sure why, then realized that my depression was back and it was pissed. Something I actually just read while doing this blog entry: Appetite changes can be an early warning sign of a relapse. That has certainly been the case for me.

Broadly speaking, one of the biggest challenges with mental health is that it is so hard to get any sort of standardization. What works for some may work catastrophically badly for others, and what is a clear cut symptom for one person may not be as clear for someone else.

As always, if you are worried about your own mental health, seek help as soon as you can – the sooner the better. Thankfully, the vast majority of people respond well to mental illness. If this is you, seek help today.

As always, I turn it over to you. What random depression challenges have you had that you never would have believed? Let us know in the comments!