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Mental Health During a Pandemic: The Psychiatric Effects of the COVID-19 Pandemic

Dr. Andre Ramos discusses the impact that the COVID-19 pandemic has had on children's collective mental health and ways we can try to combat these effects.
Featuring:
Andres Ramos, MD
Andres Ramos, MD is an Assistant Professor, University of Tennessee Health Science Center. 

Learn more about Andres Ramos, MD
Transcription:

The pandemic has not only affected our daily lives and the way we live, it has also affected our mental health in the mental health of our children. So let's talk about mental health during a pandemic and the psychiatric effects of the COVID 19 pandemic on kids. With Dr. Andrus Ramos, a child and adolescent psychiatrist at children’s hospital.

Bill Klaproth (Host): This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth.

Host: Dr. Ramos,

Bill Klaproth (Host): thank you so much for your time. It is great to talk with you. So, we can all see that the pandemic has affected everyone, including children, beyond the COVID-19 disease itself. So, what factors or results of the pandemic most effect mental health?

Andres Ramos, MD (Guest): That's a great question Bill, and that's sort of a multilayered answer. But certainly, there's a lot of different things outside of the pandemic itself, outside of the virus itself, that affects the mental health of children and adolescents and certainly adults. And so this is sort of a unique situation where we have a number of stressors that have sort of gotten together or sort of created this perfect storm. And each of those stressors, we know can lead to psychopathology in kids. In other words, each of those stressors can lead to mental health issues in children and adolescents. So, we've got things like economic recession, decreased income, interruption of education, school closures. Once in the lifetime stuff like quarantine and social isolation that's mandated and even though these are sort of once in a lifetime things for most of us, if we're lucky; there is data out there that would suggest that social isolation can lead to things like depression and anxiety and that, that effect is long lasting. We have things like fear of death, fear of illness, disruption of everyday activities. And again, each of these sort of items in and of itself has been linked to psychopathology in individuals, human beings and children and adolescents. So, to have all of these things coalesced together is quite concerning.

Host: I think you phrased it perfectly when you called it the perfect storm. That Is so true. All of these factors combining at once. So, will the pandemic have long-term effects on children's mental health? And if so, what would those long-term effects be?

Dr. Ramos: Yeah, that's also a really good question. And I think right now, it's difficult to answer. there hasn't been a lot of research done in children and adolescence mental health during times of epidemics. And so we don't really know what happens certainly during the fact, although we're learning more as some research is being done during this pandemic. We know even less about what can happen later on. So, we can only sort of extrapolate what we know about disasters that have happened across the world and certainly in this country. Things like Katrina and 9/11. The study that I cited earlier about social isolation does suggest that the increased rates of depression and anxiety are long lasting and that if you look at these kids and these were many studies pulled together; if you look at these kids, even after nine years, there were increased rates of psychopathology, of mental illness in children. And so, it's compelling. And I think what we're beginning to see is that while we think of kids as being very resilient, there is a chance that we'll have kids struggling with sequelae psychiatrically from the pandemic. But it's hard to know for sure.

Host: Right. So, you mentioned first and foremost, depression and anxiety certainly from social isolation at the very least. So, how are you and Le Bonheur working to mitigate these effects on children?

Dr. Ramos: Yeah, right. I think that's the question we should all be asking ourselves regardless of where we are as providers, as teachers, as people in the community. But at Le Bonheur, basically what we're trying to do is number one, educate parents. Number two, is screen for psychopathology. So, I'm in a unique situation because I am screening for different things as a Child and Adolescent Psychiatrist, every single time that I have kid at clinic, right? So, trying to screen not only for psychopathology or mental illness that we do anyway, but also for these very specific stressors like have you mom or dad lost your job? Are schools open for you or are they closed? Because we know now that school closures have been linked to higher rates of disruptions in daily activities and therefore disruptions of psychological functioning. So, just being more specific about screening not only for psychopathology but also these very specific stressors, I think is very helpful.

And then obviously these are very much bottom of the pyramid stuff. I mean by that that they're sort of psychosocial stressors that are difficult to modify just from an encounter. So, sometimes just involving the whole system. So, if there's a therapist, involving them. If not, we want to involve social work through Le Bonheur or through their communities. Whenever possible, involving school staff so that we can help these kids multi-systemically because again, these are very much bottom of the pyramid problems that are coming out from the pandemic.

Host: Yeah there's no question about that. And glad to hear Le Bonheur already is taking steps to help mitigate these effects on children. So, let's look at it from the parent's side now. What should parents be looking out for in their children? What are some of the warning signs of psychiatric struggles?

Dr. Ramos: Yeah absolutely. So, that's always a tricky question to answer sort as a generic answer because kids are different and not only that, temperamentally, personality wise they're different but also kids of different ages respond differently to stressors right? I always tell parents that it's not sort of looking for this very specific thing or that specific thing but it's really a change from the child's baseline. So, a kid who's usually introverted and pretty chill and not getting in trouble, all of a sudden is acting out and having some difficulty at school or becoming more oppositional defiant. Yeah that's a change from baseline. So, that should spark a level of concern. And certainly the place to start is usually with a primary care provider. Whereas you know some other kids who may be more outgoing just to give you sort of the other side of the spectrum, if you start to see them become more isolative, maybe grades are dropping, maybe they're less friendly. Maybe they're more irritable, having more interpersonal strains or fighting more with siblings and those are sort of signs. So, really any change during this time where we should have a high rate of suspicion for a psychopathology, any change from baseline should raise a level of concern and the pediatrician should be notified.

Host: So, that's easy to remember, first and foremost to look for a change from the child's baseline behavior and then you said start with the child's primary care provider first. So, start there. So, then what recommendations would you give for parents to support their child's mental health?

Dr. Ramos: Yeah, this is really important. So, not only during this pandemic but during disasters in general and certainly during other epidemics outside of this country and in this country; what we've seen is that maintaining a good structure, sort of a regular level of routine and also communicating in a way that's developmentally appropriate. Communicating with the child about what's going on. So, secrets are always a bad thing right? So, sometimes a big question mark in a child's mind, what’s going on here? Are my parents gonna die? Am I going to die is much scarier than the answer right? Then what's actually going on. But parents need to be not only transparent, but also careful not to sort of overshare. And that's a fine balance to sort of walk. But I think most parents know their children and know how to talk to them and know what they can handle and what they can't handle as far as information.

So, limiting exposure to the news is also a big deal. So, even while we want to be transparent and give kids information so that they're empowered; we also don't want them exposed to CNN or Fox News or whatever all day long because it can be kind of scary to hear some of these things that sometimes are a little bit dramatized. So, it's a combination of keeping things steady. A fair amount of routine, support and keeping the family functioning as it was functioning prior to the pandemic, if that's at all possible. And then lastly, feeding a good amount of information that empowers, but does not scare the child.

Host: I like how you said that, empowers, but does not scare the child. So, those are really good tips. So, pay attention to a regular routine, as you said, and then invest in regular communication, but don't overshare. That's a really good point. And then limiting exposure to the news, because if you do watch the news, sometimes it can be scary. And some of the images that children might see on the news can be very frightening. So, I think that's a really good tip as well. So, really good points, Dr. Ramos and this is really an important topic and things that I know parents need to pay attention to. So, thank you for your work and your work at LeBonheur. We really appreciate it. And thank you for your time today.

Dr. Ramos: Thank you so much, Bill.

Host: That's Dr. Andras Ramos. And for more information, please visit lebonheur.org/coronavirus for up-to-date information and resources on the COVID-19 pandemic. And be sure to subscribe to the Peds Pod in Apple podcasts, Google podcasts, or wherever you listen to your podcasts. You can also check out lebonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.