Pediatricians Hold the Front Lines of a Mental Health Crisis

By |2022-05-10T12:36:21-04:00May 10th, 2022|Uncategorized|

GLASGOW, Ky. — One crisp Monday morning in January, Dr. Melissa Dennison sat in a small, windowless exam room with a 14-year-old girl and her mother. Omicron was ripping through Kentucky, and the girl was among three dozen young patients — two of them positive for the coronavirus — that the pediatrician would see that day.But this girl was part of a different epidemic, one that has gripped the community and nation since long before Covid: She and her mother had come to discuss the girl’s declining mental health.The girl had dark hair and wore jeans and a T-shirt bearing the words “Purple Rain.” She was depressed, she told Dr. Dennison, and had been cutting her arm to relieve her emotional pain. Dr. Dennison suggested therapy, but the girl said she would not go.After the exam, Dr. Dennison stood in the hallway and described the case. “You need to get off the phone and the computer,” she had told the girl. “When it’s pretty outside like this, put on a bunch of clothes and go for a walk.”Dr. Dennison prescribed the antidepressant Zoloft, although she wasn’t sure the girl was clinically depressed.“I’d rather they see a psychiatrist,” she said. “But if I’ve got this child and they’re cutting and saying they’re going to kill themselves, I’ll say, ‘Well, I’ll see them today.’ If I call a child psychiatrist, they say, ‘I’ll see them in a month.’”Over the last three decades, the major health risks facing U.S. adolescents have shifted drastically: Teen pregnancy and alcohol, cigarette and drug use have fallen while anxiety, depression, suicide and self-harm have soared. In 2019, the American Academy of Pediatrics issued a report noting that “mental health disorders have surpassed physical conditions” as the most common issues causing “impairment and limitation” among adolescents. In December, the U.S. Surgeon General, in a rare public advisory, warned of a “devastating” mental health crisis among American teens.But the medical system has failed to keep up, and the transformation has increasingly put emergency rooms and pediatricians at the forefront of mental health care. Community doctors now routinely deal with complex psychiatric issues, making tough diagnoses after brief visits and prescribing powerful psychiatric medications for lack of better alternatives. “Pediatricians need to take on a larger role in addressing mental health problems,” the 2019 A.A.P. report concluded. “Yet, the majority of pediatricians do not feel prepared to do so.”Dr. Cori M. Green, a co-author of that report and a pediatrician at Weill Cornell Medicine, said medical training lagged behind. “We need to overhaul the whole system,” she said. “We need to see mental health through a prevention lens and stop seeing physical health as different than mental health.”Dr. Dennison in an examination room, wheeling a laptop from patient to patient. Twenty years ago, 1 percent of her cases related to mental and behavioral health, she estimates; now at least 50 percent do.In Glasgow, Ky., as elsewhere, there are counselors in the schools and therapists in town, including four at Dr. Dennison’s clinic. But they are often booked months out. Psychiatrists are scarce, here and nationwide. Seventy percent of counties in the United States lack a psychiatrist specializing in children or adolescents — and the psychiatrists who can be found are concentrated in wealthier areas, with many accepting only private payments.“There’s a need and nowhere else to go,” Dr. David Lohr, a child and adolescent psychiatrist at the University of Louisville, said of the growing role of primary-care doctors in mental health.Dr. Dennison, 62, has adapted. Two decades ago, she routinely prescribed antibiotics and saw patients with “strep throat, earaches and wheezing,” she said. “And no one heard of A.D.H.D.,” she said, referring to attention deficit hyperactivity disorder. She estimated that, back then, 1 percent of her cases related to mental and behavioral health; now at least 50 percent do.The causes of this crisis are not fully understood. Experts point to many possible factors. Lifestyle changes have led to declines in sleep, physical activity and other healthful activities among adolescents. This generation professes to feeling particularly lonely, a major factor in depression and suicide. Social media is often blamed for these changes, but there is a shortage of data establishing it firmly as a cause.In Glasgow, a town of 14,000, the challenges are intensified by high rates of drug addiction and poverty and their effect on families.

OCD isn't just about being a neat freak. And for those with it, this next stage of the pandemic may be hard

By |2022-04-14T15:30:50-04:00April 14th, 2022|Uncategorized|

Dell lives with obsessive-compulsive disorder, and like many people in the United States, the Covid-19 pandemic has posed huge challenges for her. "I know that the uncertainty was hard for others," said Dell, who lives in Martinsville, Indiana. "Those of us with OCD have been like, 'Welcome. This is what it's like for us all the time.'"The prevalence of OCD was on the rise even before the pandemic, according to a 2020 study. And clinicians have more patients seeking treatment, according to Bianca Simmons, a Houston therapist specializing in OCD. The stress, disruptions and uncertainty of the pandemic has posed challenges for those who have been diagnosed with OCD and those experiencing tendencies that line up with the disorder, said Broderick Sawyer, a clinical psychologist in Louisville, Kentucky. But even as the world transitions to a sense of normalcy, challenges lie ahead for many people.The disorder is not just about fastidiousness and a tendency toward organization, said Erin Nghe, a licensed clinical social worker who treats patients with OCD in the Atlanta metro area. It's an often debilitating disorder that can latch on to core fears, including concerns over morality and the potential for harming others, Nghe said.Before seeking intensive treatment, Dell said that 12 hours of her daily life was taken up by attending to her compulsions. Symptoms can be exacerbated by stress of any kind, Simmons said. And even as the pandemic disruptions wind down, there could be challenges in maintaining mental health. It's important for both people with an OCD diagnosis and those without one to recognize the stress that may come their way and learn to address it in a healthy way, Sawyer said. "The pandemic is ending, and some people are going to return to normal, but my brain will never return back to normal and it's something that I've had to learn to deal with through recovery and treatment," Dell said.More access and engagementThere is a lot of potential for relief from mental distress as more people are vaccinated and lockdowns wind down.Resources can become more accessible again, for one. They had become scarce as many providers moved to virtual appointments or were pushed to limit access to or close their clinics -- meaning many people who were seeking treatment were held in waiting-list limbo, said Elizabeth McIngvale, founder of Peace of Mind Foundation, a nonprofit that supports and advocates for people with obsessive-compulsive disorder. With widely distributed vaccines and a decrease in hospitalizations, more people can gather with social circles and engage in more public activities with a greater sense of safety, which is helpful to people managing OCD or any mental health concern, Simmons said. "People need to be around people, and people get sad when they are not," she said.Having OCD tendencies can drive those with the condition to avoid the people, places and things that are important to them, even though managing symptoms often means engaging with those you value, McIngvale said. There are crucial benefits to people feeling more at ease doing things they love again, she added.Towering obstaclesThe difficulties of the trend toward opening social spaces back up cannot be ignored, however.Scientific understanding and recommendations and even the status of the virus have changed quickly over the course of the pandemic, and the uncertainty can mean stress for anyone, Sawyer said. Things calmed down recently, but now US coronavirus cases are rising as the Omicron subvariant BA.2 takes hold. The desire to open up society even as the coronavirus continually evolves can be a disconcerting source of instability, especially for those with OCD.Then, there is the reintroduction of triggers, stimuli of many kinds that initiate anxious, obsessive thoughts, said Jelani Daniel, a therapist based in Houston. When we were isolated, we had more control over our environment, and people with OCD could more easily avoid things that might trigger their symptoms, Sawyer said. Now, people have to face those triggers again, many of whom experienced a stretch of time when they were not able to access mental health resources easily, he added.Where to turn for helpThe first hurdle to managing any mental health concern is learning to recognize what you are feeling and when negative stress is building -- because stress can make everything more difficult to manage. Sawyer advocates that everyone practice mindfulness, which is not just sitting still to meditate. It can be paying closer attention to what is going on in your internal world, observing it and learning from it —rather than getting wrapped up in it. As things feel more out of control, Simmons said it's important to make the adjustments to make your mental health a priority, whether that be asking for flexibility in your workspace or carving out time to take walks outside on a regular basis. For those experiencing intrusive thoughts and compulsions that are inhibiting daily life, McIngvale urged people to seek the help of a mental health professional with a specialty in OCD. In particular, find a provider trained at a clinic specializing in OCD who uses exposure and response prevention treatment, she suggested.And there is also a welcoming community of people with OCD to look to for support, she added."When OCD gets to feeling at its worst, it's hard to remember that there is a way out of the hole you are dug into," Dell said. "But there are resources out there."

UConn and South Carolina set to battle for the NCAA women's basketball title

By |2022-04-03T14:41:26-04:00April 3rd, 2022|Uncategorized|

No. 1 overall seed South Carolina is led by junior Aliyah Boston, the 6-foot-5 forward who has dominated the paint for the favorite Gamecocks. Boston averaged 17 points, 12 rebounds and more than 2 blocks per game on the season on her way to winning the Associated Press national player of the year.UConn, meanwhile, is led by sophomore guard Paige Bueckers, last year's national player of the year. She missed much of the season with a left knee injury but returned in February and is part of a trio of stellar guards.The title game is a rematch. South Carolina beat UConn 73-57 in November in the Battle 4 Atlantis in the Bahamas, relying on 22 points from Boston and a stifling defense that held the Huskies to just 3 points in the 4th quarter.UConn, the premier women's basketball program for almost three decades, finds itself in the odd position of underdog. A 2-seed in the tournament, UConn had 11 starting lineups this season due to a mix of injuries and Covid illnesses.Still, UConn reached the Final Four by topping 1-seed NC State in an epic 91-87 win in double-overtime, the first time in women's NCAA tournament history a game in the Elite Eight or beyond needed double overtime. They followed that up with a 63-58 win over another 1-seed in Stanford on Friday night to reach the title game.South Carolina has been the top-ranked team since the preseason and is 34-2 on the year, with each of its losses coming by 2 points or fewer.The Gamecocks reached the Final Four by beating 10-seeded Creighton 80-50 and then dropping 1-seeded Louisville 72-59 on Friday to reach the title game. In the win over Louisville, Boston and her pink and purple braids scored 23 points and snagged 18 rebounds, the 29th double-double of her stellar season.UConn, coached by Geno Auriemma, is led by its backcourt trio of guards in Bueckers, Christyn Williams and Azzi Fudd, who each average over 12 points a game on the season. The title game will take place in Minneapolis and is a homecoming for Bueckers, who grew up in the suburb of Hopkins.This is UConn's 14th consecutive Final Four appearance stretching back to 2007. The Huskies have made the championship game 11 times in their illustrious history -- and have gone a perfect 11-0 in those contests.South Carolina, under coach Dawn Staley, has made the Sweet 16 every year since 2014 and won its first national championship in 2017. They were the top-ranked team in the country in 2020 when the tournament was canceled due to Covid-19 and last year lost in the Final Four.The two teams last played in the NCAA tournament in 2018, when UConn beat South Carolina 94-65 to go to the Final Four.

Could the U.S. do More for Ukraine?

By |2022-03-29T07:50:54-04:00March 29th, 2022|Uncategorized|

President Biden says that Ukraine has the full support of the U.S. Volodymyr Zelensky disagrees.President Biden, in a passionate speech from Warsaw on Saturday, proclaimed the West’s complete support for Ukraine. “We stand with you, period,” Biden said.The next day, Ukraine’s president, Volodymyr Zelensky, offered a different message: He criticized the West for not doing enough. In a videotaped speech to Ukrainians, Zelensky contrasted their “determination, heroism and firmness” with the lack of courage from Western countries that had refused to send jets and tanks to Ukraine.In a detailed interview with The Economist this past weekend, he also called out the U.S. and, even more so, France and Germany, for not doing more. “We have a long list of items we need,” Zelensky told The Economist’s editor in chief, Zanny Minton Beddoes, and a colleague during a sit-down interview in a Kyiv bunker.Who’s right — Zelensky or Biden? Today, I will try to answer that question, with help from Times colleagues. I’ll do so by breaking Zelensky’s argument into three categories. The first critiques the West’s behavior in the run-up to the war. The second covers current requests from Zelensky that may be more performative than real. The third deals with steps that could help Ukraine and that the West is choosing not to take.1. Alternative historySome of Zelensky’s complaints are about the past. He says that the West could have altered Vladimir Putin’s war plans by imposing harsh sanctions as Russia mobilized for war. He made the same argument at the time.It is obviously impossible to know if Zelensky is right, but he has a legitimate case. The West’s initial response to Russia’s buildup was timid, offering little military support and threatening only modest sanctions. As The Atlantic’s Anne Applebaum wrote at the time, “Tragically, the Western leaders and diplomats who are right now trying to stave off a Russian invasion of Ukraine still think they live in a world where rules matter, where diplomatic protocol is useful, where polite speech is valued.”Putin seemed to assume that the Western reaction would remain fairly modest, much as the response to Russia’s 2014 annexation of Crimea had been. He decided that a full takeover of Ukraine would be worth the price.But the brutality and scope of the invasion changed the West’s approach. Biden and the leaders of other countries rallied to impose sweeping sanctions. The ruble and Russian stocks have plunged, and Putin himself has acknowledged that the economic damage will be large.Mothers and children at a center for displaced families in Lviv.Mauricio Lima for The New York Times“If tougher sanctions had been levied earlier, a full-scale Russian attack would not have occurred,” Zelensky claimed this weekend. “It would have been on a different scale,” he added, “giving us more time.”This argument is a way for him to urge the world not to make the same mistake again. Ukraine’s allies should “act pre-emptively, not after the situation becomes complicated,” he said.2. Politics as performanceIt’s often naïve to take the words of political leaders literally. The public speech of politicians tends to combine an honest expression of their views with an attempt to influence others. Zelensky, an actor by training, is well aware of the performative part of politics.Over the past few weeks, he has repeatedly asked for forms of help that he surely knows he will not get, my colleague Max Fisher says. The clearest example is a no-fly zone over Ukraine. Establishing one could require the West to shoot down Russian planes and even bomb air-defense systems inside Russia, potentially starting a world war.Still, making unreasonable requests has value to Zelensky. It signals to Ukrainians that he is doing everything possible to defeat Russia and also makes it harder for the West to say no to other requests. “He’s asking for the moon, knowing he’ll get less,” Eric Schmitt, a senior writer at The Times who has long covered military affairs, told me. “But it keeps the pressure on the West to deliver the stuff he needs.”3. What Ukraine wantsAnother set of requests coming from Zelensky and his aides is more literal and realistic. The biggest is their plea for the kind of equipment that allows a smaller army defending territory to hold off a larger, attacking army. The U.S. and other allies have already sent a large amount of such equipment, like shoulder-fired rocket launchers, but Ukraine says that it needs more.So far, Ukraine’s military has performed better than most observers expected, preventing Russia from taking over most major cities while reclaiming a few towns in the northeast. Because Russia has an enormous military, however, a war of attrition tends to work to its advantage, Eric notes. Russia can continue to bomb Ukrainian troops and civilians and hope for eventual capitulation. “The Russians have thousands of military vehicles, and they are coming and coming and coming,” Zelensky said.Western military officials argue that they are providing Ukraine with weapons and equipment as fast as is logistically possible. Zelensky says that his country’s fate may depend on the West doing better.A Ukrainian soldier reviewing drone footage.Daniel Berehulak for The New York TimesOther requests by Zelensky fall into a middle ground: It’s unclear whether Ukraine expects the West to say no. This list includes additional tanks and fighter jets as well as further sanctions on Russia and an end to European purchase of Russian energy.The bottom lineThe uncomfortable truth is that Ukraine and the West do not have identical interests, despite Biden’s suggestion to the contrary.Ukraine is fighting for survival, and its people are dying. Its leaders need to try any strategy that might plausibly help. The leaders of the U.S., E.U. and other allies genuinely want to come to Ukraine’s defense, but they are also concerned about their own economies, domestic support for their policies and the risk of nuclear war with Russia.More on UkraineBiden said he was expressing “moral outrage” — not U.S. policy — when he said Putin “cannot remain in power.”Zelensky says Ukraine will analyze the effectiveness of Western sanctions against Russia.The war has cost Ukraine almost $565 billion, including more than 4,900 miles of damaged or destroyed roadways, its economy minister said.The besieging of cities and the deliberate targeting of civilians are tactics Russia has used before: The Times’s Carlotta Gall saw it firsthand.An online video appears to show Ukrainian soldiers beating and shooting Russian prisoners of war.Novaya Gazeta, an independent Russian newspaper, has suspended publication.THE LATEST NEWSPoliticsPresident Biden at the White House yesterday.Leigh Vogel for The New York TimesBiden proposed a new tax on the wealthiest Americans and a corporate tax increase. Here’s more on his budget plan.A federal judge concluded that Donald Trump most likely committed felonies in trying to overturn the 2020 election.The Jan. 6 committee wants to interview Ginni Thomas, the wife of Justice Clarence Thomas. It also recommended charging Peter Navarro and Dan Scavino Jr., two Trump allies, with criminal contempt.Gov. Ron DeSantis signed a bill that limits discussion of sexual orientation and gender identity in Florida elementary schools.The Supreme Court agreed to hear cases on the treatment of pigs and on Andy Warhol’s images of Prince.Other Big StoriesWill Smith apologized to Chris Rock for slapping him at the Oscars. “I was out of line and I was wrong,” he wrote.A few years ago, Hillsong was the leading edge of cool Christianity. In the past two weeks, it has lost more than half of its American churches.A snow squall caused a 50-vehicle pileup on a Pennsylvania interstate.UConn won a thrilling overtime game to reach its 14th straight women’s Final Four; Louisville also clinched a spot.OpinionsNew York City rents are soaring. More housing would help, Mara Gay says.These graphics show how the coronavirus might evolve.Congress shouldn’t wait for another Covid surge to make more funding available, two Biden advisers argue.MORNING READSThe stairs at 20 Exchange Place in Manhattan.Amir Hamja for The New York Times“High-rise hell”: When you’re 50 stories up and the elevator doesn’t work.Health: How female patients can overcome “medical gaslighting.”Cold cases: Some true crime fans are funding police searches of DNA databases.A Times classic: Fix dark circles, bags and other eye woes.Advice from Wirecutter: Packing tips for your vacation rental.Lives Lived: Sara Suleri Goodyear vividly evoked her upbringing in Pakistan in her 1989 memoir, “Meatless Days.” She died at 68.ARTS AND IDEAS A throwback style guideAudrey Hepburn was a “flamboyant gamine.” Sophia Loren is a “soft dramatic.” If you’re a follower of the Kibbe method — like a growing number of people — you’ll recognize these as guidelines on how to dress.The stylist David Kibbe, who devised the system in the 1980s, came up in an era “where every woman had a ‘season’ and knew her face shape,” Mariah Kreutter writes in The Times. His system involves 13 body types based on Old Hollywood archetypes and a balance between what Kibbe calls “yin” (softness, curve) and “yang” (sharp angles, edges).There are critiques of the system, such as its frequent failure to “account for body diversity across gender and race,” Terry Nguyen writes in Vox. Still, Kibbe types have grown in popularity on TikTok, YouTube and Reddit, where fans exchange tips. Like an astrology sign or Myers-Briggs personality type, a Kibbe body type can also be a social identifier.“I think people are drawn to it because they no longer feel stuck in the loop of trend after trend,” ChloeAntoinette Santos, a 19-year-old design student, said. “They’re getting cemented in actually understanding themselves.”PLAY, WATCH, EATWhat to CookDavid Malosh for The New York Times. Food Stylist: Simon Andrews.Earthy mushrooms replace meat in this take on larb.TalkQuinta Brunson, the creator and star of “Abbott Elementary,” talks about the sitcom’s breakout success.What to ReadA violinist rethinks her devotion to music in “Uncommon Measure,” a genre-defying memoir by Natalie Hodges.Late NightThe hosts discussed Will Smith.Now Time to PlayThe pangram from yesterday’s Spelling Bee was cowgirl. Here is today’s puzzle — or you can play online.Here’s today’s Wordle. Here’s today’s Mini Crossword, and a clue: A good time (three letters).If you’re in the mood to play more, find all our games here.Thanks for spending part of your morning with The Times. See you tomorrow. — DavidCorrection: Monday’s newsletter said Americans were eligible to receive a Covid booster after six months. It’s actually five months.P.S. David Wallace-Wells is joining The Times to cover climate change. And The Times wants to answer your climate questions.Here’s today’s front page.“The Daily” is about Joe Manchin. “The Ezra Klein Show” features Larry Summers.Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti, Ashley Wu and Sanam Yar contributed to The Morning. You can reach the team at up here to get this newsletter in your inbox.

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