Life in the midst of COVID-19 has been stressful for all, to say the least. Experts worry about the toll that quarantine, job loss, and school closure will take on the emotional, physical, and nutritional health of people of all ages.
According to a CDC report, in June, three months after the World Health Organization (WHO) declared a global pandemic, 40% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder. 26% reported symptoms of trauma associated with the pandemic, 13% reported starting or increasing substance use to cope with stress or emotions related to COVID-19, and 11% reported seriously considering suicide in the 30 days leading up to completing the survey. 18-24 year-olds were the age group hit the hardest with 75% of respondents reporting at least one adverse mental or behavioral health symptom in the past 30 days.1 These are terrifying findings.
Not surprisingly, prescriptions for psychotropic medications are on the rise. One week after the WHO declared a global pandemic, 78% of all filled anti-insomnia, antidepressant and anti-anxiety prescriptions were new prescriptions.2
Experts are concerned about the impact that school closure has on children. When classes are in session, children are moving around within a social environment which can support their developmental needs for human interaction and activity. Additionally, many children rely on school for the majority of their nutrition; 30 million American children receive free or subsidized school lunches. According to the Food Research and Addiction Center, these lunches have been found to provide a more balanced, nutrient-dense meal replete in protein, fiber, vitamin A and calcium than lunches packed at home, which tend to be higher in calories, fat, saturated fat, and sugar. Not surprisingly, research shows that children experience unhealthy weight gain during the summer months when they are out of school, and that weight is maintained during the school year, accruing from summer to summer. Hence, experts warn that the lockdowns associated with the pandemic could lead to an increase in childhood obesity that will worsen with increased time away from school. Unhealthy weight gain in childhood is associated with higher weight in adulthood.3,4 In addition, as many as 18% of households in the US report food hardship during COVID-19 lockdowns.5
Nutrition has long been thought to play a role in the maintenance of balanced mental health, and nutritional deficiency has been shown to play a role in the onset and maintenance of depressive disorders.6 A 2019 review of 1000 articles published between 1978 – 2017 explored the potential importance between dietary patterns and quality of mental health throughout the lifespan. Healthy foods such as olive oil, fish, nuts, legumes, dairy products, fruits and vegetables were shown to be inversely associated with the risk for depression, and even showed potential for improving symptoms. The Standard American Diet (SAD) on the other hand, consisting of sweetened beverages, fried foods, processed meats and baked products, is associated with an increased risk for depression.7
What can providers offer? A lot! Remember, this is an unprecedented and very stressful time. For many families, home life has changed significantly since March. The first priority is to check in with your patients’ mental/emotional state and put your finger on the pulse of the situation at home. Validate their concerns and ascertain if they need help finding resources for food and rent. Are there children or elders in the home? Are there essential workers working outside the home, or family members working from home?
After basic needs are addressed, it’s important to gauge the stress level in the home. According to the book Burnout: The Secret to Unlocking the Stress Cycle, research shows that the stress cycle will continue without resolution until it’s completed by one of the following: physical activity, breathing, positive social interaction, laughter, affection, crying, and creative expression.8 For example, a 20-second hug has been shown to increase the “feel good” hormone oxytocin, and decrease blood pressure.9 And research shows that one feels better after a walk even if they didn’t want to take one in the first place!10 Share these very accessible yet powerful tools with your patients for these times of uncertainty.
For objective assessment, consider diurnal saliva testing to assess your patient’s reserves of the stress hormone cortisol. Also consider neurotransmitter testing to evaluate the status of nine neurotransmitters including dopamine, norepinephrine and epinephrine, which play a role in the stress response, as well as serotonin and GABA, which may contribute to a sense of well-being. Or combine them all into a Neuroadrenal Profile. Because neurotransmitter production is reliant upon nutrient cofactors, results can also be an indicator of nutritional status. If “desperate times call for desperate measures,” it can be reassuring to have scientifically-based evaluation and lifestyle treatment measures to fall back on.