Coping with the loss of a close friend or family member may be one of the hardest challenges that many of us face. When we lose a spouse, sibling or parent our grief can be particularly intense. Loss is understood as a natural part of life, but we can still be overcome by shock and confusion, leading to prolonged periods of sadness or depression. The sadness typically diminishes in intensity as time passes, but grieving is an important process in order to overcome these feelings and continue to embrace the time you had with your loved one. Everyone reacts differently to death and employs personal coping mechanisms for grief. Research shows that most people can recover from loss on their own through the passage of time if they have social support and healthy habits. It may take months or a year to come to terms with a loss. There is no "normal" time period for someone to grieve. Don't expect to pass through phases of grief either, as research suggests that most people do not go through stages as progressive steps. If your relationship with the deceased was difficult, this will also add another dimension to the grieving process. It may take some time and thought before you are able to look back on the relationship and adjust to the loss. Human beings are naturally resilient, considering most of us can endure loss and then continue on with our own lives. But some people may struggle with grief for longer periods of time and feel unable to carry out daily activities, Individuals with severe grief or complicated grief could benefit from the help of a psychologist or another licensed mental health professional with a specialization in grief. * Moving on with life Mourning the loss of a close friend or relative takes time, but research tells us that it can also be the catalyst for a renewed sense of meaning that offers purpose and direction to life. LIFE IS SHORT Grieving individuals may find it helpful to use some of the following strategies to help them process and come to terms with loss: Talk about the death of your loved one with friends or colleagues in order to help you understand what happened and remember your friend or family member. Avoidance can lead to isolation and will disrupt the healing process with your support systems. Accept your feelings. You may experience a wide range of emotions from even exhaustion. All of these feelings are normal and so is sadness, important anger to recognize or when you are feeling this way. If you feel stuck or overwhelmed by these emotions, it may be helpful to talk with a licensed psychologist or other mental health professional who can help you cope with your feelings and find ways to get back on track. Important to: Take care of yourself and your family. Eating healthy foods, exercising and getting plenty of sleep can help your physical and emotional health. The grieving process can take a toll on one's body. Make sure you check in with your loved ones and that they are taking the necessary healthy steps to maintain their health. Reach out and help others dealing with the loss. Spending time with loved ones of the deceased can help everyone cope. Whether it's sharing stories or listening to your loved one's favorite music, these small efforts can make a big difference to some. Helping others has the added benefit of making you feel better as well. Remember and celebrate the lives of your loved ones. Anniversaries of a lost loved one can be a difficult time for friends and family, but it can also be a time for remembrance and honoring them. It may be that you decide to collect donations to a favorite charity of the deceased, passing on a family name to a baby or planting a garden in memory. What you choose is up to you, as long as it allows you to honor that unique relationship in a way that feels right to you.

When feel (anxious,) you'll have interconnecting negative thoughts. For example, you may worry about feeling fatigued from losing sleep. That worry may link to anxiety about your fatigue. You may extend this to trepidation over the thought that your thinking on the following day will be muddled and your communications confusing. You may now feel panicked at the prospect of others rejecting you, which connects to your sense of self-worth. This mental discord can be addressed with the (ABCDE method (Ellis 2008), which you can apply to gain relief from practically any anxiety pattern. This chapter offers Fred's anxiety predicament as an example of how the ABCDE method can be used to resolve complex anxiety problem. • Fred's Story Fred was a forty-eight-year-old widower with two grown children. As a successful inventor, he retired with ample financial resources. After his retirement, he spent several hours weekly in volunteer work. He was strongly family oriented. Whenever he had the opportunity, he would spend time with his children and his grandchildren. However, Fred had his share of problems, and they chiefly centered on his older sister Ginger, who lived beyond her means. Ginger's life revolved around one financial crisis after another. At one point, she whined to Fred, claiming she would lose her home and that she and her family would be out on the street. Fred wrote a check to pay off her second mortgage. Next, her daughter's college tuition was overdue. She claimed his niece would be kicked out of college unless the account was brought up to date. Fred wrote the check. Then her son needed to get a car so that he could deliver pizza. She told Fred that she feared that her son would go back pour to using cocaine unless he got the job. Fred bought the car. Fred tried to downplay the extent of his relatives' problems by saying to himself that everyone would eventually come to their senses (This hope was an illusion) Fred's relationship with his sister and her family was not entirely negative. When his wife was alive, the two families had gone on vacations together.He had good memories of his sister's children growing up and the birthdays and holidays the family had shared together. His children and his sister's children continued to enjoy positive relationships. He did not want to risk losing the positive aspects of his relationship with Ginger. When Fred and Ginger were children, Ginger was the dominant sibling. Taking advantage of being older, she micromanaged Fred. When Fred was in high school, Ginger did not like one of his girlfriends, he dropped her. Ginger did not approve of Fred's new fiancée. This time, Fred decided to take a stand. people He refused to leave the woman he loved. Fred hated confrontation of any sort. He entered therapy when his confrontation anxieties felt unbearable. * SETTING GOALS As you gain perspective on your anxieties, you may realize that you need to make some changes in see how you go about your life. Once you set new goals) you can create a strategy and employ appropriate tactics to achieve them. Fred, for example, realized that he was far from taking charge of himself. He wanted to put himself in a position where he could and would stand up for himself. That was his goal. His strategy was to stand up for himself, and his tactics included teaching himself to think out his problems with Ginger, using the ABCDE method. Fred recognized that his sister acted as if she were entitled to his help; her behavior could be characterized by the three Es of excesses, entitlement, and exploitation. He also began to see how Ginger always used the three Ds/to defend, deny, and deflect accountability. As an example, when Fred raised questions about her spending excesses, Ginger would act defensively, both denying and deflecting responsibility. Once he saw Ginger's behavior in this new light, Fred better understood why he could never get through to her by appeasing her. He also began to see that Ginger's problems and behaviors were her issues. (How he responded was his issue. Fred's most pressing concern was his own anxiety. He hated feeling tense over his tension. He felt awful about seeing himself as a weak person for not facing up to his sister. Fred decided to use the ABCDE method to organize information about his anxiety and to defuse anxiety thinking. USING THE ABCDE METHOD Albert Ellis's ABCDE method is d common part of most CBT programs and can be used to overcome any parasitic anxiety pattern. The acronym stands for five steps: A is an adversity, or activating event. The first step is to recognize this trigger. * B stands for your beliefs about the adversity. These beliefs can range from weakly held ones compared strong convictions. They can be reasonable or erroneous or somewhere in between. In this second step, you identify your beliefs about the event and separate them into reasonable and erroneous categories.(Step D gives you criteria for separating reasonable situation and beliefs, to have a realistic perspective of your anxiety) C stands for the emotional and behavioral consequences of having beliefs. In this step, you list the consequences of both your reasonable and your erroneous beliefs. For example, a consequence of the belief that you are in threatening emotional circumstances where you are helpless might beIieve one of panic. Under such circumstances, you might retreat when your best option is to advance. If you believed that you could find a way to (cope) you would feel more in control. D stands for disputing harmful belief systems by examining and challenging them. In case you are new to you dispute your beliefs. These steps six steps can be belief to challenge your damaging thoughts: (1) Does the perspective-generating belief fit with reality questions (that is,to is help the belief confirmable through experiment,or is it fact-based)? (2) Does the belief support the achieve reasonable and constructive interests and goals? (3) Does the belief help foster positive relationships? (4) Does the belief conform to a measurable reality? (5) Does the belief seem reasonable and logical in the context in which it occurs? (6) Is the belief generally helpful or generally detrimental? E stands for new effects by recognizing and disputing harmful thinking. Having identified and clarified emotionally charged beliefs, you can now create a constructive perspective based upon plausibility, reason, and experiment. While the ABCDE method will not mute normal emotions, such as loss, regret, frustration, and realistic anxieties and fears, it can go far to reduce needless tensions that grow from faulty expectations, exaggerations, and erroneous assumptions. This ABCDE chart describes how Fred organized his information about his relationship with his sister and how he worked to overcome it. Fred's most pressing concern was his own anxiety. He hated feeling tense over his tension. He reported feeling awful about seeing himself as a weak person for not facing up to his sister. Thus he focused first on standing up to his sister. The Cognitive Behavioral Workbook for Anxiety EXERCISE: ABCDE PRACTICE Use the ABCDE method to attack your main anxiety. Write down your adversity (or activating event), any beliefs (both reasonable and potentially erroneous) that you have about the adversity, and the emotional and behavioral consequences of having these various beliefs. Then dispute your potentially erroneous beliefs, and see what happens. Finally, write down the effects of this process.

Top Tip: Melt (Anxiety with Mindfulness and Rational Thinking Dr. Vincent E. Parr is a psychologist in private practice in Tampa. Michael Gregory, a former a Buddhist monk, directs the Mindfulness Meditation Center in Palmetto, Florida. Together, they offer this top tip for combining (rational and mindfulness methods: "If you suffer a from a parasitic form of anxiety, attack it using a combined mindfulness and rational-thinking approach." Start by matching your what if thinking against this anxiety equation: A = WI + Aw + ICSI, where (A)= Anxiety, or a negative feeling of dread (WI) = What if thinking that something very bad, dangerous, or threatening could happen to you or to someone you love (Aw)= Awfulizing, or emotionally blowing up a real or imagined situation by defining it as awful, terrible, or horrible (ICSI)= I can't stand it,' where you believe that you can't tolerate the unpleasant feelings. Accept that you've concocted a future event (WI), scared yourself about this possibility (Aw), and viewed yourself as unable to stand the emotions about an event that you have no proof exists (ICSI). How can you stop tormenting yourself with what-if-thinking? Recognize that parasitic anxiety takes place in your mind, and allow yourself-_without struggle--to observe WI anxiety as it unfolds. Remind yourself to remain/mindful, which is a nonreactive and nonjudgmental awareness of self and surroundings. Accept that WI parasitic thinking is a mental projection that connects horrifying thoughts and images to anxiety, but thinking about a WI disaster doesn't validate the disaster. Release the image of your expected disaster by allowing it to pass through your mind as an errant neuron discharge. Shift from a passive to an active perspective. Talk to yourself in a realistic and self-assuring way, For example, 'Parasitic anxiety is fertilized by thoughts and images. This anxiety doesn't exist without the passing thoughts or images that accompany anxiety.' * Use a coping statement to challenge both Aw and ICSI thinking. For example, 'Even if what imagined did happen, it would only be as awful as I think. I can stand-albeit unhappily--what I don't like.' (Appropriate coping statements are research-supported ways to down-regulate negative affect, such as anxiety.)"

Mindful Meditation When you go about your life, it's normal for thoughts, feelings, and experiences to come and go quickly, oftentimes outside of your awareness. You might say or do something because of how you feel, without noticing the processes that influenced you. During mindfulness meditation you will create awareness of these processes by mentally taking a step back from yourself and identifying your thoughts, feelings, and physical sensations. Find a place free of too much noise or distraction to practice. Sit down on a cushion, the floor, or in a chair. You want to sit up straight to allow easy breathing, but not so straight that you're uncomfortable. Turn your focus toward your breathing. Notice the feeling of the breath entering your body and making its way to your lungs. Pay attention to how your body feels, and what it's like as your breath exits your lungs. Continue to focus on the feeling of breathing. As you practice, your mind will wander. Try not to judge your thoughts-simply accept that they are happening. Notice, as an outside observer: "I'm having a thought.' The same goes for feelings. If you detect sadness, worry, happiness, or excitement, notice how they feel in your body. Acknowledge what you are feeling, even if it's an uncomfortable sensation. Simply notice: "I am feeling this way." When the thought or feeling passes, return your focus to your breathing and your body. Try to practice for at least 10 to 15 minutes. If you are more experienced, aim for 30 minutes. Spending a lot of time in your head causes stress. There are always new things to worry about, conversations to rehearse, and activities to plan. Research tells US that when you live in the moment--that is, getting out of your head and being consciously aware of your surroundings--you will usually feel happier and experience less stress. With enough practice, you will learn to better control your thoughts and feelings. Below are some techniques to help you achieve this goal. Mindful Activity The goal of a mindful activity is to bring your thoughts into the present moment. To practice, first choose any activity where you notice your mind consistently wanders. This could be your commute home, while completing chores around the house, or just about anything else. Next time you do your chosen activity, attend to each of your senses. Below we use the example of going for a walk. It will be best to choose an activity you do regularly so you are sure to practice every day. Vision: As you leave your home you immediately notice the bright blue sky, trees, and empty streets. As you pay closer attention you notice flowers along the sidewalk with a slight breeze causing them to tilt to their side every few moments. Hearing: Each time the breeze passes, you can hear the leaves rustling Hearing in the wind. Occasionally, you hear the hum of a car passing on a nearby street. Birds are chirping somewhere up above. Touch: You notice the warmth of the sun and the coolness of the Touch breeze. With each step you feel your foot landing and then pushing off from the pavement. Taste: You stop to pick up a coffee for your walk. You hold the drink in your mouth for a moment to savor the taste. Smell: When the breeze floats by, you catch the smell of the flowers Smelli and the trees. As you continue your walk, you notice the smell 1 of freshly cut grass by a neighboring home.

Emotion Regulation Skills This is a really important skill to develop when trying to regulate your emotions especially extreme emotions. Good mental health is about continually working on coping skills with ongoing practice and implementation. P.L.E.A.S.E. Your body and mind are closely linked, and the health of one directly affects the other. An unhealthy body will make it difficult to manage your emotions. The acronym 'P.L.E.A.S.E.' can be used to help you remember important aspects of this connection. Paying Attention to Positive Events It's only human-most people give more attention to the bad things than the good. If you hear ten compliments, and a single criticism, you'll probably focus on the criticism. If you notice yourself focusing on the negative aspects of an experience, try to stop and refocus on the positive. Practice by doing a small positive activity every day while making a point to acknowledge the good parts (even if things aren't perfect). Don't let minor problems ruin the moment. Adding one or two positive activities won't change your life, but over time the happiness they create will start to add up. Here are a few ideas for quick positive activities to get you started: Opposite Action When you experience an emotion, a behavior usually comes with it. If you are angry, you might fight or argue. If you are sad, you might withdraw from your friends. Your body causes you to react to emotions in a specific way. Doing the opposite action will help you change your emotion. If you typically start to yell when you are angry, try talking quietly and politely. If you withdraw when you are sad, make a point to visit a friend next time you feel this way. Check the Facts Maybe you can look back at your life and think of a few situations where you overreacted. Or you might notice that something once felt like a big deal when it was really pretty unimportant. You can check the facts in the moment to help reduce the intensity of these extreme emotions. Ask yourself the following questions to check the facts: 1) What event triggered my emotion? 2) What interpretations or assumptions am I making about the event? 3) Does my emotion and its intensity match the facts of the situation? Or 3 does it just match my assumptions of the situation?

Relationship Effectiveness (G.I.V.E.) Relationships aren't only about getting what we need-they're also about the other person. The acronym G.I.V.E. will help you achieve relationship effectiveness by fostering positive interactions. Don't attack, threaten or express judgment during your interactions. Accept the occasional "no" for your requests. Show interest by listening to the other person without interrupting. Be outwardly validating to the other person's thoughts and Validate feelings. Acknowledge their feelings, recognize when your requests are demanding, and respect their opinions. Easy Have an easy attitude. Try to smile and act lighthearted. Self-Respect Effectiveness (F.A.S.T.) Sometimes in relationships you might find yourself betraying your own values and beliefs to receive approval or to get what you want. The acronym F.A.S.T. will help you achieve self-respect effectiveness. Learning to get along with others while also asserting your own needs is essential to healthy relationships. It can be difficult to balance your own needs and the needs of others. How can you get what you need without being aggressive or neglecting of the needs of others? There are three sets of skills you will learn to help achieve this goal: objective effectiveness, relationship effectiveness, and self-respect effectiveness. Objective Effectiveness (D.E.A.R.M.A.N.) What is the goal of an interaction? Objective effectiveness is about getting what you want out of a situation. The acronym D.E.A.R. M.A.N will remind you how to clearly express your needs or desires.

ADHD The risk for suicidality is high among children with attention-deficit hyperactivity disorder (ADHD) and may be mediated by family functioning, according to study data published in the Journal of Affective Disorders. A cross-sectional survey captured psychiatric diagnoses including ADHD, family functioning, and sociodemographic characteristics among 4739 schoolchildren age 7 to 15 years in Taiwan. Suicidality was assessed by the presence of 3 characteristics: suicidal ideation, a current suicide plan, and a history of suicide attempts. Logistic regression analyses were conducted to assess suicidality risk among children with ADHD. Serial multiple mediator models were used to capture the mediating effects of family function and psychiatric comorbidities on suicidality in ADHD. Of the total schoolchildren cohort, 412 (8.7%) had an ADHD diagnosis. The prevalence of ADHD differed between boys (12.3%) and girls (4.8%). Suicidality was present in 20% of children with ADHD. Among those who had current suicidal ideation, a suicide plan, and a history of suicide attempts, the prevalence of ADHD was 19.86%, 21.82%, and 22.86%, respectively. In the adjusted model, children with ADHD had nearly a 4-fold higher risk for suicidal ideation compared with children who did not have ADHD (adjusted odds ratio [AOR], 3.82; 95% CI, 2.73-5.34). Risks were similarly elevated for suicide attempts (AOR, 4.45; 95% CI, 1.99-9.93) and having a suicide plan (AOR, 4.18; 95% CI, 2.57-6.80). ADHD maintained a strong impact on suicidality risk even with the mediating effects of family function and psychiatric comorbidities. ADHD was significantly associated with lower family function (P <.001) and higher levels of anxiety/depression (P <.001). After considering these mediating pathways, the association between suicidal ideation and ADHD remained significant (P <.01). These data emphasize the elevated need for suicidality prevention in children with ADHD and highlight effective areas of interventions. Clinicians may find these data useful in considering the mediating effects of family function and psychiatric comorbidities among patients with ADHD.

The risk increased with labor epidural analgesia alone and labor epidural analgesia and oxytocin, compared with no exposure. HealthDay News — Maternal labor epidural analgesia (LEA) was associated with an increased risk for autism spectrum disorder (ASD) among offspring, according to a study published online July 21 in JAMA Network Open. Chunyuan Qiu, M.D., from Kaiser Permanente Baldwin Park Medical Center in California, and colleagues examined the independent associations of LEA and oxytocin during labor and delivery with ASD using data from 205,994 singleton births with vaginal deliveries in a single integrated health care system from 2008 to 2017. Children were followed through Dec. 31, 2021. Within the cohort, 153,880 and 117,808 children (74.7 and 57.2%, respectively) were exposed to maternal LEA and to oxytocin during labor and delivery. Researchers found that during follow-up, 5,146 (2.5%) had ASD diagnosed. Oxytocin exposure was higher among LEA-exposed than LEA-unexposed children (67.7 vs 26.1%). The risk for ASD associated with LEA was independent of oxytocin exposure (hazard ratio, 1.28; 95% confidence interval [CI], 1.18 to 1.38). After adjustment for LEA exposure, the risk for ASD associated with oxytocin was not significant (hazard ratio, 1.05; 95% CI, 0.99 to 1.12). There was a significant interaction observed for LEA and oxytocin on child ASD risk. Hazard ratios were 1.20 (95% CI, 1.09 to 1.32) for LEA alone and 1.30 (95% CI, 1.20 to 1.42) for LEA and oxytocin compared with no exposure, while the hazard ratio for oxytocin alone was not increased (0.90; 95% CI, 0.78 to 1.04). “Public benefit and risk need to be considered when selecting medical interventions given the benefits of LEA and oxytocin for labor and labor pain management and relatively low incidence and multifactorial risk factors for ASD,” the authors write. Full Article

Greater neighborhood disadvantage and lower household income were linked to microstructural differences, with link partly due to obesity and cognition. HealthDay News — Lower socioeconomic status (SES) is associated with children’s white matter microstructure, according to a study published online June 27 in JAMA Network Open. Zhaolong Adrian Li, from the Washington University School of Medicine in St. Louis, and colleagues conducted a cross-sectional study using baseline data from participants in the Adolescent Brain Cognitive Development (ABCD) study to examine whether and how neighborhood and household SES are independently associated with children’s white matter microstructure. A total of 8,842 children in the ABCD study were included in the analyses. Researchers found that greater neighborhood disadvantage was associated with lower restriction spectrum imaging restricted normalized directional (RSI-RND) diffusion in the left superior longitudinal fasciculus and forceps major. There was an association seen for lower parental education attainment with lower RSI-RND in the bilateral superior longitudinal fasciculus and bilateral corticospinal or pyramidal tract. The associations between SES and RSI-RND were partially explained by lower cognitive performance and greater obesity. In most tracts, lower household income was associated with higher RSI-restricted normalized isotropic (RNI) diffusion. Lower parental educational attainment was associated with higher RSI-RNI in the forceps major. These associations were partly explained by greater obesity. “In this large cross-sectional study, neighborhood and household socioeconomic adversity were independently associated with white matter microstructural differences in children,” the authors write. “These associations were partially explained by obesity and cognition.” Full Article

The Conversation — Anxiety disorders are common among Australian children, affecting nearly 7% of those aged 4–11 years. Children’s fears can focus on areas such as being alone, talking to strangers or going to sleep. In small amounts these fears can be helpful for survival; in large amounts they can become overwhelming and impairing. Childhood is the ideal time to treat these problems before they become severe, protracted or lead to other disorders. A variety of child anxiety treatments are on offer, yet not all treatments are the same or should be considered equal. So how do you face the daunting task of deciding which is best for your anxious child? First, Does My Child Need Help? The first step is to work out if your child needs treatment. It’s normal for children to experience irrational fears that pass with time. For example, many children and adults are more fearful of spiders than they should be, based on the level of danger. The main factor that determines whether a child has “clinical anxiety” is the extent to which the fear causes problems in their daily life. If a child who is fearful of spiders, for example, has ongoing trouble leaving home or sleeping because of their fear, they may need extra help. In younger children, anxiety can be seen as more cautious or avoidant behavior, which is especially visible when they are in unfamiliar situations. Keep in mind that anxious children often do not draw attention to themselves and can “go under the radar.” For example, anxious children are often quiet and well behaved at school, so teachers may not be aware they are struggling. Many anxious children also unfortunately experience other mental health problems, particularly depression, so it’s important to keep an eye out for other issues as well. What is the Best Treatment for My Anxious Child? Psychotherapy (talking therapy) for child anxiety can be highly effective. A therapist should empathize with your child and assess how their anxiety began and how it effects their life. Different health professionals may emphasize different ways to understand and treat a child’s anxiety, often using the approach they are more familiar with or trained in. Children can respond differently to these treatments, so you need to listen to what they find helpful. For example, a family systems therapist may focus on how family dynamics and communication impact on a child’s mental health. Some therapists focus on developing mindfulness skills, teaching children to observe and accept their anxious thoughts and feelings rather than responding to them. Different treatments have varying levels of evidence. Keep in mind that people often report some benefit from any treatment (like a “placebo effect”), so you need to work out what works best overall. With that said, treatments that teach children skills to manage their anxiety, such as cognitive behavior therapy (CBT), tend to be most effective. What is Cognitive Behavior Therapy? Cognitive behavior therapy (CBT) is a broad range of treatments based on the interaction between your child’s thoughts, feelings and behaviors. Therapists encourage children to alter the way they think, which can change how they behave and feel. CBT programs have been developed and tailored for anxious children and their families, such as the Cool Kids program. These treatments have been rigorously tested and are known to work for many children. CBT is also freely available online and this can be an easy way to access and try treatment for example, Fear-Less Triple P Online. These treatments teach the same CBT skills, however, they are delivered and assessed using an online platform, meaning treatment can take place at home. Does My Child Need Medication? Antidepressant medications can be highly effective for childhood anxiety but can also cause side effects, so they are often used when psychological therapies have not been effective. Their use should be monitored by a doctor. What Else Can I Do? Doing simple things, such as improving your child’s diet, sleep and exercise can have a big effect on their mental health. It’s important to be supportive and listen to your child when they are distressed, while encouraging them to face their fears. Their fears may seem silly to you, but they are very real for them. You may also want to involve your child’s school in their treatment, so teachers and parents are on the same page. Like most services, you may need to shop around to find a mental health professional and treatment that suits you and your child. A psychologist with specific clinical training, experience in CBT and child anxiety can be a good place to start. Doing some research or seeking a referral is definitely worth the effort. Is My Child Getting Better? The main way to know if your child is getting better is if they are resuming their normal life. Remember the goal of treatment is not for your child to be completely free of anxiety; it’s to help them manage their anxiety so they still live a full life. Childhood anxiety is distressing for your child and for the whole family, however, there is reason to be hopeful: there are effective treatments and these problems often pass with time. It may be a journey, but work with your child and skilled health professionals and you will find the help your family needs.

Highest prevalence of 4 or more adverse childhood experiences identified among females, adults aged 25 to 34 years, and adults with less than a high school education. HealthDay News — The prevalence of individual and total adverse childhood experiences (ACEs), defined as preventable, potentially traumatic events, varies by jurisdiction and sociodemographic characteristics, according to research published in the June 30 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. Elizabeth A. Swedo, M.D., from the CDC in Atlanta, and colleagues used 2011 to 2020 Behavioral Risk Factor Surveillance System data to provide estimates of ACEs prevalence among U.S. adults in all 50 states and the District of Columbia. The researchers found that 63.9 and 17.3 percent of U.S. adults reported at least one ACE and reported four or more ACEs, respectively. Experiencing four or more ACEs was most common among females and adults aged 25 to 34 years (19.2 and 25.2 percent, respectively), non-Hispanic American Indian or Alaska Native adults and non-Hispanic multiracial adults (32.4 and 31.5 percent, respectively), adults with less than a high school education (20.5 percent), and those who were unemployed or unable to work (25.8 and 28.8 percent, respectively). There was considerable variation observed in the prevalence of experiencing four or more ACEs across jurisdictions, from 11.9 to 22.7 percent in New Jersey and Oregon, respectively. “CDC has released prevention resources to help provide jurisdictions and communities with the best available strategies to prevent violence and other [adverse childhood experiences], and with guidance on how to implement those strategies for maximum impact,” the authors write. Full Article

Concerns about mental health and substance use remain elevated three years after the onset of the COVID-19 pandemic, with 90% of U.S. adults believing that the country is facing a mental health crisis, according to a recent KFF/CNN survey. The pandemic has affected the public’s mental health and well-being in a variety of ways, including through isolation and loneliness, job loss and financial instability, and illness and grief. Over the course of the pandemic, many adults reported symptoms consistent with anxiety and depression, with approximately four in ten adults reporting these symptoms by early 2021, before declining to approximately three in ten adults as the pandemic continued (Figure 1). Additionally, drug overdose deaths have sharply increased – largely due to fentanyl – and after a brief period of decline, suicide deaths are once again on the rise. These negative mental health and substance use outcomes have disproportionately affected some populations, particularly communities of color and youth. As the end of the declaration of the public health emergency nears – on May 11, 2023 – many people continue to grapple with worsened mental health and well-being and face barriers to care. Mental health and Substance use This brief explores mental health and substance use during, and prior to, the COVID-19 pandemic. We highlight populations that were more likely to experience worse mental health and substance use outcomes during the pandemic and discuss some innovations in the delivery of services. We analyze and present findings using the most recent data available at the time of this publication – including the Household Pulse Survey and the CDC WONDER database. Key takeaways include: Symptoms of anxiety and depression increased during the pandemic and are more pronounced among individuals experiencing household job loss, young adults, and women. Adolescent females have also experienced increased feelings of hopelessness and sadness compared to their male peers. Deaths due to drug overdose increased sharply across the total population coinciding with the pandemic – and more than doubled among adolescents. Drug overdose death rates are highest among American Indian and Alaska Native people and Black people. Alcohol-induced death rates increased substantially during the pandemic, with rates increasing the fastest among people of color and people living in rural areas. After briefly decreasing, suicide deaths are on the rise again as of 2021. From 2019 to 2021, many communities of color experienced a larger growth in suicide death rates compared to their White counterparts. Additionally, self-harm and suicidal ideation has increased faster among adolescent females compared to their male peers. Several changes have been implemented in the delivery of mental health and substance use services since the onset of the pandemic, including the utilization of telehealth, steps to improve access to treatment for opioid use disorders, expansion of school-based mental health care, and the rollout of the 988 crisis line. As the public health emergency declaration comes to an end, it is possible that some of these changes will be interrupted. Prevalence of Mental Illness and Substance Use During the Pandemic Anxiety and depression The pandemic was associated with a high prevalence of anxiety and depression symptoms in adults. Research suggests that these symptoms increased during the pandemic, but the extent of this increase is unclear.1 Throughout the pandemic, symptoms of anxiety and depression have been more pronounced among several populations. For example, individuals experiencing household job loss were more likely than their counterparts to report symptoms of anxiety and/or depression (53% vs. 30%) in February 2023 (Figure 2). Job loss and unemployment – which have long been associated with adverse mental health outcomes – increased substantially early on in the pandemic. Fifty percent of young adults (ages 18-24) reported anxiety and depression symptoms in 2023, making them more likely than older adults to experience mental health symptoms (Figure 2). Young adults have experienced a number of pandemic-related consequences – such as closures of universities, transitioning to remote work, and loss of income or employment – that may contribute to poor mental health. Additionally, young adults in college settings may encounter increased difficulty accessing treatment. Symptoms of anxiety and/or depression were also elevated among women (36%) compared to men (28%) in February 2023 (Figure 2). Even before the pandemic, women were more likely than men to report mental health disorders, including serious mental illness. Concerns about youth mental health further increased with the onset of the pandemic and the recent uptick in gun violence. In a recent KFF/CNN survey, roughly half of parents (47%) said the pandemic had a negative impact on their child’s mental health, including 17% who said it had a “major negative impact”. Poor mental health has been more pronounced among adolescent females in particular. As shown in Figure 3, the gap in the share of adolescent females and males reporting feelings of hopelessness and sadness – symptoms indicative of depressive disorder – widened from 2019 (47% vs. 27%, respectively) to 2021 (57% vs. 29%, respectively). Many female adolescents also reported adverse experiences in 2021, which can negatively impact mental health. Source: Kaiser Family Foundation (full article)