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DURHAM, N.C. -- The mental health challenges associated with the COVID-19 pandemic have overwhelmed many Americans. The stress and anxiety from sickness, lost employment and a pivot for children and parents to isolated, virtual schooling has had a devastating cumulative effect.

As the first anniversary of the pandemic approaches, three Duke experts reflected Wednesday on the impact it has had on various aspects of mental health during University Communications’ 50th virtual briefing for journalists since last March.

Watch the briefing on .

Here are excerpts:

ROBIN GURWITCH, professor of psychiatry and behavioral sciences

On how children are processing the pandemic, the vaccine, and a chaotic world

“Children are definitely trying to figure out where they fit in this world. And we’ve had multiple other events happen at the same time.”

“COVID-19 and all that comes with COVID as well as the social injustice movement, racism and health care disparities that have been brought into focus. We’re dealing with multiple issues all happening at the very same time and our children are truly trying to figure out where they fit.”

On cumulative stress on children

“I absolutely adore Kelly Clarkson. I think she’s fantastic. But she got it so very wrong. What doesn’t kill you doesn’t make you stronger. What we know is that the more stressors, the more traumas, the more difficulties we have put us at greater and greater risk for both short-term and long-term challenges.”

“When we’re thinking about families, and particularly children, we’re seeing increases in anxiety and depression, and substance use. Those traumas are cumulative. What we will see – when children are stressed out, when parents are stressed out – it comes out in behavior problems.”

“The pot is boiling and it is boiling over. We know from long studies … the more stressors you have, the more at risk you are. More at risk for health problems, more at risk for homelessness, more at risk for unemployment, more at risk for health problems like cancer or diabetes that don’t seem like they should be connected to stressors from childhood, but that’s what we’ve seen. So we need to be sure we appreciate the cumulative nature of stressors.”

“We have tremendous grief happening in this country. That is a unique stressor. Children are experiencing grief in ways that are unprecedented.”

“Let’s just add a few disasters. Wildfires out in California. Massive ice and snowstorms in the Midwest and in the Northeast. It’s not just COVID. Then throw in the racial disparities for services. Those cumulative stressors are building and building and building.”

On whether we’ve had a lost year

“It’s important to take a long-lens look. What happened in this past year doesn’t define where kids or teens are going to be in the long term. We still have that potential. But has this disrupted education? Absolutely. And it has brought up the disparities even more. For families that did not have access to reliable internet, or families with children in special education services that were incredibly derailed in this pandemic, we know those students are at a higher risk for not meeting those academic milestones.”

“For some children who were doing great in person but virtually they couldn’t make the transition and their grades slipped, it has effects on their self-esteem. It affects their view of their own future.”

“I do think this has served as a year of disrupted education. I don’t want to say this is a lost year of education.”

On importance of telehealth

“We truly have learned a lot about our pivot into telehealth. It has to be covered. It truly needs to be expanded. Along with that, I think we still need to work on campaigns to reduce stigma, particularly in minority populations, around accessing mental health.”

“I really do believe we need to do a better job training our mental health providers. We do not have enough to deal with the current as well as the long-term … need for mental health services. I think we really need to do a better job training our providers in trauma-informed care and trauma-informed services.”

On mental health services in schools

“Sometimes in school systems, you might have one mental health provider for thousands of students. This is an equation that is not going to work.”  

“As we look ahead to how do we help schools get back to the learning environment … we also have to look at mental health providers. How are we going to do that in schools? How do we make sure there are services to reach the childrens’ needs?”

On what families can do to help their kids reduce stress

“I can’t stress enough the importance of routine to help reduce stress. In the pandemic, that has been a very hard thing to develop and to maintain. Just a routine. Thinking about what does our day look like? Routine allows us to feel more in control, to feel that things are more predictable. We know what’s coming.”

“Within that routine, there needs to be time for each family member to have some quiet alone time. I know that’s easier said than done, but if it’s built in and families can even have a say in what they want to do in that time, that can be helpful.”

“Petting an animal reduces our blood pressure. Find your pet and pet it!”

“Getting up and moving. Activity and exercise helps. I think it’s also important to maintain open communication within family members. Check in with your kids.”

“If families have lost a loved one, and there are certainly over a half-million families with empty chairs – together, how can we think about honoring the memory of the loved one. That can help.”

“We know also that even when we’re stressed as much as we may be, if we can find a way to help someone else, we do better. So … think about how can we help someone else. Even if I’m struggling, I still may volunteer time at a food bank. Even if I’m struggling, I may still help my neighbor shovel their snowy driveway. Even if I’m struggling, I may still write an old-fashioned letter to a family member so they can feel connected. There are so many ways we know that can help.”

On hope

“I am very, very hopeful for our future. I really do think this is an opportunity we have had unlike any other time in my lifetime … that we have opportunities to teach our children some values, some ideals, some beliefs that may move us forward into a more hopeful place.”

“I truly do think that there are opportunities for growth; there’s opportunities for hope, that we will be kinder and maybe more connected.”

ANNA GASSMAN-PINES, associate professor, public policy, psychology and neuroscience

On parents struggling to work and care for kids at home

“Parents, largely mothers, have had to leave the workforce in order to oversee remote schooling. We’re also seeing that school and care have been very likely to be disrupted throughout the fall in a variety of ways. It could be that your internet goes out and so your child can’t log into school. It could be that you’re using in-person care for a young child and that care has to close because there has been an exposure at that site. We’re finding that on any given day, about 25 percent of families are saying school and care did not go the way we thought it would today. That is a very high level of disruption in families’ daily routines.”

“On days when school and care has been disrupted, everyone is feeling a lot worse. Parents’ mood is worse. Children’s behavior is worse. The ongoing daily strains, especially around care and school, have been particularly hard to handle.”

On cumulative stress on parents

“The pandemic has heightened health risk. It has also had tremendous economic impact for families. It has changed so many things about family life. When families experience an accumulation of stressors related to the pandemic – like an adult in the household being laid off … when those accumulate in families, that is really when we see the absolute highest levels of mental health problems for both parents and the young children in those families.”

On how the pending federal stimulus package may help people

“What families, lower-income families, need right now is more money. In some ways it’s actually quite straight-forward. By losing jobs or keeping jobs but having fewer hours, (families) experienced substantial income loss. That was affecting their ability to cover the basics. Many families worry about paying their rent. Many families being quite worried about having enough food.”

“That first round of stimulus (in 2020) really did help. When we surveyed families in summer – through the CARES Act and the one-time stimulus checks that went out – that really buffered families from the most severe income losses.”

“But of course those were temporary. By fall when those CARE Act provisions largely lapsed, families were once again suffering quite high levels of income loss and resulting strain.”

“If the government can pass another round of stimulus checks … that will make a tremendous amount of difference right away, especially for the most vulnerable families.”

On the vaccine, and other reasons for hope

“Many parents (we survey) are working largely in essential jobs, particularly in food service, grocery stores, pharmacies. As we move forward, here in North Carolina essential workers are next on the (vaccine) list. That’s happening around the country.”

“And I think also there is room for optimism around the policy response. We don’t yet know what this additional (stimulus) bill will look like ... but I do think just to highlight and underscore the fact that these stimulus measures, getting the stimulus checks to families, making unemployment insurance more generous during this period of real crisis will really support families’ needs.”

JENNIFER PLUMB-VILARDAGA, clinical psychologist

On pandemic stress for people with substance abuse disorders

“It’s affecting every area of our lives. For folks who already had difficulty managing a substance use disorder – in the very beginning of the pandemic, everything shut down, including care, because we didn’t know how to do that safely. Now we’ve learned a lot and clinics are opening back up.”

“This chronic stress is really making substance abuse recovery harder. We’re also seeing individuals struggling with new substance use problems.”

“It’s very difficult to find positive social support. Even when we reach out to others, everyone is stressed. So it’s really making it a challenge for people to meet their recovery goals.”

“A lot of parents and adults are really struggling with how to turn to healthier behaviors when it’s very easy to numb out with substances and it’s very easy to isolate.”

“Recovery is possible. We do have to work harder to engage in other behaviors. But it is possible. Even right now, virtual options are available if you’re afraid to do it in person.”

On stress leading to substance abuse

“People have estimated that not just the mental health impact of this pandemic but the substance use impact of this pandemic will persist for years afterwards because of the lack of resources. The need far outweighs what we have to offer in terms of professional support.”

“Substance use actually puts people at increased risk of infection of COVID and increased risk of complications – even death – from COVID. We know there’s a huge problem with the increasing use of substances because it’s actually a huge risk factor for staying alive through this pandemic and seeing our way through to the other side.”

“This cumulative stress will build, not to mention the lingering effects of the grief. All of these missed milestones. Students who were not able to graduate from a level of school. Family members passing and not being able to have funerals or to honor their passing. All of these will persist because anniversaries will come. We will have missed out on many, many milestones. It is a crisis and it will persist. We need more resources to help people.”

On need for insurance to cover telehealth

“Telehealth is a great option for families. I’ve seen an increase in engagement and care from telehealth. So being able to support third-party payers, insurance companies, Medicare, Medicaid actually paying for telehealth … those are important features. Telehealth increases engagement. You don’t have to drive to an appointment. You don’t have to take a half day off from work.”

“It really increases engagement and care.”

“Also, being able to have financial support for substance abuse and treatment, that needs to be taken seriously. As people’s stressors increase, the level of substance abuse care that folks may need may actually be more intensive.”

On problems with opioids in the home

“Opioids are a huge problem. They are accessible and are problems we see across every segment of the population. One of the easiest things you can do is reduce access. If someone had a surgery … put away the opioids. Most pharmacies will take back your old opioids. One way to reduce risk is to not have it in the home.”

On hope

“I have long been amazed by the resilience of the human spirit. While there’s a lot stacked against us with folks exposed to chronic stressors, multiple traumas … there is resilience. One of the things I’ve seen emerging from the pandemic, we’re all looking at what actually matters to us. We’re letting go of some of the things maybe we weren’t attending to when we were busy.”

“As people are able to feed their families, maybe we can have people return to that natural inclination to think about what is actually most important.”

Meet the experts:

Anna Gassman-Pines
 is an associate professor of public policy, psychology and neuroscience, and faculty affiliate of the Center for Child and Family Policy. She studies low-wage work, family life and the effects of welfare and employment policy on child and maternal well-being, and the effects of job loss on children’s test scores. 

Robin Gurwitch
 is a professor in psychiatry and behavioral sciences at the ��ţӰ�� School of Medicine and director of parent-child interaction therapy at the Center for Child and Family Health. She studies the impact of trauma on children and families.

Jennifer Plumb-Vilardaga
 is a clinical psychologist with Duke Health and an assistant professor in psychiatry and behavioral sciences in the addiction division at the ��ţӰ�� School of Medicine.
 

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Duke experts on a variety of other topics related the coronavirus pandemic can be found

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