Jan 8, 2022Liked by Katelyn Jetelina

I feel this in my bones, Dr. J.

I am a single mom to an 8yr old (asthmatic and immune-compromised) and a 6yr old. We haven’t had traditional in-person school since April 2020. My older daughter had a HALF a year of “normal” Kindergarten. But I cannot send my kids to school even now (with them vaxxed) because my state (Georgia) has no mitigations in schools and very low vaxx rate and just yesterday, the Governor lifted any remaining requirements for schools to contact trace/isolate/quarantine. The risk to my immune-compromised child is too great to send her to school.

So, here we are, 21 months into this, with no light at the end of the tunnel and a state that has decided to let Covid rip. My kids are starting to really show the strain of uncertainty and isolation. They miss other kids so much… but other kids (overwhelmingly unvaxxed here) are the biggest risk to my child’s health. I am starting to get really scared because I see their mental health starting to decline, but I live in a community that has decided not to value the vulnerable. My choices in this situation as a parent are all bad, terrible, and risky.

And for me? As a parent? Let’s just say that I am in weekly therapy and antidepressants and just trying desperately to cope with an utter lack of normalcy, no federal or state leadership to manage public health during this pandemic, no social structure (no family nearby and having to keep physical distance from friends because of risk), and a progressively less flexible and understanding workplace.

Thank you for speaking to this. I feel increasingly overwhelmed, terrified, squeezed, and rudderless. I am not sure how much longer many of us can hang on.

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This post is important and excellent. Nonetheless it is crucial for epidemiologists, especially, to recognize a severe defect in youth suicide reporting. For generations epidemiological and clinical understanding of mental illness has been constrained by the symptom complexes defined in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). The DSM-5 attends to child maltreatment trauma only at the end of the volume after defining the accepted diagnostic categories for various mental illnesses based on symptom complexes. On page 715, there is a brief section called “Other Conditions That May Be as Focus of Clinical Attention.” Here it states that the conditions listed there merely affect mental disorders; they are not mental disorders themselves; and they cannot be treated as mental disorders. Thus designated by the DSM-5 coding system, they are not reimbursable by insurance companies. Conditions relegated to this section include Child Physical Abuse, Child Sexual Abuse, Parent-Child Relational Problems, Child Affected by Parental Relationship Distress, Child Psychological Abuse, Spousal Violence, and others. Although the ICD-10 recognizes these categories, the USA depends on the outdated DSM system, thus the presence of any of these conditions is rarely specifically coded in an American child’s clinical medical record. Thus American records cannot be validly curated into ICD-10 form. This presents a major problem to clinicians who study and treat the effects of child abuse trauma and associated morbidities, not to mention suicide prevention efforts.

For instance, in most pre-covid, baseline studies of youth suicide, the presence or absence of child maltreatment trauma is simply not mentioned. Child maltreatment trauma is not mentioned as a diagnosis or comorbidity in the 2021 JAMA meta-analysis of youth suicides cited here. It is commonly thought that the pressure cooker family environment created by covid-19 markedly increased the incidence and prevalence of child maltreatment, but there is some confusion due to a decline in reporting resources at the same time. It is important to know how much of the observed increase in youth suicides is associated with child maltreatment trauma and potentially its differential impact in specific youth sub-populations. But there is no data! We do not know because of the outdated and inadequate coding system promulgated by the American Psychiatric Association.

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Aren’t the recommendations more focused on addressing the symptoms than the (social) causes? 😿

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Excellent post but only one comment; blaming the Pandemic alone for the increase in Youth struggling with mental health is wrong. Extrapolate the weeks graphed in the mental health ED visits and there is a period roughly between June and Aug 2019 that demonstrates a significant shift in ED visits. This period is pre-Pandemic and perhaps linked to the sense of loss of safety and belongingness, observation of deep societal division contributing to a loss of innocence and, no doubt, contributing to feelings of a lack of control as related to 1) out of control weather effects in the summer of 2019, 2) extreme political unrest and division experienced throughout USA society between the Mueller Report and Trump impeachment, and cultural unrest after far too many shooting incidences, amplification of cultural division along political lines and dehumanisation of people along cultural and racial divides.

Perhaps we shouldn’t get distracted by the Pandemic frosting on the very troubled, divided and bitter layer cake that has been baked for American children to feast on; it isn’t normal, it isn’t right, it isn’t fair and it is far too easy to avoid individual responsibilities and blame « The Pandemic ».

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Jan 8, 2022·edited Jan 8, 2022

We definitely need to focus resources on more mental health training - both in providing more training for all sorts of providers and encouraging more people to pursue a career in mental health, especially for kids and teens. Before the pandemic there was a huge shortage. Waiting lists were long. I know well-off people in large cities with lots of medical facilities who were willing and able to self-pay for their kids' counseling, and even they couldn't find anyone to see them within three or four months unless it was the sort of emergency that would be likely to lead to hospitalization. I can only imagine how hard it is now.

I know lots of students and parents who complain about the lack of mental health care on college campuses, but it is often easier there than in the "real world." It is just that the problems on campuses have become so dire that that they are beyond the capability of campus mental health centers to deal with. People call for hiring more counselors, but there is no one to hire. My city has an excellent School of Social Work, and those students are all employed within days of graduating.

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As a K12 educator, it's been an absolute nightmare navigating this pandemic, even at an independent school that supposedly has the means and ability to choose to do everything right.

There's a false dichotomy being pushed by non-teachers everywhere - schools are either allowing students' mental health to decay by being remote, or "supporting mental health" by returning to in-person learning. The problem is that the latter doesn't take into effect the simple idea that being in person in the middle of the pandemic is, at best, marginally better for mental health - students (and teachers!) feel less safe, and learning is still impacted because they're in a situation of constant worry and stress from the pandemic. In lulls like now, between BA.1 and BA.2, when they can pretend there is no pandemic, they seem fine - unless, of course, they live in multi-generational households with elderly family members, or have immunocompromised relatives (or are immunocompromised themselves). In those cases (a significant portion of the student body), they're now left to suffer and worry alone, without the support of their community. We've let the privileged kids return to not having to care about others, though, so I guess we really have returned to normal.

I'm avoiding the fact that the physical/mental health of the adult faculty and staff, especially those at high risk or those with families with high risk, is completely ignored. I'm a K12 educator with a pregnant wife and a number of high risk factors myself, and yet it was "return to normal" in January at the peak of BA.1 - no remote learning was ever seriously considered because the messaging at the national level was some perversion of 2003's "Mission Accomplished" banner as the cases skyrocketed. It took a week of sick leave to even find a doctor willing to write a note for accommodations, and I was told explicitly by my school that my pregnant wife's health would never be a consideration for present or future accommodations during a surge.

From a wider lens, this push to return to in-person learning AT ALL COSTS has been so blatantly economically-driven and need-blind to legitimate concerns for student and teachers' physical and mental health. A nihilistic and fatalistic attitude among students and teachers has grown in every school I have teacher friends in. I'm leaving education at the end of this school year, along with 35% of my school's entire faculty, because it's been made clear by our school and our government that we are expected to choose between our financial health and our physical/mental health; I can put myself and my family on the front line for the sake of the economic engine, or you can find another job. Guess what most people are choosing?

As the kids say - thank you for coming to my TED Talk.

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Zvi shares some data about this as well here - https://thezvi.substack.com/p/covid-1622-the-blip

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