Psychological Support During COVID-19 Pandemic #S1/03

 

Stress and psychological strain affect your body and will at times increase the blood glucose level on account of the way different hormones behave. Different individuals are more or less sensitive to these reactions in their bodies. Biologically, when the body is exposed to stress, the adrenal glands secrete the hormone adrenaline which in turn increases the output of glucose from the liver “Dr Ragnar Hanas, MD, Ass. Prof. Consultant Paediatrician, 2019” 

Did you know? 

• Stress that cannot be influenced (such as problems in the family or at work) will have the greatest effect on your health.

• Stress can also affect your blood glucose for the simple reason that you will not have as much time to care for your diabetes when life becomes busy and stressful.

• Adrenaline (stress hormone) gives:

1. Increased blood glucose level by:

A) Release of glucose from the liver.

B) Decreased uptake of glucose into the cells.

2. Ketones by: Breakdown of fat into fatty acids that are transformed into ketones in the liver.

However, this study will focus on Paediatrics (Children), Adolescents, and young adults with diabetes. 

Why does the Support Matter?

Worsening mental health for parents, alongside worsening behavioural health for their children; Loss of regular child care; Change in Insurance status; and worsening food security.

COVID-19 Pandemic and mental health

Different variables responsible for different outcomes:

Age (higher anxiety in older kids, depressive symptoms).

NB. The younger the kid, the lesser depressive symptoms

Gender (adolescent girls are more depressed than boys)

Isolation (people in the rural areas are more depressed comparing to metropolitan area/urban)

School Closure (affecting food nutrition & physical activity)

Knowledge & expectations about COVID-19

Access to information (better knowledge→ lower anxiety/depression)

Community & family relationship (belongingness)

Risk factors

All these should be taken into consideration:

Domestic violence

Children infected with COVID-19 (separation from adults)

Vulnerable socioeconomic condition (economic recession, no internet)

Online and telephone support: increased/high demand compared to very low supply

Pre-existing health conditions:

Those living with chronic illnesses→ elevated stress, anxiety, depression, post-traumatic stress disorder (PTSD)

The huge problem is the chronic illness can deteriorate because of the pandemic: access to care, intervention, treatment, medicines are lower.

The huge problem is the chronic illness can deteriorate because of the pandemic: access to care, intervention, treatment, medicines are lower.

Mental health and Paediatric diabetes

The most important recommendation from International Society for Paediatric & Adolescent Diabetes “mental health professionals should be available to interact not only with patients and families at clinic visits to conduct screening and more complete assessments of psychosocial functioning but also to support the diabetes team in the recognition and management of mental health and behaviour problems”. There should also be easy access to consulting psychiatrists for cases involving severe psychopathology and the potential need for psychotropic medications. All mental & behavioural health specialist should have training in diabetes and its management. 

Mental health and Paediatric diabetes- depression 

“Children with diabetes are at slightly elevated risk for psychological difficulties” (Reynolds Helgeson, 2011).

“People with diabetes are at risk of developing major depressive disorder” (Kreider, 2017)

Diabetes Distress

“An emotional state where people experience feelings such as stress, guilt or denial that arise from living with diabetes and the burden of self-management”. Diabetes distress has also been linked to worse health outcomes (Kreider, 2017).

“patients who are not coming/going to the clinics, complaining about diabetes in their lives, those that are demotivated, not checking their blood glucose levels at all and do not want to do anything because there are just distressed”. Diabetes distress is thus quite common and most frequently associated with suboptimal glycaemic control, low self-efficacy and reduced self-care.

NB. Everyday stress factors can cause a higher HbA1c.

Eating Disorders

Disordered Eating behaviors (restricting food intake and insulin omission)

More common in girls with diabetes than in boys, 7% of adolescents girlsT1D may meet diagnostic criteria for an eating disorder (anorexia, bulimia, diabulimia)

Diabulimia (eating disorder in a person with diabetes, wherein the person purposefully restricts insulin in order to lose weight).

NB. Risk of developing Diabetic ketoacidosis (DKA) and serious medical outcomes (complications) is very huge.

What can we do?

When you see a deterioration in diabetes control do not focus on “how to improve it” only

“Fight” for increased psychological support, in particular now, in the “new normal”

Try to think outside the box and your bubble

Do not forget the mental health of people living with diabetes. Protecting the psychological health of children through effective communication about COVID-19 “The Lancet Child & Adolescent Health, 2020”

“Health-care workers are experiencing unprecedented demands caring for a predominantly adult patient population, magnifying the invisibility of children’s urgent psychological needs. However, ignoring the immediate and long-term psychological effects of this global situation would be unconscionable, especially for children and young people, who account for 42% of our world’s population”

Any advice to parents? Resources

Steps to Help Provide Stability and Support to Children and Adolescents:

·         Maintain a normal routine
·         Talk, listen, and encourage expression
·         Under supervision, allow them to crawl and explore, returning to a trusted caregiver (0-5 years old)
·         Give honest and accurate information
·         Teach simple steps to stay healthy
·         Be alert for any change in behaviour
·         Reassure children/ADOLESCENTS about safety and well-being (6-12, 13-17 years old)

Any advice to parents/young adults (18-24yo)?

Healthy Ways to cope with Stress (18-24)

·         Know what to do if you are sick
·         Know where and how to get treatment
·         Take care of your emotional health
·         Take breaks from the news
·         Take care of your body
·         Make time to unwind
·         Connect with others
·         Connect with your community- or faith-based organisations

18 Practical Tips For Parents To Support The Psychological Wellbeing Of Children During The COVID-19 Crisis

·         Manage Your Own Anxiety	·         Maintain Children’s Social Contacts Virtually
·         Validate Children’s Worries	·         Remind Children That Being Homebound Is Temporary
·         Help Children Find Creative Ways To Express Difficult Emotions	·         Try And Keep A Predictable Structure And Routine To Your Children’s Day
·         Talk To Children About The Corona Virus Honestly And At A Level They Understand	·         Maintain A Healthy Diet For Your Child
·         Let Children Know That They Are Safe	·         Make Sure Children Get Exercise
·         Limit Children’s Exposure To Corona Virus Related Media And Discussion	·         Allow Children To Be Part Of The Decision Making Process
·         Explain Importance of Washing Hands And Social Distancing	·         Plan And Engage Children In Enjoyable Family Activities
·         Give Children A Sense Of Ownership Over Combating The Corona Virus	·         Try And Set Aside Time For Just You And Your Child
·         Encourage Children To Help Others In conclusion and with a citation “Mental health is a critical concern in a pandemic scenario. Children and Adolescents are considered a vulnerable subgroup and there’s a need to reduce the mental health burden of this pandemic” Curtsey of: @Katarzyna Anna Gajewska, PhD	·         Pay Attention To Your Own Self-Care