During the early months of the pandemic, when people, politicians and medical professionals alike struggled to understand the dimensions of the emerging crisis, fear spread rapidly throughout society. In North America and around the world, lockdown measures added to the anxiety. Soon economies were spiraling into recession. No one knew when it would all end. As 2020 continued to deliver shocks to the system, it was easy to predict that many individuals would face mental health challenges. Less understood at the time was the eventual reality that millions of kids would sink into depression. Separated from classmates, classrooms, activities and outdoor recreation, they struggled to develop on their own, guided only by frazzled parents and lessons learned from the omnipresent iPad. A new study from Ontario’s COVID-19 advisory panel has measured the extent of this damage. As kids and their families became largely inactive, mental distress soared. The report confirms that young children carried the heaviest burdens. Citing guidelines developed by the World Health Organization, the panel contends that even 1- to 2-year-olds need at least three hours of physical activity each day. The recommendation is an hour a day for older individuals and 150 daily minutes of exercise and activity for seniors. The panel notes that half of Canadians were falling short of these standards even before COVID. Among post-secondary students, just 10 percent were meeting or exceeding the guidelines. “Patterns of declining rates of physical activity worsened during the COVID-19 pandemic, as Ontarians and other Canadians were significantly less active and even more sedentary,” the panel concluded. “Global data indicates that participation in physical activity has been associated with improved quality of life, well-being, and reduced depressive symptoms and anxiety during the pandemic.” The report notes that although loss of social and recreational opportunities was a big part of the problem, so was the nature of the activities which filled the void. Isolated from friends and deprived of the ability to visit the park, run across a field or score a goal in soccer, kids withdrew into a virtual world, a liquid-crystal-screen reality: “A recent systematic review and meta-analysis of 65 studies on the effects of the pandemic on SB (sedentary behaviour) showed that across all age groups (children and youth, adults), SB increased during the pandemic and was attributable to increased ‘screen time’ or greater use of computers or other devices. … Increased time spent in SB was associated with poorer overall mental health and increased risk of depression and anxiety across all age groups. A more recently published Canadian study reported that increases in SB were evident within the first month of the pandemic. Thus, both increased SB and reduced PA (physical activity) during the pandemic have been linked to poorer mental health outcomes, while maintenance or increase of pre-pandemic levels of PA was associated with better mental health in Canada and globally.” The COVID viral pandemic has also created a mental health epidemic in Canada. With lockdown measures easing and hospitalization rates steadily improving, many observers expected the mental health outlook to brighten as well. But a new report suggests this is not the case, and that stress levels among the population may have been reset to a new normal of high anxiety.
The study by LifeWorks, a company focused on wellness solutions for businesses and individuals, indicated that 46 percent of Canadians report higher levels of stress than before the pandemic — and that 49 percent of workers have noticed high stress in colleagues. The figures are much worse for the under-40 category. LifeWorks’ “mental health index” (MHI) has been below 2019 levels since the start of the pandemic. “Stressors inside and outside of the workplace continue to make it challenging for individuals to manage their wellbeing in a healthy way,” said LifeWorks CEO Stephen Liptrap. “It is important for employers to recognize there is often more than meets the eye when it comes to how employees are feeling, and that providing ongoing communication and support is critical to ensure employee mental health remains a top priority.” The mental health metrics are worse for women. According to the report: “Since the launch of the MHI, women have had significantly lower mental health scores than men. In April 2022, the mental health score of women is -12.4 compared to -7.5 for men.” The nature of the family unit also affects stress levels: “Differences in mental health scores between those with and without children have been reported since the launch of the Index in April 2020. More than two years later, this pattern continues with a lower score for those with at least one child (-12.3) than those without children (-8.8).” Where Canadians work is also key: “Individuals who are self-employed have the highest mental health score (-4.5). Respondents working for companies with 51-100 employees have the lowest mental health score (-13.1). … From January to October 2021, the mental health scores of managers were lower than non-managers and lower than the Canadian average.” The differences are the starkest — and most troubling — in the age category. Since the start of the pandemic, age has been the best and most consistent predictor of overall stress. It’s an inverse relationship, with stress levels falling as age rises. Comparing the ends of the curve shows a wide generation gap: In April of this year, the 60- to 69-year-old group had a mental health score of -1.9. During the same month, the score was -21.2 for the 20-29 age category. “Canadians have been experiencing nonstop changes and uncertainties for over two years, and time has not made it any easier to navigate the ongoing turbulence,” said LifeWorks VP Paula Allen, reflecting on the findings. “Employers should be aware that a return to pre-pandemic routines does not mean a return to pre-pandemic mental health. Now is not the time to ease back on the focus on mental health supports and services, and in fact, the opposite is true.” Opioid victims are becoming younger and more numerous in Canada, according to a new study by researchers at the University of Toronto.
Their report, “Identifying the changing age distribution of opioid-related mortality with high-frequency data,” was published in April in the academic journal PLOS ONE. Its central finding was chilling: Death from opioid overdoses soared exponentially from 2003 to 2020 in Canada, rising 500 percent. As the mortality base broadened, the average victim also got younger. The typical opioid OD patient in Canada is now in the mid-30s. A total of 11,633 people had died from opioid misuse in the province during this period, according to researchers Patrick Brown, Lauren A. Paul, Ye Li, Pamela Leece, Tara Gomes, Ahmed M. Bayoumi, Jeremy Herring and Regan Murray, who sifted through health data compiled by the Office of the Chief Coroner for Ontario. Although 72 percent of the victims in the 15- to 69-year-old target group were male, deaths rose dramatically in all demographic categories. In 2003, the highest opioid death rate for men was seen at age 44. By 2020, the peak age for males had dropped to 35. The peak age for opioid death for women was 51 in 2003 and 37 in 2020. The authors noted that during this same approximate period, opioid deaths rose nearly 400 percent in the U.S. Disturbing as the findings are, the data indicate that these trends have not stabilized. The number of opioid victims in Canada will continue to grow, and the peak age of death can be expected to fall further. The authors note that there was a brief improvement in opioid mortality rates in Ontario in 2019, which was quickly erased with the onset of COVID in early 2020. In fact, the epidemic of isolation, depression and social pathologies that took hold in the wake of COVID and pandemic-related lockdowns made the situation much worse, according to the report: “In Canada, opioid-related mortality increased from 7.8 deaths per 100,000 persons to 16.7 deaths per 100,000 persons between 2016 and 2020, and had already reached a rate of 19.6 deaths per 100,000 persons in the first quarter (January to March) of 2021. Ontario … has seen a particularly large increase in opioid-related mortality over the last two decades; mortality rates jumped more than fivefold between 2003 and 2020. Of particular note, there was a 79% increase in the number of opioid-related deaths between February 2020 (the month prior to Ontario’s state of emergency declaration) and December 2020.” Beyond the pandemic, a key factor contributing to these worsening statistics has been the spread of synthetic opioids: “Large increases in morbidity and mortality involving opioid drugs were initially attributed to over-prescribing of opioids for pain. As prescribing rates slowed, following widespread recognition of the risks of opioid analgesics and close monitoring/regulation of prescribing, several regions observed some stabilization or decline in deaths from prescription opioids. However, due to the emergence of highly potent non-pharmaceutical opioid drugs such as fentanyl and fentanyl analogs, deaths from synthetic opioids have continued to rise.” The prospect of an economic downturn in the near future threatens to accelerate the pace of opioid deaths. The authors advocate a comprehensive approach to address the deepening crisis: “This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.” It is both potent and deadly, the opioid class called nitazenes has been found in syringes after people have overdosed. Though it is surfacing in the current drug crisis, the medication is actually over 60 years old and was created as a strong form of pain-relief medication, according to the World Health Organisation.
Nitazene is often cited by professionals as being 20 times more powerful than fentanyl, “a drug that is already 50 times more powerful than heroin and 80 to 100 times more potent than morphine,” according to a Healthline article. It seems the opioid epidemic is worsening in spite of, and in light of, the global pandemic. “In areas throughout the United States, a highly potent new synthetic opioid is starting to show up on the streets and is having devastating effects on its users,” according to the article. The potent opioid found in syringes after overdose deaths have been examined by scientists throughout the U.S. Synthetic Opioid Dangers The first wave of the epidemic was met with a surge in prescription pain medication abuse. This was later replaced by heroin in opioid-related deaths. Now, the synthetics are on the rise, according to the article. Nitazenes are the most popular subclass of the new synthetic opioids, according to Alex Krotulski, PhD, associate director at The Center for Forensic Science Research & Education. People’s preferences for opioids change the longer they are addicted to them. As a result, anytime something cheaper and stronger surfaces, the numbers of overdoses surge, according to Dr. Rebecca Donald, assistant professor of anesthesiology and pain medicine at Vanderbilt University Medical Center in Tennessee. “Synthetic opioids, such as fentanyl, overtook heroin, and in the past year our country saw more opioid overdose deaths than ever before,” she Donald. What are nitazenes The nitazene class of medication Initially believed to be a powerful pain medication that did not have the dependency-related effects of other opioids, the drugs were still never approved for clinical uses in the United States. “However, in recent months, synthetic pain medications have started to crop up throughout the world including Canada, Germany, the United Kingdom, and domestically in the United States,” according to the article. The use of nitazenes are still not fully understood, but deaths have been increasing and any kinds of drug mixing can produce much more lethal results in light of their presence. The harm reduction approach to addiction and substance use disorders is client-centred and functions with the goal of reducing the health and social harms associated with substance use and addiction.
Harm Reduction is an evidence-based, client-centred approach that seeks to reduce the health and social harms associated with addiction and substance use, without automatically requiring that users of substances abstain or stop. There are programs, services and practices in place that aid the harm reduction approach to substance use, according to the Canadian Mental Health Association. The approach arms people who use substances with options of how to minimise harm with non-judgemental and non-coercive strategies to further skills and knowledge for healthier and safer lives. This approach understands that many people coping with substance use and addiction may not be in a position to abstain from their substances of choice. “The harm reduction approach provides an option for users to engage with peers, medical and social services in a non-judgemental way that will ‘meet them where they are,’” according to the article. “This allows for a health oriented response to substance use, and it has been proven that those who engage in harm reduction services are more likely to engage in ongoing treatment as a result of accessing these services.” Harm reduction initiatives have shown a reduction in blood borne illnesses like HIV/AIDS and Hepatitis C, and have also decreased the rates of fatality from drug overdoses. Examples of harm reduction practices include the nicotine patch in lieu of smoking, drinking water while drinking alcohol, using substances in a safe environment with people they trust, and needle exchange initiatives for those who inject drugs. Harm reduction applies to everyday life and not just to the use of substances, it means wearing a seatbelt when driving and wearing a helmet when riding a bicycle. Overdose Prevention Sites Otherwise known as safe consumption sites or supervised injection services, these facilities further harm reduction strategies. “These facilities are health services that provide a hygienic environment for people to consume substances under the supervision of medical professionals,” according to the article. Individuals are also given sterile supplies, overdose prevention, intervention, and education on safer consumption as well as counselling and medical services. They are also given referrals to services like housing, drug treatment and income support. Overdose prevention sites have been shown to reduce costs for the healthcare system and prevent the spread of blood borne illnesses as well as help individuals find support services and prevent overdose deaths. Further, research shows that the presence of an overdose prevention site in a community does not lead to increased crime, and actually works to decrease public substance consumption. “These facilities are helpful in reducing the harms related to substances, particularly opioids. Overdose prevention sites are an evidence-based component to a comprehensive treatment response,” according to the article. Life has never been simple or easy for any parent. The balancing of duties and of work-life responsibilities leaves many working parents feeling lacking. It is one of the great challenges of adulting–to never feel that you are accomplishing enough in one or more areas of your life. While the pandemic presented additional challenges for most families, it also brought some perspective. What really matters, after all? When our day-to-day lives are stripped down to the bare bones, so to speak, what makes life worth living and enriches our relationships with our children? The pandemic gave everyone the chance to be considerate of how we are living our lives and the opportunity to create ways of living more fully and authentically. I’d like to think the pandemic made us better parents and better human beings. Writer and mother Ambrosia Brody shared a list of five mindsets and practices she will maintain in her family long after the pandemic is over. 1. Say no more often, and do not feel guilty or badly about it Working parents view the weekends as times for immersive family experiences. After the work week, weekends are rarely times for relaxing, but instead often function as the couple of days where parents feel like they can make up for lost time with their children and put incredible effort into making them feel valued by driving them to playdates and birthday parties. “To be honest, we also spent many weekends at events that we would have preferred to skip but felt obligated to attend. Let’s just say that saying ‘no’ was not something I was good at,” she wrote. “Then the pandemic came along and saying no was my go-to response to anything and everything that felt unsafe.” Saying no is your right as a human being and something you should be capable of doing with your children and with other adults in your life, she explained. Being overscheduled puts everyone under undue stress and a slower pace, while sometimes initially difficult for children to accept, means that time spent as a family can be better enjoyed by everyone. It takes confidence to say no, she pointed out, and she plans on carrying that confidence into post-covid life. “Some people may take it personally, but I’ve learned it’s not my responsibility to make other people like my choices,” she wrote. 2. A willingness to ask for help from your partner during the school day Many mothers mistake shouldering the bulk of responsibility for their children for involvement and denying their husband’s offers to help. This behaviour, as she explained, is a shortcut to burn out. When daily routines changed from the pandemic, partners had to adapt. Having a home classroom while working remotely was something that seemed deceptively simple and easy. Well, many parents discovered it was another layer of stress. “The [first] week was filled with tears (mostly mine) and so much frustration. There was no way to sustain a productive work schedule and be available to my children during distance learning,” she wrote. “I needed help, which was hard for me to admit.” That transition demanded incredible collaboration and a whole new level of teamwork for couples. Asking for and actually accepting help is something that can bring balance to parenting responsibilities and to the relationship itself. “The pandemic brought my husband and me closer and improved our communication because we relied on one another to make sure everything with the kids ran semi-smoothly,” she wrote. That transition meant that she was able to be vulnerable and ask for help when she was feeling overwhelmed and allowed for her to let go of some responsibilities she was shouldering alone. 3. Understand that it is not always your responsibility to entertain the kids Play-acting with dolls may be something your kids want you to do all the time, but finding a balance and maintaining enough time for adulting is also important. Her husband reminded her that it is okay to not always entertain the children. Those kinds of boundaries can be important for remote working parents. Brody and her husband ordered activity boxes and board games, things that the kids could use to entertain themselves. “Letting them entertain themselves resulted in some important discoveries and interesting creations,” she wrote. Her second grader developed a love of crafting and sewing. 4. Give kids more responsibilities Kids are often capable of doing more than adults give them credit for, including their own creative snacks once they hit a certain age. This can serve as a valuable lesson in autonomy and let kids build some confidence in their abilities and independence. They need to be age-appropriate responsibilities, but there are often a number of areas where kids can be helpful. When kids are bored, give them the chance to be helpful, she explained. “Now they have a chore chart that includes more ‘big girl’ responsibilities such as helping take out the trash, dusting, and washing the dishes,” she wrote. 5. Have frequent family check-ins Many families took walks during the pandemic just to stretch their legs and get some fresh air and sunshine. This also presented an opportunity for discussions. It is a chance to truly connect and engage with family and figure out the challenges and successes of each day. “As things begin to feel more normal, we no longer take as many walks as we used to. However, we try to squeeze them in here and there, and we always check in with one another at dinner time,” she wrote. So many aspects of the pandemic have been tragic and challenging, but perhaps the silver lining (maybe the only one) is that we learned a greater idea of family and friend connection, self-care and a willingness to help our neighbours. After all, we are all struggling through this crazy world together. Adults often find themselves watching as their children are absorbed in television and cell phone screens. Some remember bygone days, the fond recollections of their own childhoods. Some experienced blissful days outside with neighbourhood children and siblings, playing. The lucky ones were not expected home until dinnertime.
What those adults may not know is that, scientifically, their childhoods spent in the outdoors primed them for happiness to a level that “indoorsy” people do not realise. Research confirms what many have long suspected: playing outside is good for children and their development. According to a recent study from Aarhus University in Denmark, children who spend more time in nature may be less likely to develop psychiatric disorders as adults. Or, as the article noted, “having more ‘cumulative green space’ is associated with a ‘lower risk of a wide spectrum of psychiatric disorders later in life.’” While there are a number of things that impact mental health including certain conditions, genetic predispositions and family history, the concept of green spaces, even in city centres, can be beneficial for child development and for the long-term mental health of residents. Data is showing that kids are spending nearly half the time outside as their parents did as children. “We can chalk it up to our busy schedules and the rise of technology, but that doesn't change the fact that our kids aren't getting much fresh air and sunshine,” according to the article. What is occurring now is a concerted effort to get kids outside, including an online movement generated by a mom and dad in Michigan. Ginny and Jason Yurich have started an online community aimed at getting families to spend 1,000 hours per year outside, with the ultimate goal of having children outside 4-6 hours at least three to four times per week. This time spent outside is also typically a boon to unstructured outdoor play, which is essential to childhood development. Longer periods of time outdoors equals big benefits for kids, according to the Yurichs. "Children who are allowed this freedom of time outside get lost in nature," Ginny said. "They get lost in their imaginations and they get lost in wonder. And then they rapidly develop. There are many factors why but one reason is due to the rich sensory environment that nature always provides." To actively explore the world is a gift that parents can give to their children, and it does not usually take much investment beyond time. The societal push and pull between widespread acceptance of new technologies and the draw of more analog traditions continues. While many parents become contemplative and a little mournful of the loss of cursive writing and abundant–and imaginative –outdoor play, they also foster an understanding that technology is the future. Children must be prepared for it from an early age.
Yet is there a balance that can be found? A method that allows for the maintenance of “old” traditions and the utilization of new technology? It is a topic that has been widely explored. In fact, Andy Robertson, a consumer tech Contributor for Forbes writes almost exclusively about the intersection of technology and family life. He has read most books on the subject, and recently chose to highlight the book Parenting for a Digital Future. Written by Sonia Livingstone and Alicia Blum-Ross, the book explores how fears and hopes about technology help shape childrens’ lives. Robertson notes that it is an evidence-based and detailed exploration of the struggles of modern parents in the shaping of their children’s perspectives. The book touts qualitative and quantitative data accumulated by home visits and research. “It forms a clear picture of what it’s like to be a parent of children in this technological age. There are some fascinating, and moving, insights that come from this,” he writes. He provides an example from the book: “As parents strive to understand the profound changes they are living through, digital dilemmas act as a lightning rod for contemporary contestations over values, identity and responsibility... our research has led us to observe, over and over again, how [technology] provokes fundamental anxieties about agency, values and (the loss of) tradition.” Notably, he says that communication between parents, supportive networks, links between school and the home with regard to learning all play an important role in whether or not technology will benefit children. Ultimately, technology alone will not prepare children for the future and better position them for harnessing technology. Rather, a supportive network that bolsters their learning is what is required for their success. “Programming might be the new Latin, but learning it isn’t about accessing a new tablet but growing up in a context where this new language is supported and appreciated,” Robertson writes. The book uses data to uncover the current dilemma of caregivers and parents: they are told to capitalise on tech and also warned about how too much screen time can harm their children. What parents ultimately need is not an idea of exactly how much time children should spend with technology, but greater frameworks for tech and deeper support “that provides a coherent way forward.” “Not only with how to benefit from it individually, but how to have wider conversations and ongoing connections with other families, teachers and services who are doing similar work,” Robertson writes. So the debate of the push and pull should rather be about greater collaboration. The pandemic proved challenging to parents the world-over. Households seemed like they shrank as many people created makeshift home offices for their remote work as well as dedicated study spaces for their children.
Yet for many parents in Kholowa Village, Katete District, Eastern Province, Zambia, their take-home pay diminished just as a local resource for families had to shut down out of concern over the pandemic. In other words, it was a particularly difficult year for most, if not all, parents, but particularly so in impoverished areas. Still, UNICEF and the LEGO Foundation, the organizations behind the community-based Insaka Early Childhood Development (ECD), pivoted just as adeptly as large for-profit organizations. The regular group parenting sessions have become a valuable resource in the area, facilitating things like sanitation, nutrition and playful parenting. In lieu of meeting at the hubs, volunteers dispersed throughout the communities at pre-established dates to meet with families and further teach playful parenting and responsive care “offering parents support and counseling while still maintaining physical distancing.” And the meetings could not have come at a more necessary time. “The pressures of the COVID-19 crisis have affected the mental health and well-being of parents and caregivers, sometimes straining their ability to engage in responsive and playful interactions with their young children, which are so important for building strong emotional bonds and healthy brains,” according to the Forbes article. At the hubs, parents learn about proper feeding practices, good nutrition, how to know when a child is unwell, and the importance of playful play for early brain development. For example, they learn that sensory-focused games are a good way to stimulate and engage the brains of babies. Faustina Phiri told Forbes that before the playful parenting classes, the children would be in the observer stage of development for much longer than they needed to be. “Because we as parents were too busy with other things,” she explained. “Taking time to play with the children seemed to be time-wasting.” Now, she and her husband know better. Volunteers visit the homes of participating families each month as they await the eventual reopening of their local hub, a place that also serves as a foundation for integrated community development, adult literacy, learning through play and promoting good nutrition to all ages. A silver lining of the pandemic, and notably one of the few, is that families have been able to spend more time together. Faustina’s husband Peter has utilized his extra freetime to procure local materials and make toy instruments for his daughters. The family are thankful for the community-based volunteers who help ensure they do not forget lessons they have been taught and that they continue to practice the lessons correctly. “As a volunteer, it brings me joy to see the great impact that the lessons have played in child growth and development in my community,” Kholowa hub volunteer Beatrice Banda told Forbes. Since the hub’s opening, nearly 600 volunteers have been trained, who have reached over 10,000 parents and caregivers with the important lessons. |
AuthorDr. Angela Carol MD,CCFP,FCFP is a family physician focused on treating chronic illnesses. Archives
May 2022
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