Kentucky gets a 'D' grade on second annual report card on maternal mental health, a bit worse than the national average

By Melissa Patrick
Kentucky Health News

Kentucky received a D grade on the second annual report from the Policy Center for Maternal Mental Health, moving up from a D-minus in last year's report card. The national grade was D-plus; D was the most common grade, and 23 states had grades higher than Kentucky's.

“Maternal mental health is core to the health and well-being of women and families. Our report cards provide state government and advocacy leaders with a tool for identifying areas of opportunity and the ability to track annual progress,” Joy Burkhard, executive director of the policy center, said in a news release from the Milken Institute School of Public Health at George Washington University, which supported creation of the report cards.

“We are particularly hopeful about one of the new measures added this year, which tracks how often women are being screened for these disorders,” Burkhard said. ”Asking about symptoms is the first step toward diagnosis and treatment.”

The report notes that two things changed in Kentucky to improved the state's grade, however slightly. The state now meets the recommended maternal-mental-health prescriber ratio for the perinatal population and has a perinatal quality collaborative that prioritizes maternal mental health (a new category).  

The 2024 report cards include 18 measures that are divided into three key domains: Providers and Programs, Screening and Screening Reimbursement, and  Insurance Coverage and Treatment Payment. 

Kentucky met six of the 18 measures on the report card, with most of them in the Insurance Coverage and Treatment Payment domain, for things like expanding Medicaid, extending Medicaid coverage to one year after birth, and the ability to submit claims to proivate insurers for pre- and post-birth maternal mental-health treatment.

Kentucky got a D for providers and programs, an F for screening and screening reimbursement, and a C for insurance coverage and treatment payment.

What's Kentucky doing? 

Kentucky has several groups working on this issue, including a mental-health initiative in the state Department for Public Health, called the Maternal Mental Health Collaborative, and the Kentucky Perinatal Quality Collaborative, an effort of hospitals, doctors, nurses, public-health experts and others.

Another group working on this issue is the Mind the Gap Kentucky Coalition, which includes Postpartum Support International along with a host of other members, led by Nikki Boyd, the director of maternal infant health initiatives with the March of Dimes. 

"One thing all the groups involved in maternal mental health are doing is being sure to work together, to share resources and reduce unnecessary duplication of effort across the board," Marcie Timmerman, executive director of Mental Health America Kentucky, said in an email. 

In 2023, the legislature passed Senate Bill 135 to require the Cabinet for Health and Family Services to make information on postpartum depression and a postpartum assessment tool available on its website. It also required the cabinet to develop and implement a collaborative program aimed at improving the quality of prevention and treatment of postpartum depression.

In 2024, legislators passed a multifaceted bill dubbed the "Momnibus" as part of Senate Bill 74. It was originally House Bill 10, sponsored by Rep. Kim Moser, D-Taylor Mill. The Momnibus portion of this bill came out of a working group of Republican and Democratic women in the House and the Senate. 

Among other things, the Momnibus ensures access to health-insurance coverage for pregnant women by adding pregnancy to the list of exceptions for enrollment outside the normal open-enrollment period.

It also establishes a mental-health hotline called Lifeline for Moms that allows providers access to an immediate mental-health consultation for a mother in need; expands the Health Access Nurturing Development Services (HANDS) home-visitation program and lets it be available up to three years after birth; covers lactation consultation and needed equipment to encourage breastfeeding; and will educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

"I'm not surprised by our report card here, but I am energized by the existence of more than one advocacy group, the commitment to improving maternal mental health by legislators who were involved in HB 10, which turned into SB 74, and by providers who are increasingly involved in this effort to improve and ultimately save lives," said Timmerman, of Mental Health America.

Boyd said the results of the report card drive a lot of work being done by the Mind the Gap Coalition and the state task force. 

"These are things that can't be done overnight," she said. "There's a lot of policy involved and a lot of across the aisle work that needs to happen for these to happen. . . . It's a good guide, a good metric to help us figure out what the needs are." 

Boyd said each measure on the report card needs to be considered related to the needs of the state. For example, the report card shows Kentucky does not have at least one inpatient maternal-mental-health treatment program, but does not consider that the state does not  have enough patient volume to support one. Places are available to provide this kind of care, but she said this is something the state should monitor. 

Boyd said she's excited that Kentucky is taking the reins on this issue. 

"Kentucky's really doing a good job around prioritizing this and doing small things to ensure that Kentuckians are getting access," she said. "So obviously, there's a long way to go, but  I think getting it started, it's a great, great start." 

National numbers and efforts

The national grade improved slightly from a D to a D+, with four states earning B grades, up from one in the 2023 report; 19 states receiving C grades, up from 10 in 2023; 24 states receiving D grades, down from 25 in 2023; and five states getting a failing grade, down from 15 in 2023.  

"The U.S. is failing mothers," says the report. 

On May 14, the U.S. Department of Health and Human Services released the Task Force on Maternal Mental Health's national strategy to address maternal mental health, calling it an "urgent public-health crisis." The news release said the U.S. has the highest maternal death rate among high-income countries and 22% of the deaths are related to suicide, drug overdose, mental-health issues and substance-use disorder. 

“Many of these tragic deaths can be prevented by eliminating health disparities and understanding the impact of mental health during pregnancy and in the first months as a parent,” said HHS Secretary Xavier Becerra. “We want to address the challenges people are facing, decrease stigma associated with these challenges, and improve access to support both inside and outside of the health-care system.”

The five pillars of the national strategy are: building a national infrastructure that prioritizes perinatal mental health and well-being, with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting up the voices of people with lived experience, according to the news release.

Top UK surgeon discusses diseases of the thyroid gland, which are common, more so in Kentucky than in the rest of the nation

A thyroid exam (Photo by Antonio Diaz, iStock/Getty Images Plus)

By Dr. William Inabnet III

University of Kentucky

Twenty million people in the United States suffer from thyroid disease, and Kentucky has a higher rate of thyroid cancer than the rest of the country, according to the National Cancer Institute.

The thyroid gland is an organ that sits in the neck and controls the body's metabolism. The metabolism processes the food you consume and turns it into energy. Around 50% of the population develops thyroid nodules, yet only 5% of these nodules are malignant.

There are two types of thyroid disease: overactive and underactive. With overactive thyroid disease (hyperthyroidism), there is an excess of the thyroid hormone in the body which leads to the metabolic rate rising. This can lead to panic attacks, anxiety, heat intolerance, hair loss and palpitations of the heart.

The metabolic rate lowers when there is too little thyroid hormone being released (hypothyroidism). Depression, weight gain and thinning of the hair are all symptoms of an underactive thyroid.

Types of thyroid disease have names: Hashimoto's is the most common thyroid disease, leading to hypothyroidism. Graves’ disease is more dangerous than Hashimoto’s because the excess amount of thyroid hormone being pumped into the body can lead to hyperthyroidism.

What to look for: To monitor your thyroid health at home, there is a self-examination you can perform called “check the neck.” In this process, you are feeling for a lump, or nodule, on the thyroid gland.

Touch the thyroid gland where it sits over your airway on the neck. If you feel a lump — don’t panic. You can check in with your primary care provider for further care. Typically, an ultrasound is the best way to diagnose thyroid disease or cancer, followed by a biopsy on the nodule.

One of the first ways to check for a problem with your thyroid is to go to your primary-care provider and get a blood test. This cannot diagnose thyroid cancer but can check your levels of thyroid-stimulating hormone. This blood test can rule out conditions like hypothyroidism or hyperthyroidism.

The prognosis of thyroid cancer is very favorable. There is a combination of surgical therapy and other therapies indicated for this cancer. If you have any questions or concerns, talk to your primary-care provider.

William B. Inabnet III, M.D., is UK HealthCare surgeon-in-chief and chair of the Department of Surgery in the UK College of Medicine.

FDA hasn't OKd ketamine for mental health, so treatments vary widely, creating a new 'wild West' and generating big markups

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By Dawn Megli
KFF Health News

In late 2022, Sarah Gutilla’s treatment-resistant depression had grown so severe, she was actively contemplating suicide. Raised in foster care, the 34-year-old’s childhood was marked by physical violence, sexual abuse, and drug use, leaving her with life-threatening mental scars.

Out of desperation, her husband scraped together $600 for the first of six rounds of intravenous ketamine therapy at Ketamine Clinics Los Angeles, which administers the generic anesthetic for off-label uses such as treating depression. When Gutilla got into an Uber for the 75-mile drive to Los Angeles, it was the first time she had left her home in Llano, California, in two years. The results, she said, were instant.

“The amount of relief I felt after the first treatment was what I think ‘normal’ is supposed to feel like,” she said. “I’ve never felt so OK, and so at peace.”

For-profit ketamine clinics have proliferated over the past few years, offering infusions for a wide array of mental health issues, including obsessive-compulsive disorder, depression, and anxiety. Although the off-label use of ketamine hydrochloride, a Schedule III drug approved by the FDA as an anesthetic in 1970, was considered radical just a decade ago, now between 500 and 750 ketamine clinics have cropped up across the nation, including in several Kentucky cities.

Market researcher Grand View Research pegged industry revenues at $3.1 billion in 2022, and projects them to more than double to $6.9 billion by 2030. Most insurance doesn’t cover ketamine for mental health, so patients must pay out-of-pocket.

While it’s legal for doctors to prescribe ketamine, the FDA hasn’t approved it for mental health treatment, which means that individual practitioners must develop their own treatment protocols. The result is wide variability among providers, with some favoring gradual, low-dosage treatments while others advocate larger amounts that can induce hallucinations, as the drug is psychedelic at the right doses.

“Ketamine is the wild West,” said Dustin Robinson, the managing principal of Iter Investments, a venture capital firm specializing in hallucinogenic drug treatments.

Ketamine practitioners stress that the drug’s emergence as a mental-health treatment is driven by a desperate need. Depression is the leading cause of disability in the United States for individuals ages 15-44, according to the National Institute of Mental Health, and around 25% of adults experience a diagnosable mental disorder in any given year.

Meanwhile, many insurance plans cover mental-health services at lower rates than physical health care, despite laws requiring parity. Thus many patients with disorders receive little or no care early on and are desperate by the time they visit a ketamine clinic, said Steven Siegel, chair of psychiatry and the behavioral sciences at the University of Southern California.

Matthew Perry (Wikipedia)

But the revelation that “Friends” star Matthew Perry died in part from a large dose of ketamine, along with billionaire Elon Musk’s open use of the drug, has piqued fresh scrutiny of ketamine and its regulatory environment, or lack thereof.

Commercial ketamine clinics often offer same-day appointments, in which patients can pay out-of-pocket for a drug that renders immediate results. The ketamine is administered intravenously, and patients are often given blankets, headphones, and an eye mask to heighten the dissociative feeling of not being in one’s body. A typical dose of ketamine to treat depression, which is 10 times lower than the dosage used in anesthesia, costs clinics about $1, but clinics charge $600 to $1,000 per treatment.

Ketamine is still shadowed by its reputation as the party drug known as “Special K.” Siegel’s first grant from the National Institutes of Health was to study ketamine as a drug of abuse. It has the potential to send users down a “K hole,” otherwise known as a bad trip, and can induce psychosis. Research in animals and recreational users has shown chronic use of the drug impairs both short- and long-term cognition.

Perry’s death in October raised alarms when the initial toxicology screening attributed his death to the acute effects of ketamine. A December report revealed Perry received infusion therapy a week before his death but that the fatal blow was a high dose of the substance taken with an opioid and a sedative on the day of his death — indicating that medical ketamine was not to blame.

Variety of protocols

Sam Mandel co-founded Ketamine Clinics Los Angeles in 2014 with his father, Steven Mandel, an anesthesiologist with a background in clinical psychology, and Sam said the clinic has established its own protocol. That includes monitoring a patient’s vital signs during treatment and keeping psychiatrists and other mental health practitioners on standby to ensure safety. Initial treatment starts with a low dose and increases as needed.

While many clinics follow the Mandels’ graduated approach, the dosing protocol at MY Self Wellness, a ketamine clinic in Bonita Springs, Florida, is geared toward triggering a psychedelic episode.

Christina Thomas, president of MY Self Wellness, said she developed her clinic’s procedures against a list of “what not to do” based on the bad experiences people have reported at other clinics.

The field isn’t entirely unregulated: State medical and nursing boards oversee physicians and nurses, while the FDA and Drug Enforcement Administration regulate ketamine. But most anesthesiologists don’t have a background in mental health, while psychiatrists don’t know much about anesthesia, Sam Mandel noted. He said a collaborative, multidisciplinary approach is needed to develop standards across the field, particularly because ketamine can affect vital signs such as blood pressure and respiration.

The protocols governing Spravato, an FDA-approved medication based on a close chemical cousin of ketamine called esketamine, are illustrative. Because it has the potential for serious side effects, it falls under the FDA’s Risk Evaluation and Mitigation Strategies program, which puts extra requirements in place, said Robinson. Spravato’s REMS requires two hours of monitoring after each dose and prohibits patients from driving on treatment days.

Generic ketamine, by contrast, has no REMS requirements. And because it is generic and cheap, drugmakers have little financial incentive to undertake the costly clinical trials that would be required for FDA approval.

That leaves it to the patient to assess ketamine providers. Clinics dedicated to intravenous infusions, rather than offering the treatment as an add-on, may be more familiar with the nuances of administering the drug. Ideally, practitioners should have mental health and anesthesia expertise, or have multiple specialties under one roof, and clinics should be equipped with hospital-grade monitoring equipment, Mandel said.

Siegel, who has researched ketamine since 2003, said the drug is especially useful as an emergency intervention, abating suicidal thoughts for long enough to give traditional treatments, like talk therapy and SSRI antidepressants, time to take effect. “The solutions that we have and have had up until now have failed us,” Mandel said.

The psychedelic renaissance in mental health is accelerating. A drug containing MDMA, known as ecstasy or molly, is expected to receive FDA approval in 2024. A drug with psilocybin, the active ingredient in “magic mushrooms,” could launch as early as 2027, the same year a stroke medicine with the active ingredient of DMT, a hallucinogen, is expected to debut.

Robinson said many ketamine clinics have opened in anticipation of the expanded psychedelic market. Since these new drugs will likely be covered by insurance, Robinson advises clinics to offer FDA-approved treatments such as Spravato so they’ll have the proper insurance infrastructure and staff in place.

For now, Sarah Gutilla will pay out-of-pocket for ketamine treatments. One year after her first round of infusions, she and her husband are saving for her second. In the meantime, she spends her days on her ranch in Llano where she rescues dogs and horses, and relies on telehealth therapy and psychiatric medications.

While the infusions aren’t “a magic fix,” they are a tool to help her move in the right direction.

“There used to be no light at the end of the tunnel,” she said. “Ketamine literally saved my life.”

UPDATE, Feb. 8: Ketamine’s promise as a treatment for severe depression is growing, but major questions remain, the University of Michigan says in a research report.

'Blue Monday' is a myth, but Seasonal Affective Disorder is not

Blue Monday candy is a product of
Ruth Hunt Candies of Mount Sterling.

Kentucky Health News

Monday, Jan. 15, is considered by some to be “Blue Monday,” the most naturally depressing day of the year as people feel “blue” from holiday bills, bleak weather and forsaking their New Year resolutions, says Hackensack Meridian Health of New Jersey in a press release.

It’s common for all these factors to have a compounding effect on mental health, but point out that sadness or depression don’t follow a calendar and can happen at any time, say the hospital group's psychiatrists and psychologists. "Understand you are not alone and talk to others about your stressors and, most importantly, seek help if the symptoms of depression are severe or persist," the release says.

“It is OK if you haven’t succeeded at your resolution yet. Start now. Don’t attach your success to the calendar,” said psychiatrist Dr. Rehan Aziz. “Make sure your resolution is measurable and manageable, with small steps.When starting new habits, set reasonable expectations.“

“Blue Monday” is a myth, but is emblematic of feelings of depression at this time of year, experts say. “Although the most difficult time of year may vary for each person, any time with higher stress, less sunlight, feeling lonely, or barriers to enjoyable activities can take a toll on our moods,” said psychologist Heather Derry-Vick. “For many people, wintertime checks a lot of those boxes,”

Seasonal affective disorder (SAD) is a type of depression that usually happens in fall and winter, when less daylight triggers chemical changes in the brain. SAD can be trated with therapy using light and and antidepressants.

“Some researchers believe that SAD can be linked to a reduction in serotonin production, a chemical in the brain that helps to regulate mood; or a vitamin D deficiency, which can occur due to changes in exposure to sunlight,” psychiatrist Dr. Yolanda Picket said. “Some also believe that there is a link to increased melatonin production, which may be triggered by the darker days in fall and winter seasons.”

Treatment options that may help patients with depression or SAD include:

• Talk therapy, such as cognitive behavioral therapy
• Medication
• A combination of talk therapy plus medication

Lifestyle changes that may help patients with depression or SAD include:

• Getting exercise regularly
• Socializing with friends regularly
• Participating in activities that you typically enjoy regularly

Other treatments that may help patients with winter-pattern SAD include:

• Light box therapy – exposure to a certain type of bright light
• Vitamin D supplements, if they’re recommended by a doctor

Lifestyle changes that may help patients with winter-pattern SAD include:

• Regulating sleep patterns, to avoid sleeping too much
• Regulating diet, to avoid overeating or craving carbs

Even though the data may not support the idea of Blue Monday, it can be a good reminder to do a personal mood check.

“Have you been feeling down or having a hard time getting going most days, for a few weeks or more? Is that making it more difficult to do the things you normally do? If so, Blue Monday is as good of a day as any to reach out to your primary doctor or to a mental health professional for an assessment,” Derry-Vick said. “They can help you to figure out steps to improve your mood.”

2023 was a tough year in many ways, but saw significant positive developments in science and medicine, Washington Post reports

2023 saw new understanding and the start of a treatment

for dementia, as clinical trials cotinue at the University

of Kentucky and other sites. (iStock photo via Washington Post)

Kentucky Health News

Despite wars, the most mass killings since 2006 and the hottest average temperatures in human history, "2023 also was a year with significant positive developments, including in scientific research and medicine," The Washington Post reports, with a motive: "Research has indicated that uplifting news can provide an emotional buffer against distressing news and feelings of hopelessness — and even encourage optimism or action." Here are some things the Post listed:

The World Health Organization approved a new malaria vaccine that has been shown to be much more effective than the only previous vaccine against the potentially deadly disease. "The WHO said it expects the vaccine, which costs $2 to $4 per dose and has been shown to reduce symptomatic cases by 75 percent after three doses within a year, to be available by the middle of 2024," the Post reports. The U.S. has about 2,000 cases of malaria each year, most of them contracted in other nations.

The Food and Drug Administration approved the first pill to treat postpartum depression, which affects up to one in five womenand can cause "experience intense hopelessness and, in rare cases, psychosis — and it can last for years," the Post notes. "The new drug is taken once a day for two weeks and, unlike the existing treatment of an IV injection that may take as long as 60 hours to administer in a health-care setting, it can be taken at home."

The FDA also approved two gene-therapy treatments for sickle-cell disease, "a rare and debilitating condition that affects around 100,000 Americans, most of them Black. The disease causes extreme, constant pain and can drastically cut the life span of those affected," the Post notes. "Both are intensive, expensive procedures — and require chemotherapy, which has significant side effects. But patients who have received the treatments have spoken of its profoundly beneficial impact on their lives."

Scientists made progress in understanding dementia, the Post reports. One study "suggested that lifestyle habits, including regular mental and physical activity, eating a healthful diet, and regular social contact were linked with a slower rate of memory decline," the Post reports. "Another found that living in areas with more natural green spaces was associated with lower rates of hospital admissions for diseases including dementia, while separate research indicated that the use of hearing aids could cut the risk of cognitive decline by nearly half."

Meanwhile, the FDA approved, for the first time, to a drug that modestly slows Alzheimer’s disease. While difficult questions about safety, effectiveness and cost remain, many neurologists say that having a drug that slows Alzheimer’s is nonetheless a milestone after years of failed trials. The University of Kentucky is one of the sites of the clinical trials, and at last report was still seeking participants.

One-fourth of Kentuckians say they have ever been diagnosed with depression; only W.Va. was higher in national CDC survey

Centers for Disease Conrol and Prevention map, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

One in four Kentucky adults in a poll taken in 2020 said they had ever been diagnosed with depression, a higher share than in any state but West Virginia.

Kentucky's age-adusted percentage was 25%; West Virginia's was 27.5%. The national figure in the poll, taken by the Centers for Disease Control and Prevention, was 18.4%.

The poll was taken by the Behavioral Risk Factor Surveillance System, an ongoing CDC-state project in which state employees do random-digit–dialed landline and cell phone calls to adults. The question was, “Has a doctor, nurse, or other health professional ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression?”

In Kentucky, the county with the highest age-adjusted percentage of people answering "yes" was Wolfe County, at an estimated 30.7%. (That was the most likely percentage in a range of 28.8% to 32.5%, at a confidence level of 95%, or 19 out of 20 cases.)

The rest of the top 10 were Harlan, 29.7% (27.9-31.6); Jackson, 28.9% (27.1-30.9); Casey, 28.9% (27.1-30.7); Clay and Magoffin, 28.8% (27.1-30.6); Bell and Knox, 28.7% (27-30.5); Letcher, 28.6% (26.9-30.5); and Lewis, 28.6% (26.9-30.4). Figures for all counties can be downloaded here.

The 29 counties with the highest estimated shares of reported depression, and 38 of the top 40, were in Appalachia as defined by the Appalachian Regional Commission, which includes 54 Kentucky counties. The highest estimated rate, 31.9%, was in Logan County, West Virginia.

Phil Galewitz of KFF Health News went to Logan and reports that stigma around the topic of mental health is a major obstacle to addressing the problem. Psychiatrist David Lewis of Coalfield Health Center, who grew up in the and taught high-school math there, told Galewitz that people in the region often view seeking mental-health help as being “weak in faith.”

Most states with the highest levels of reported depression were in Appalachia, the southern Mississippi Valley, Missouri, Oklahoma, and Washington, the CDC said in reporting the data. It noted, "Depression is a major contributor to death, illness, disability, and economic costs."

In Kentucky, the counties with the lowest rates of reported depression were Oldham, 21.9%; Boone, 22%; Lyon, 23.6%; Shelby, 23.8%; Fayette, Hardin and Woodford, 24%; Jefferson, 24.2%; Christian, 24.3%; Nelson, 24.4%; Jessamine, 24.5%; Scott and Spencer, 24.6%; Bullitt, 24.7%; and Boyle, 24.8%.

Generally, high-income counties had lower rates of reported depression, and low-income counties had higher rates. Reported depression was "higher in women, younger adults, and adults with lower education levels," the CDC said.

Having been diagnosed with depression is not the same thing as having had depression. Another CDC survey in 2020 asked people if they had suffered symnptoms of depression, and at one point 31% of Kentuckians in the poll said they had.

As a whole, Kentucky seniors are the third most unhealthy in the nation, ranking better than only Louisiana and Mississippi

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd

Kentucky Lantern

New data shows Kentucky among the worst states for key health points among senior citizens, including tooth extractions, food insecurity, insufficient sleep and more.

The statistics, published in the America’s Health Rankings Senior Report in May, show Kentucky seniors have the most tooth extractions.

As a whole, Kentucky seniors rank second for insufficient sleep, exercise and cognitive difficulties; third for food insecurity, and sixth for obesity.

As a whole, Kentucky seniors are the third most unhealthy, healthier only than their counterparts in Louisiana and Mississippi.

Dr. Michael Stockman, a geriatric physician based in Minnesota, said there is a “bright side” of the report: Older Kentuckians, generally, don’t drink too much or have severe housing insecurities, and they consume sufficient fruits and vegetables.

For older Kentuckians not to drink excessively “is great because excessive drinking can lead to things like liver disease, diabetes,” said Stockman, who works for UnitedHealthcare. “It can also interfere with the medications that people are taking as well.”

The United Health Foundation released the report, which examines the health of older adults with 52 measures including social and economic status, physical environment, clinical care, behaviors and more. The rankings are based on data available up to March 8.

Kentucky had higher rates of physical inactivity than the national average, the report showed, which Stockman said can itself lead to poor health.

Nationally, 31% of seniors 65 and older are physically inactive, while the number jumps to 37% in Kentucky.

“It’s important to do those simple daily things like walking 30 to 45 minutes a day to really make a positive impact on overall health and well being,” Stockman explained.

Exercises like walking, stretching, yoga and tai chi can all help strengthen the body and prevent falls, which can lead to fractures, he said.

Social isolation

Kentucky seniors are at high risk of social isolation, the report says, a fact exacerbated by the Covid-19 pandemic. The report ranks Kentucky ranks fifth in social isolation among older adults.

“The pandemic did really create a social isolation amongst all of us. I think seniors were disproportionately affected and it … worsened during that pandemic,” Stockman said. “Being socially isolated puts people in a very vulnerable situation, particularly as they’re going through stressful life events common with aging, such as losing maybe a close friend or a family member, or as they move into retirement. Being socially isolated can lead to, really, a decline in a person’s cognitive functioning. It can increase the risk of depression and decrease the overall quality of life of older adults.”

The bright side to that point, though, is that there are more households now with access to high-speed internet than in 2019. The internet can help seniors gain access to telehealth appointments, stay in contact with family and friends and participate in social activities.

Kentucky seniors seem to be closing the gap in high-speed internet. From 2019 to 2021, 9 percent more of them used broadband, while the national increase was 7 percent.

It's SAD, but: Seasonal affective disorder, associated with winter darkness, is common and has a wide range of treatments

As much as three percent of the U.S. population is thought to experience seasonal affective disorder, a type of depression associated with winter darkness and northern latitudes. But about 10 percent of patients suffering from SAD have symptoms in the summertime instead, Sarah Gibbens reports for National Geographic.

The symptoms are the same as clinical depression, Kelly Rohan, a psychologist at the University of Vermont who specializes in the disorder, told Gibbens: “We would look for things like a persistently sad mood. Losing interest in things. Sleep changes. Significant eating or appetite change. Losing energy. Fatigue. Difficulty concentrating.”

At Yale University’s Winter Depression Research Clinic, "The most commonly reported symptoms of winter depression are hypersomnia—the desire to sleep more than usual—and an increased appetite, says Paul Desan, a psychiatrist and the clinic’s director," Gibbens reports, quoting him: “It’s like human beings are trying to hibernate.”

  

But not exactly: “About three times as many women as men get SAD for reasons we don’t understand,” Desan said.

Illustration by Very Well Health; to enlarge, click on it.

"Whether in winter or summer, mental health experts say there are solutions to treat SAD," Gibbens writes. "For those who think they may be experiencing SAD, experts say a professional diagnosis is a crucial first step toward treatment."

“People should really avoid self-diagnosis,” says Rohan. “Depression is a serious mental health problem, so it’s best to leave it to trained professionals.”

One of the most common treatments is sitting daily in front of a bright box of light for 30 minutes, usually first thing in the morning, Gibbens reports: "Experts say the key is to look for light boxes that provide light equalling 10,000 lux, a measure of brightness. . . . Desan's clinic’s website lists vetted boxes."

A treatment that may last longer is Cognitive Behavioral Therapy, a form of talk therapy that Rohan endorses: “Negative thinking tends to breed negative emotions, and we want to change those into slightly less negative, more neutral thoughts” “I hate winter,” might be reframed as, “Winter isn’t my favorite season, but I still find things to enjoy.”

Hobbies may also help, Rohan suggests: “People with SAD often have hobbies and interests that are summer specific—growing gardens, beach going,” Winter alternatives are knitting, joining a book club, or going to the gym.

Norman Rosenthal of Georgetown University, who first identified SAD in 1984, told Rohan that lifestyle changes can also be useful against it. "Exercising, learning ways to manage stress, or planning a sunny vacation during the winter can all help to boost your mood, he says. Whether using light or talk therapy, Rosenthal stresses that there’s no reason to not seek mental health treatment, even if symptoms are only present for a few months out of the year."

How to manage your mental health in the holiday season

By Dr. Gopalkumar Rakesh

Assistant professor of psychiatry, University of Kentucky

For many, the holiday season is not always the most wonderful time of year. With work and school deadlines quickly approaching, holiday shopping expenses piling up, and back-to-back large social gatherings, this time of year can eventually take a toll on one’s mental wellness.

According to the National Alliance on Mental Illness, a study showed that 64% of people with mental illness report holidays make their conditions worse. In a separate study conducted by the American Psychological Association, 38% of people surveyed said their stress increased during the holiday season.

Photo by Tommaso79, Getty Images / iStock Plus

Increased stress can cause symptoms of physical illness, depression, loneliness and more. If you or a loved one are experiencing increased stress this year’s holiday season, here are some tips to help make your season a bit jollier.

Manage your time: Remember that your priorities still matter, and procrastination is not your friend. Putting off important projects can cause unwanted stress. Be sure to prepare ahead of time if you have important deadlines approaching to ensure that you do your best. Try making a schedule of when you will work on your projects and do your holiday prep to make sure your schedule is balanced, productive and not rushed.

Set boundaries: Communicate your limits as early as possible to friends and family so that everyone is on the same page. It is okay to say no to social obligations that may be too stressful. Choosing to set boundaries surrounding stressful conversations on topics that may be contentious in a family setting may also be advised.

Take care of yourself: The holiday season is not only about spoiling those you love but making yourself a priority as well. Fight seasonal depression by staying on top of your sleep and exercise schedule. If you can, work near a window throughout the day to get as much sunlight as possible. Even adding bright holiday lighting throughout your work or engaging with mindfulness apps on your smartphone can help boost your mood.

Seek support: Check in with a local support group or friends who understand what you may be going through. Surrounding yourself with people who feel similar can help combat feelings of loneliness.

If you or someone you know needs additional support, reach out to your therapist if you have one, talk to a mental-health professional or contact your primary-care physician.

Additionally, if you or a loved one are experiencing a suicidal crisis or mental distress, call or text 988 to reach the Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline) to access free and confidential support 24/7.

Had Covid-19? You're 60% more likely to have mental illness, study finds; researcher says it shows disease isn't 'like the flu'

Los Angeles Times photo

People who've had Covid-19 have a 60 percent higher chance of experiencing mental health problems, including anxiety, depression, and thinking of suicide, as well as drug and alcohol abuse and disturbances in sleep and cognition.

The results come from a study by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Using anonymous data from the VA, the nation’s largest integrated health-care delivery system, the researchers compared the mental-health outcomes of more than 150,000 patients who had mild or severe Covid-19 cases from March 1, 2020 to January 15, 2021, with the outcomes of two control groups: one of more than 5.6 million patients who did not have Covid-19 during the same time period, the other of more than 5.8 million people who were patients from March 2018 to January 2019, well before the pandemic. The study is published in the BJM (British Medical Journal).

People diagnosed with Covid-19 were 60% more likely to suffer from mental-health problems than those who were not infected, leading to an increased use of prescription medication to treat such problems and increased risks of substance-use disorders including opioids and non-opioids such as alcohol and illicit drugs, the study found.

“People need to know that if they have had Covid-19 and are struggling mentally, they’re not alone, and they should seek help immediately and without shame,” said Ziyad Al-Aly, the study's lead author. “It’s critical that we recognize this now, diagnose it and address it before the opioid crisis snowballs and we start losing more people to suicide.”

Al-Aly continued, “Our findings suggest a specific link between SARS-Co-V-2 [the novel coronavirus] and mental-health disorders. We’re not certain why this is, but one of the leading hypotheses is that the virus can enter the brain and disturb cellular and neuron pathways.”

To better understand whether the increased risk of mental-health disorders is specific to Covid-19, the researchers also compared the Covid-19 patients with 72,207 flu patients, including 11,924 who were hospitalized, from October 2017 through February 2020. Again, the risk was significantly higher in those who had mild and serious Covid-19 infections.

“My hope is that this dispels the notion that Covid-19 is like the flu,” Al-Aly said. “It’s so much more serious.” He stressed the importance of identifying and treating mental-health disorders in Covid-19 survivors.

“Our goal was to provide a comprehensive analysis that will help improve our understanding of the long-term risk of mental-health disorders in people with Covid-19 and guide their post-infection health care,” added Al-Aly. “Studies on Covid-19 and mental health have been limited by a maximum of six months of follow-up data and by a narrow selection of mental-health outcomes; for example, examining depression and anxiety but not substance-use disorders.”

Bill would allow a year of Medicaid for new mothers, almost 1/2 of whom don't get routine care in Ky., where death rate is highest

By Melissa Patrick
Kentucky Health News

A bill that would extend Medicaid coverage to new mothers up to 12 months after giving birth passed unanimously out of the House Friday and now heads for the Senate for consideration. 

Rep. McKenzie Cantrell

House Bill 174, sponsored by Rep. McKenzie Cantrell, D-Louisville, would extend Medicaid eligibility for persons who have given birth for up to 12 months postpartum. It also requires the Cabinet for Health and Family Services to seek a Medicaid waiver to achieve this additional coverage if necessary. 

Cantrell told the House that the small addition that the bill would make to state law "is a seven-word change that can have a huge impact on women and families in our commonwealth." 

Rep. Kim Moser, R-Taylor Mill, co-sponsor of the bill, told the House that the United States is the only industrialized nation that has a consistently rising maternal mortality rate, and Kentucky's rate is the highest. 

"Kentucky has rates of maternal death that really rival Third World countries," Moser said. "We have 37.7 maternal deaths per 100,000 live births, which is the highest in the nation." 

Rep. Lisa Willner, D-Louisville, added that nationwide, 60% of pregnancy-related deaths are preventable, but in Kentucky, 80% are. Willner is chair of the House Democratic Women's Caucus, which created the Kentucky Maternal and Infant Health Project that includes a slate of bills and resolutions to improve maternal health outcomes. 

"This is one step toward preventing those complications from pregnancy," she said, "and there are many more steps we can take."

In an e-mail encouraging Kentuckians to sign a letter of support for the bill, Kentucky Voices for Health explains that the expanded coverage is possible through the American Rescue Plan Act, the pandemic relief bill Congress passed a year ago. It allows postpartum care to go from 60 days to a full year following the birth of a child for mothers with incomes up to or slightly higher than 138% of the federal poverty level. That is the limit for Medicaid coverage. 

KVH said, "This is important because about one in three pregnancy-related deaths occur one week to one year after delivery. Of those deaths, three in five are preventable and the ratios of pregnancy related deaths among people of color are up to five times higher than white birthing people."

Kentucky Youth Advocates Executive Director Terry Brooks said, "Despite the increased risk of postpartum death and illness, nearly half of women do not receive routine care after birth, regardless of whether or not they experienced complications during pregnancy. HB 174 is good news for the health and well-being of new moms and their babies."

The bill also has the support of the Kentucky Association of Health Plans, the insurance companies doing business in the state, including Medicaid managed-care companies.

“Postpartum depression affects a significant portion of new mothers, and when left untreated is one of the leading causes of pregnancy-related death. Kentucky’s Medicaid managed-care organizations are well-positioned to ramp up outreach and connect moms to supports services that can change and save lives,” KAHP Executive Director Tom Stephens said in a statement issued after the bill passed out of committee.

Suicide, ideas of it, depression, and anxiety have affected more Kentucky students since the Covid-19 pandemic began

Kentucky Youth Advocates image

By Melissa Patrick

Kentucky Health News

Kentucky's students are experiencing more anxiety, depression and ideas of suicide in the pandemic, and schools need more resources to help them, mental-health experts told state legislators Oct. 5. 

Before the Interim Joint Committee on Education, they called for putting more mental-health professionals in schools, giving teachers more first-aid training in mental health, and programs that would help students be more resilient and keep them from taking their own lives, an increasing problem.

“The needs are many, but the resources are few,” Marsha Duncan, a social-emotional learning specialist for LaRue County Schools, told the committee.

Among Kentuckians under 25, deaths by suicide increased 11% in 2020, according to state-provided data. Emergency-room visits related to self-harm were 5% below historical averages last year, but hospitalizations for self-harm rose 8%. Figures for 2021 are not yet available. 

One three-month period in the last year had a youth suicide rate 57% higher than the previous year, said Linda Tyree, crisis response director for the Green River Regional Educational Cooperative, which serves 45 school districts.

The Bowling Green-based co-op has crisis teams that are typically called in when there is a death or serious injury of a student or staff member, but during the pandemic they've been called in for issues of anxiety, depression and having ideas of suicide, Tyree said.

 

"When students transitioned to remote learning, we know there was a lot of exposure to trauma, to stress, family stress, even exposure to pornography when they're learning online," she said. "So all of these things just compound the problems of adolescence that are just part of normal growing up." 

Amy Riley, a school counselor in Mercer County, told the legislators, "The isolation of the Covid pandemic has had a profound effect on the mental health of my students and students across the state."

In her Mercer County Intermediate School in Harrodsburg, "There were weeks this past spring, shortly after returning from virtual learning, that we would assess two to three students a day for viable suicidal threats," Riley said. "Just this morning, I had to do a suicide risk assessment on a 9-year-old in my school before I came to this hearing today."

She said the reasons for these suicidal threats include unmanageable anxiety, home problems and often loneliness. 

Duncan, of LaRue County, added grief to the list of things students are dealing with, and not just for those who have died of Covid-19. 

"Grieving for these students has taken on a grief of the loss of the normal … fun, activities and programs that are offered and provided at the schools," Duncan said. "Dealing with the lack of consistent routines has been detrimental to the mental health of our students."

Similar issues are reported around the world. A global analysis of 29 studies that included more than 80,000 youth, published in JAMA Pediatrics, found that anxiety and depression has doubled in children and adolescents over the course of the pandemic. It also found they occurred more later in the pandemic, in older adolescents and in girls. 

Duncan said it has been "impossible" to meet students' mental-health needs during remote learning and "extremely difficult" under the hybrid model. She said access to mental-health professionals in her small, rural community is limited, as are the funding sources to pay for it, which makes school-based mental-health care vital. 

In a survey conducted by The Prichard Committee Student Voice Team, Kentucky students expressed a desire for increased access to mental-health services. 

Asked open-ended questions about what challenges they were facing in the pandemic, 15% of the students reported a concern related to mental health. Among that group, 35% said they wanted mental-health services but did not have access to them. That's 5% of the total. The share of students who wanted but lacked access to mental-health services was 15% during the pandemic and 10% before it.

Another indicator that young people are struggling with their mental health is the increase in mental-health screenings done by youth at MHAScreening.org. 

According to data provided by Mental Health America of Kentucky, there has been a 191% increase in  voluntary mental-health screenings among the state's 4- to 10- year-olds, from 23 done in the first half of 2020 to 67 in the first half of 2021. Among 11-to-17-year-olds, the increase was 231%, from 1,077 to 3,562.  

"These screening increases reflect anecdotal evidence that our children and youth have been negatively affected by the pandemic," Marcie Timmerman, executive director of MHA, said in an e-mail. 

Rep. Shane Baker, R-Somerset, asked what parents, educators and the community could do. Riley said all students should receive support through a "tier one" program, and Tyree agreed. 

"We don’t want to be reactive. We want to be proactive," Tyree said. "Tier one means that every single student, every kindergartner, every first grader that comes in the door, before they ever show any kind of problems or at-risk behavior, we’re already talking about articulating their feelings, how to be socially acceptable with the way that they address those feelings, how they can regulate themselves and have social regulation."

Riley wrapped up her prepared comments with a plea for more mental-health professionals in schools.

“It is my earnest plea that when making crucial funding decisions, you not forget the mental health needs of Kentucky students,” she said. “Any money and resources spent on mental health needs in Kentucky schools is money that will have an infinite return for the investment.”

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Even with Kentucky's anxiety and depression rates dropping since January, the state still ranks ninth for this measure in the U.S.

image: pulichealthnotes.com

By Melissa Patrick
Kentucky Health News

While rates of anxiety and depression in Kentucky are among the top 10 states in the nation, the good news is that since January, those rates have dropped. Those findings are consistent with what is going on across the nation, according to an analysis of Centers for Disease Control and Prevention data. 

"Our team of analysts found that while anxiety and depression levels increased during the first year of the pandemic, they have decreased dramatically throughout 2021," says the Quote Wizard report. "We found that nationwide, the number of people dealing with anxiety or depression increased by 6.3% in 2020 and has decreased by 23% throughout 2021." 

In Kentucky, that rate dropped 19% throughout 2021, with 34% of people in Kentucky reporting symptoms of anxiety or depression -- the ninth highest rate in the nation.

Marie Timmerman, executive director of Mental Health America of Kentucky, said she wasn't surprised by these results, pointing to all of the uncertainty that Kentuckians experienced at the height of the pandemic as the likely cause for the increase in symptoms of depression and anxiety. 

"The coronavirus pandemic exacerbated the mental-health and substance-use-disorder pandemic in Kentucky," Timmerman said in an e-mail. "I'm not surprised that anxiety and depression symptoms were going down as vaccines were becoming more widely available over the spring and summer months." 

The Quote Wizard analysis did not address substance-use disorders, but the state's latest overdose report found that drug-overdose deaths in Kentucky rose 49% in 2020.

The analysis also looked at rates of anxiety and rates of depression in each state separately. In Kentucky 30% of people surveyed in August reported experiencing anxiety, a drop of 19% since the beginning of the year. The highest this rate has been in Kentucky during the pandemic is 38%, the report says. 

Twenty-four percent of Kentuckians reported being depressed in August 2021, a drop of 22% since January. During the pandemic, the highest this rate got was 31%. 

Nationwide, women reported having higher anxiety and depression levels than men, while older and more educated Americans have some of the lowest levels, says the report. 

The researchers note that the decline in the number of people experiencing symptoms of anxiety and depression coincides with a decline in the number of coronavirus cases and the easing of lockdown restrictions. 

However, with the current surge in cases and subsequent restrictions -- whether required or suggested -- they also note that only time will tell if this new round of cases and restrictions will lead to an increase in anxiety and depression levels. 

Timmerman encouraged Kentuckians to take a free Mental Health America of Kentucky mental health screening if they are concerned about their mental health. Click here for the link. For more resources or information, reach out to mhaky@mhaky.org or call 859-684-7778. 

"It's okay to have bad days," she said. "It's a real concern, though, when bad days become bad weeks that interfere with your ability to work or to attend to the activities of daily living. If you're not sure if your mental health symptoms are a result of the day-to-day stress or are something more, a mental health screening is a great way to find out." 

Doctors tell patients to 'take their exercise pills' because physical activity is good for your mind, not just for your body

Wendy Suzuki, a neuroscientist at New York University, gives a TED talk.

By Arash Javanbakht

Associate professor of psychiatry, Wayne State University

Republished from The Conversation

As with many other physicians, recommending physical activity to patients was just a doctor chore for me – until a few years ago. That was because I myself was not very active. Over the years, as I picked up boxing and became more active, I got first-hand experience of positive impacts on my mind. I also started researching the effects of dance and movement therapies on trauma and anxiety in refugee children, and I learned a lot more about the neurobiology of exercise.

I am a psychiatrist and neuroscientist researching the neurobiology of anxiety and how our interventions change the brain. I have begun to think of prescribing exercise as telling patients to take their “exercise pills.” Now knowing the importance of exercising, almost all my patients commit to some level of exercise, and I have seen how it benefits several areas of their life and livelihood.

We all have heard details on how exercise improves musculoskeletal, cardiovascular, metabolic and other aspects of health. What you may not know is how this happens within the brain.
How exercise improves the brain.

Brain biology and growth

Working out regularly really does change the brain biology, and it is not just “go walk and you will just feel better.” Regular exercise, especially cardio, does change the brain. Contrary to what some may think, the brain is a very plastic organ. Not only are new neuronal connections formed every day, but also new cells are generated in important areas of the brain. One key area is the hippocampus, which is involved in learning and memory and regulating negative emotions.

A molecule called brain-derived neurotrophic factor helps the brain produce neurons, or brain cells. A variety of aerobic and high-intensity interval training exercises significantly increase BDNF levels. There is evidence from animal research that these changes are at epigenetic level, which means these behaviors affect how genes are expressed, leading to changes in the neuronal connections and function.

Moderate exercise also seems to have anti-inflammatory effects, regulating the immune system and excessive inflammation. This is important, given the new insight neuroscience is gaining into the potential role of inflammation in anxiety and depression.

Finally, there is evidence for the positive effects of exercise on the neurotransmitters – brain chemicals that send signals between neurons – dopamine and endorphins. Both of these are involved in positive mood and motivation.

Exercise improves clinical symptoms of anxiety and depression

Researchers also have examined the effects of exercise on measurable brain function and symptoms of depression and anxiety. Exercise improves memory function, cognitive performance and academic achievement. Studies also suggest regular exercise has a moderate effect on depressive symptoms even comparable to psychotherapy. For anxiety disorders, this effect is mild to moderate in reducing anxiety symptoms. In a study that I conducted with others among refugee children, we found a reduction in symptoms of anxiety and PTSD among children who attended eight to 12 weeks of dance and movement therapies.

Exercise could even potentially desensitize people to physical symptoms of anxiety. That is because of the similarity between bodily effects of exercise, specifically high-intensity exercise, and those of anxiety, including shortness of breath, heart palpitation and chest tightness. Also, by reducing baseline heart rate, exercise might lead to signaling of a calmer internal physical environment to the brain.

It is important to note that the majority of studies examined the effects of exercise in isolation and not in combination with other effective treatments of clinical anxiety and depression, such as psychotherapy and medication. For the same reason, I am not suggesting exercise as a replacement for necessary mental health care of depression or anxiety, but as part of it, and for prevention.

There are other perks besides the neurobiological impacts of exercise. When going out for a walk, one gets more exposure to sunlight, fresh air and nature. One of my patients befriended a neighbor during her regular walks, leading to regular taco Tuesdays with that new friend. I have made some great friends at my boxing gym, who are not only my motivators, but also a great supporting social network. One might pick a dog as their running mate, and another might meet a new date, or enjoy the high energy at the gym. Exercise can also function as a mindfulness practice and a respite from common daily stressors, and from our electronic devices and TV.

By increasing energy and fitness level, exercise can also improve self-image and self-esteem.

Practical ways for a busy life

So how can you find time to exercise, especially with all the additional time demands of the pandemic, and the limitations imposed by the pandemic such as limited access to the gyms?

Pick something you can love. Not all of us have to run on a treadmill (I actually hate it). What works for one person might not work for another. Try a diverse group of activities and see which one you will like more: running, walking, dancing, biking, kayaking, boxing, weights, swimming. You can even rotate between some or make seasonal changes to avoid boredom. It does not even have to be called an exercise. Whatever ups your heartbeat, even dancing with the TV ads or playing with the kids.

Use positive peer pressure to your advantage. I have created a group messaging for the boxing gym because at 5:30 p.m., after a busy day at the clinic, I might have trouble finding the motivation to go to the gym or do an online workout. It is easier when friends send a message they are going and motivate you. And even if you do not feel comfortable going to a gym during the pandemic, you can join an online workout together.

Do not see it as all or none. It does not have to be a one-hour drive to and from the gym or biking trail for a one-hour workout vs. staying on the couch. I always say to my patients: “One more step is better than none, and three squats are better than no squats.” When less motivated, or in the beginning, just be nice to yourself. Do as much as possible. Three minutes of dancing with your favorite music still counts.

Merge it with other activities: 15 minutes of walking while on the phone with a friend, even around the house, is still being active.

When hesitant or low on motivation, ask yourself: “When was the last time I regretted doing it?”

Although it can help, exercise is not the ultimate weight loss strategy; diet is. One large brownie might be more calories than one hour of running. Don’t give up on exercise if you are not losing weight. It is still providing all the benefits we discussed.

Even if you do not feel anxious or depressed, still take the exercise pills. Use them for protecting your brain.

4 Kentucky lawyers have killed themselves in the last 3 weeks; bar association head tells all, 'Take better care of each other'

Four Kentucky lawyers have committed suicide in the last three weeks, according to the Kentucky Bar Association.

"The suicides have prompted many to encourage colleagues to seek help if they need it and renewed calls for more continuing education about suicide, mental health, substance abuse and depression for the legal community," report Beth Musgrave and Valarie Honeycutt Spears of the Lexington Herald-Leader.

"Lawyers are 3.6 times more likely to suffer from depression than non-lawyers, according to the American Psychological Association. Substance abuse rates for lawyers are also much higher than non-lawyers."

Lexington lawyer Corey Fannin killed himself on Christmas.
(Lexington Herald-Leader photo illustration)

Three of the lawyers who killed themselves practiced in Lexington and one was from Paintsville.

Corey Fannin, 40, was "a highly successful Lexington trial lawyer who in 2015 won a $18 million verdict against a nursing home that included the largest award for pain and suffering in a nursing-home case," reports Andrew Wolfson of the Courier Journal.

"The president of the state bar association has taken the extraordinary step of emailing all 19,000 attorneys in Kentucky urging them to 'help take better care of each other'," Wolfson reports. Thomas Kerrick of Bowling Green also wrote, "I urge everyone reading this to lift up our friends and colleagues whenever and wherever we can."

Louisville lawyer Wilson Greene wants the bar association to require one hour of education for lawyers focusing on mental health, substance abuse, depression and stress management, partly so they are aware of how to get help. “This is a problem that lawyers have known about for a while,” Greene said. “Because of the stresses, lawyers are more prone to suicide and substance abuse.”

Greene and other lawyers told the reporters that many attorneys are afraid to get help or go into treatment, for fear of losing referrals from other lawyers. 

"Lawyers are also problem solvers and fixers," and can spread themselves too thin, the reporters note. "The legal profession is also adversarial. That sets up a win/loss situation."

Greene said, “Your clients are looking for positive outcomes and sometimes that doesn’t occur. That’s unfortunately a reality of the practice of law. But that drains you, and and can pull you down.”

In 2013, the director of the American Association of Suicidology told the Courier Journal "that the competitiveness and perfectionism that make good lawyers — and the lack of fulfillment many lawyers feel in practicing law — put them at high risk of alcoholism, drug use, depression and suicide," Wolfson writes. 

Also, during the pandemic, “Lawyers are hurting financially. It’s a grim period for the nation and practicing law, a grueling gig anytime, is even harder,” Shannon Ragland, editor of Kentucky Trial Court Review, told the Courier Journal. He initially reported the rash of suicides.

This story has been updated.

State's poor health rankings are a caution flag in pandemic, but virus shouldn't keep you from making regular visits to doctors

Ben Chandler

By Ben Chandler
President and CEO, Foundation for a Healthy Kentucky

A new state-by-state comparison of the nation’s health ranks Kentucky near the bottom in a variety of significant categories. Though the 2020 America’s Health Rankings Annual Report from the United Health Foundation may underscore Kentucky’s longstanding position as a state with serious health challenges, this year’s rankings also provide a great service by raising a caution flag related to Kentucky’s battle against Covid-19.

First, consider that Kentucky is ranked 49th among all states for percentage of residents (15 percent) who suffer from three or more of these chronic conditions: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease (COPD), cardiovascular disease, cancer, depression and diabetes.

Though the study was performed prior to the Covid-19 pandemic, its findings spark concern related to the current crisis. Notably, the Centers for Disease Control and Prevention states that adults with any of these chronic conditions are at increased risk of severe illness from the virus that causes Covid-19.

Also, the United Health Foundation study shows 36.5% of Kentucky adults are obese (compared to 31.9% nationally). And the CDC reports that adults who are obese also face increased risks related to the virus.

Of course, more broadly, the rankings are a reminder that chronic health conditions and generally poor health make us more susceptible to a wide range of risks – and not just during this current global pandemic. So these rankings are also a call to action: a rallying cry to each of us as individuals and community leaders to continue addressing Kentucky’s chronic health conditions and other health needs despite the pandemic.

As Covid-19 cases have climbed in Kentucky, one major concern is that Kentuckians still may be skipping preventive and non-Covid-related visits to the doctor to reduce their risk of exposure to the virus. But the decision to delay such visits – which may include screenings such as mammograms and colonoscopies, as well as annual wellness exams – could have serious health consequences, especially for those with chronic conditions that require regular, ongoing medical attention.

We don’t have to skip these important visits. In recent months, health providers and clinics have taken a variety of steps to reduce the risks of contracting Covid-19. In addition to mask requirements, doctors’ offices are implementing strict social distancing policies, limiting the number of people in waiting rooms, and instructing patients to wait in their cars until their appointments begin. And many providers are offering telehealth options, where patients can meet their providers without leaving their homes.

So, while Kentuckians must remain vigilant in their efforts to avoid contracting or spreading the coronavirus, we cannot neglect our broader health care needs.

For the record, America’s Health Rankings also include some positive observations about Kentucky. They note that the commonwealth’s air pollution has decreased 12.6% from 2009 to 2019. We are ranked third in percentage of adults who are high school graduates (90.3%), which is important because education attainment generally equates with more secure employment, higher earnings and better health. Our poverty rate also has been declining, from 19.4% in 2012 to 16.3% in 2019. These represent movement in the right direction. And though Kentucky has dropped slightly in recent years, we are ranked 14th in percentage of residents (93.6%) covered by private or public health insurance.

In this Covid-19 era, managing our health is a multi-pronged approach. We need to keep ourselves safe and prevent the virus from spreading, yet also ensure we aren’t adding to its toll through delayed care or missed diagnoses. And then there is the even bigger picture: Challenging ourselves, our loved ones and our communities to improve our state’s health through policies that increase access to health care, reduce exposure to health risks and improve health equity. As we close out a year full of turmoil and uncertainties, there has never been at better time to pursue a healthier Kentucky.

Even as the pandemic becomes more dangerous, 'pandemic fatigue' makes some take risks; here are tips to cope with it

Photo illustration from Skagit County, Washington, Public Health

As coronavirus cases surge across the country with no end in sight, many of us are experiencing "pandemic fatigue" and are heading into the fall with "an odd mix of resignation and heedlessness," the New York Times reports. 

"In sharp contrast to the spring, the rituals of hope and unity that helped people endure the first surge of the virus have given way to exhaustion and frustration," Julie Bosman, Sarah Mervosh and Marc Santora write as they report on how this mindset has also settled across much of Europe.

“People are done putting hearts on their windows and teddy bears out for scavenger hunts,” said Katie Rosenberg, the mayor of Wausau, Wis., a city of 38,000 where a hospital has opened an extra unit to treat covid-19 patients. “They have had enough.”

Some of this shift in attitude can be attributed to improved medical treatments to treat the virus, which have reduced its mortality rate and severity, but much of it is the result of people just wanting to return to normal. 

Mark Harris, county executive for Winnebago County, Wisconsin, told the Times that he is frustrated by the "loud minority" in his county who are successfully pushing back on all public-health measures taken against the pandemic. They have a singular frame of mind, he said: “This has been inconveniencing me long enough and I’m done changing my behavior.”

Gov. Andy Beshear offered examples Wednesday of how such returns to normal activities have opened the door for infection, citing examples from the state's contact tracers. A wedding was connected to 44 cases, a family gathering was connected to 14 cases, a college party was connected to 63 cases, a bingo-hall event was connected to five cases, a yard sale was connected to seven cases, a funeral was connected to six cases and a coffee gathering was connected to eight cases and two deaths.

"There is so much spread at family gatherings, events at the house, weddings and funerals. It's where we are seeing a huge amount of spread," said Beshear, who regularly warns Kentuckians that such gatherings will become even more dangerous as we move them indoors during the fall and winter.

"Pandemic fatigue" is hitting Kentucky at a time when cases, hospitalizations and deaths are at record highs.   

In a separate Times article, Marie Tae McDermott and Jill Cowan talked to Elissa Epel, professor at the University of California, San Francisco’s Department of Psychiatry and Behavioral Sciences, about how to prevent pandemic fatigue from slipping into unsafe behavior. 

Epel told the Times that psychological distress conditions that look like depression and anxiety are not necessarily psychiatric disorders in the classic sense, but instead can be a "normal response to what's happening." Epel offered tips for how to cope with these stressors:

• Limit exposure to upsetting news.
• Be kind to yourself and others who are experiencing emotional distress.
• Spend some time thinking about what personal care means to you because this is different for every person. For example, she said some people need more sleep, while others need to exercise.  
• Avoid long periods of sedentary behavior. 
• Epel also  noted that a little anxiety is good, because it propels us to socially distance, keep our hands washed and to wear a mask. 

Psychologist Carisa Parrish of Johns Hopkins Medicine also writes about "pandemic fatigue" and says: "Trying to adhere to anything extra is always a challenge. You can add extra steps to your routine for a few days, but sustained behavior change is hard. Especially when no one around you is sick, and you just don’t feel like wearing a mask or saying no to things you like to do. But the fact is, the precautions work.”

She offers these tips for dealing with coronavirus burnout and pandemic fatigue:

• Just like you make a commitment to putting on a seatbelt, she says make a commitment to washing your hands, maintaining social distance and wearing a mask in public. 
• Stick with reliable, trustworthy information sources and stay flexible as recommendations change because new facts are emerging as we learn more about the virus. 
• Practice precautions until they become second nature.
• Keep necessary supplies, like hand sanitizer and mask, handy.
• Make sure you are reading about others who have gone through covid-19 to make it personal, because for many getting sick with covid-19 is an abstract idea.
• Allow kids to pick out a mask and hand sanitizer scent that they like and give them permission to remind other family members if they aren't following safety guidelines. 

Studies show that stress, anxiety and depression have been on the rise since the pandemic hit.

A study, recently published on JAMA Network, found that depression rates are three times higher during the pandemic; a Centers for Disease Control and Prevention study in late June found 40% of U.S. adults report they are struggling with mental health or substance abuse; and the annual Stress in America 2020 survey, conducted by The Harris Poll on behalf of the American Psychological Association, found that 78% of adults said the pandemic is a significant source of stress for them and 67% said they have experienced increased stress over the course of the pandemic.