Transcript | Mental health, the echo pandemic

Sarah Widmeyer: Welcome to Conversations on Wealth, a podcast dedicated to helping Canadians with your total financial picture. I'm Sarah Widmeyer, Director of Wealth Strategies at Richardson Wealth. I'm delighted to welcome Dr. Nasreen Khatri - I call her Dr. Nas - an award winning registered clinical psychologist with over 15 years of professional experience in her field. She's a gerontologist, neuroscientist, and educator who specializes in the assessment, treatment and research of mood and anxiety disorders in older adults. From 2004 to 2012, she led the mood and related disorders clinic and founded the cognitive behaviour therapy, or CBT, services at Baycrest. In 2012, she joined the Rottman Research Institute at University of Toronto where she innovates treatments for depression and anxiety for older adults, including CBT, mindfulness and exercise. Dr. Nas, thanks for being here with me today. 

Dr. Nasreen Khatri: Thank you so much, Sarah. It's a pleasure to be here. 

Sarah Widmeyer: So we're going to get right into it. There's obvious concerns around mental health for people of all ages because of this pandemic. As Dr. Nas puts it, the "echo pandemic" of mental health problems caused and exacerbated during this time will soon be revealed, perhaps even over the years to come. Dr. Nas, I'm so happy you're here to help us learn how to optimize brain health and well being now and into the future. So how have women fared in terms of mental health during the pandemic, in workers, mothers, caregivers, partners, any of the above and all of the above for some of us?

Dr. Nasreen Khatri: That's a very good question, Sarah. In terms of mental health, let's just define what that is. So mental health is the absence of mental illness, but it's also the presence of a sense of emotional well being. And that has really been compromised during the pandemic. But let me give you a little context. So let's talk about pre-pandemic times. It's important to understand that women and men's mental health haven't actually been on an equal footing to begin with. And so we know that women are diagnosed with depression, and anxiety twice as often as men are. We also know that 20% of us - so one in five of us - will experience a mental health problems sometime in our lives. And those two statistics are actually merely exacerbated through the pandemic. So what that means is, I'll get into it a little bit more specifically, but there's been many more new cases of depression, anxiety, especially amongst women during the pandemic. But the pandemic also exacerbates the conditions that people already have. So if they have agoraphobia, they have OCD, if they have generalized anxiety, whatever it may be. So why is that because it's a stressful time, economically in terms of health concerns, in terms of stresses of all kinds, personal and otherwise. Let me kind of break that down a little bit. In terms of people who, for women experiencing mental health problems during the pandemic, we know that all people say that their mental health is, to a greater degree, impacted during the pandemic compared to beforehand. So for example, 4 in 10, Canadians now say that their mental health is worse than it was before the pandemic hit. So that's a very, very high number, and we know that women predominate in that number. We also know that there's different reasons for why women's mental health has been compromised. So we know that everything from anxiety disorders, depression, and suicidality has all increased and eating disorders, in fact, during the pandemic. Let's go through them more systematically.
The first one is economically. Women's mental health has taken a hit, because women have been disproportionately impacted by the pandemic in terms of job loss, in terms of staying home to take care of children who are not in bricks and mortar school, because they may be the caregivers and individuals who actually get sick with COVID. They may also be caregivers of both young children, but also aging parents. So they may have many caregiving responsibilities that we know we're actually depressogenic in and of themselves. They also have higher rates of mental have health problems to begin with. But another important demographic to kind of pull out of this terms of women is that the stereotypical caregiver is a woman. So we know that two thirds of caregivers are women, is 49 years old, still works, is taking care of aging parents, and also is looking after a partner, in a relationship with a partner, and raising children who haven't been launched yet. And so when you look at that picture, I think a lot of us can see ourselves in that demographic. What we find is, that's a heavy load. That's a heavy load for anybody. And I want to make mention of another serious occurrence during the pandemic, which is that, we're lucky to be in Canada. Obviously, it's much better to be in a pandemic here than in many other places in the world. And we're grateful for that. But it doesn't mean we're all safe at home. And in fact, we know that we're not all safe at home. Domestic abuse rates, child abuse rates have gone through the roof during the pandemic. So women's mental health has suffered because the abuse rates for women have skyrocketed. As well, we know that girls are more likely to be abused in any situation compared to boys. And so the fact that schools are closed, that could be one of the safe spaces that girls turn to. And boys, obviously. So it's it's difficult to consider that. But it's the truth, that abuse rates are also rising. And so for all of these reasons, women's mental health has not fared well during the pandemic.
I want to make a final point I talked about middle aged woman, I want to talk about young women. we know that the loneliness rates are highest between 18 and 25 year olds during this pandemic. And know that eating disorders, especially for girls and young women, have really skyrocketed during this time. Why why might that be? Let's stay with the with the eating disorders and anxiety. Well, let's say that you're a teenage girl, so you're 17 years old, and you are in virtual school. So this is a time when you are really forming your identity. And you're not getting natural in-person exposure to your peers and friends. Where are you getting your information from? Social media. This is where you're learning how other girls look, how other girls dress, what they eat, what they do. And so I think that that has a huge impact on what is happening to young girls in terms of eating disorders. And the other part of it is, we're at home. And a lot of what we do is about the mind and management of meals, preparing meals and cleaning up afterwards. And so the focus on food, or the ability to focus so much on food, can really be a trigger for lots and lots of girls, and of course boys, who suffer from eating disorders. And so just want to make mention of that as well.

Sarah Widmeyer: Wow. So much to unpack there. Thank you. So let's talk about the echo pandemic that you've called it. What do you mean by the echo pandemic?

Dr. Nasreen Khatri: The echo pandemic, is the mental health pandemic that has already begun, and is going to take time to unpack and to really assess and understand going forward. The echo pandemic happens after the initial global health and economic emergency is over. Because let's face it, that's where a lot of our resources went, because that's where they had to go. And the difference between a global health pandemic and a mental health eco pandemic is the following. What did we do about COVID? Well, we had structures in place, things like lockdowns to stop the spread of COVID. But there are no such lockdown exists for mental illness. In fact, mental health has actually been compromised by the very lockdowns that were absolutely necessary to save us physically, but had negative impacts on us emotionally. The second part is that we have a vaccination rollout, which is going to be effective, it is going to be successful, no doubt over time, and not much more time. But no such vaccination exists for mental health problems. So we are going to have to come up with a different kind of way to contain the mental health crisis as opposed to lockdowns, and a different way to actually treat people who have mental health problems going forward.

Sarah Widmeyer: So what can we do then to optimize our mental health now and into the future? What are the some of the practical - you say you're a practical person - what are the practical tips that we can incorporate now? 

Dr. Nasreen Khatri: Yeah, so there's many practical things that we can do during this time to hold us in good stead. So it sounds sort of negative that there's this eco pandemic. But the reality is, I want to caution people, I have a measured response in terms of the echo pandemic. We don't know yet what the mental health fallout will be, though surely there'll be some. Why is that? Because the research we have right now is cross sectional. So we don't want to extrapolate a time of mental health emergency into five years into the future. So we need longitudinal data to see how folks are doing. And I think the second thing is, you know, these are self report measures. So there's a kind of reporting self selection. And that means that if you say that, hey, I can take part in a mental health survey during the pandemic, I'm more likely to participate if I feel that something's wrong, than if I feel that my mental health is just fine. And a third point is that having an emotional symptom is not the same as having a mental illness. So in other words, having a mood is not the same thing as having a mood disorder. So when individuals are asked if they feel depressed or anxious, they mean that in the layman sense. Yeah, I feel nervous, I feel anxious. They don't mean they actually feel clinically anxious. I mean, they may or they may not, but we don't know. So therefore, the jury's out a little bit. So it's important to take a measured response.
I think that the main message of our conversation today is not that we're doomed or that this is going to be a mental health disaster for everybody. But that we need to be aware, we need to have policies, and we need to have programs in place to help people and support them. And we also need to understand how resilient we are, that there's a lot in our control, there's many things we can do to thrive into the future. And the first thing here is to acknowledge our emotions. So studies show that people who are aware of their emotions - so if I asked you how you're feeling, and you say, bad, that's less effective than if you can tell me that you feel a sense of loss, you feel frustrated, at times you feel guilty. That nuanced understanding of your own emotional life actually means you have better mental health. So it's not a negative thing to know that you have different shades of grey are different shades of negative emotions, it's actually helpful.
I think the second point is, it's important to connect. We've all lost something through this pandemic. No doubt, many of us have lost a lot, too much to a tragic point, and others lost a lot less. But that is something that's a link in our common humanity, it's important to reach out and stay connected right now, in safe ways, whether that's a phone call, a letter through snail mail, exchanging recipes, exchanging jokes, music, whatever it may be, it's important to stay connected. And that means informally with friends, family, neighbours, and also a little bit more professionally, if that's what's indicated. It's important to understand that mental illness is just two things: it's a feeling of subjective distress, like feeling too low, too anxious, too lonely, too much of the time. And then the fact that mood or feeling impairs your functioning, in two or more areas of life, like relationships, or work or parenting. And so if that's the way that you've been feeling or the experience you've been having, it's important to connect, but it's important to connect with someone who can help you with that checkup from the neck up, whether it's your family doctor, or seeking help from a mental health professional. So it's important to stay connected.
I think another key point is sleep, diet and exercise. So that's a lot. But let me just mention that what it comes down to is we need to stay on a schedule. On a regular sleep schedule. Sleep is extraordinarily important for cognitive health, for mental health and for emotional balance. All adults need between seven to nine hours of good sleep. So if you wake up in the morning, repeatedly, and you don't feel refreshed, it's time to see the doctor. Sleep is a very, very key point of our well being.
The second point is diet. There's been a lot of pandemic baking, there's been a lot of comfort eating, and in a way that's natural, but I can share with you my tip for snacks, for example, which is that a silver lining of the pandemic is that we shop less often. So in our home in our family, we just buy what we are comfortable eating. If you don't buy it, you don't need it. And all snacks have just one ingredient: apples just have apples nuts just have nuts and that's the way we do it here. Another point is exercise. And so it's really important to move and every little bit counts - taking a walk, being in nature while staying safe, stretching, getting up from your computer. Studies show that we can actually grow our brain, the part of the brain, that is the crossroads of mood and memory, that brain structure actually can grow at any age at any time, through exercise that makes us sweat. So please continue to be active. There doesn't need to be any kind of perfection about this, we don't have to do you know, an hour exercise every day. Just do what you can do where you are.
Which brings me to my next point, which is a little less brass tacks a little bit more attitudinal, which is it's important to lower our standards. As we know, studies show that resilient people know when to pull back, they know when to take it easy, and when to cut themselves some slack. So just lower your standards. I have and I found it to be very helpful. And when things are back on track, and we have a lot more cultural events, going to restaurants, being able to see people that we love and like, you know, when those supports are in place, maybe I'll push myself a little harder, but right now I'm not. And also, I would say that it's important to have gratitude. There's studies that show that people who write down three things are grateful for every day, I do this every evening. It's really, really important. It helps your mental health. And it gives you perspective. And I think the other kind of final thing is it's important to have hope. I think, in these times of uncertainty, we're taught especially as women, we're taught, whether it's financial, or whether it's in our career, to not take too many risks, to not put yourself out there too much. And I say the opposite. This is the time - look at what we've been through, look at what we've been able to endure and survive, we are going to thrive. I have every faith and confidence that we are going to do fine as a society. We need to have hope and embrace risk.
And so I think before the pandemic, I would have said that I'm an optimist. But now I think I'm a hopist, because the differences and optimists does something because they think it's going to turn out well. Whereas a hope is does something because they think it's worthwhile doing no matter how it turns out. And that's how I feel about the situation we're in. We have no choice but to go forward but we can take a lot of pride in that and we can really support each other through it.
I'd like to end with what a reporter asked me about, years ago at a brain health conference, and put a microphone in my face and said, Can you tell women how to save their brain health in five words or less? And I said, Yes. Learn to say no.

Sarah Widmeyer: I love it. Two things I love. I mean, I love everything. I could just listen to you for hours. But but there's two things: a hopist. I was so filled with hope when I got my vaccine. I am even getting emotional now thinking about it. I was so filled with hope. And I think yeah, I think maybe I've become a hopist as well. And yes, learn to say no, my poor mom. It's not funny, but it's kind of funny. She would say I always say no, because it gives me time to change my mind. So there you go. That's her turn on it.
Thank you again. Learning to deal with uncertainty is extremely difficult, especially during this pandemic environment. But I hope today's conversation with Dr. Nas has given you some clarity in terms of how you can optimize your own brain health and well being critically now and into the future. Dr. Nas, where can listeners find out more about your work?

Dr. Nasreen Khatri: Well, thank you so much, Sarah, for having me on today. It's been delightful. And folks can reach me at Toronto brain health, you can just Google it. And there'll be a part that says Our Team and you can see my name and picture there. And my full name. Dr. Nasreen Khatri, thank you so much. 

Sarah Widmeyer: Perfect. And again, thank you, Dr. Nas. And thank you all for listening. Remember to follow Richardson Wealth on LinkedIn for the latest in wealth strategies and visit our website for more information. Conversations on Wealth is available wherever you get your podcasts. Please join me again next time.

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