COVID-19 has exacerbated many people’s stressors, and the restrictions, including social distancing, may make it more difficult for some people to regulate their emotions and anxieties.
If you’re finding it difficult to cope in the pandemic, there are a number of ways you can get help, and numerous ways to help make your situation easier.
First, give yourself some credit and remember the circumstances. You’re bound to feel a little more anxious, since there is a risk to you and your loved ones of getting COVID-19, and because your usual support system has been affected by social distancing measures. But keeping on top of how you’re feeling can help to avoid things getting worse.
For this reason, it’s advisable to pay attention to how you’re feeling – including your mood, appetite, energy levels and concentration levels – so you know if and when you might need to ask for help or step up your self-care.
One good indicator of your wellbeing is the quality of your sleep.
If you are waking during the night because something is worrying you, for example, you could try writing down your worries and allocating another time where you will address them.
If it feels too hard to tackle these worries on your own, perhaps you could allocate a person to talk about them with.
If you can’t talk to a loved one or friend, you should talk to a professional involved in your care or your GP. Likewise, if you’ve noticed you are more fatigued than normal during the day or have significant concerns about your sleep you should also seek professional advice.
You may have noticed changes to your mood, which could be associated with concerns about catching COVID-19 and the impact the virus is having on your life and your ability to see loved ones.
You may also be concerned about the relaxing of social distancing measures that might increase anxiety or confusion about what is now ‘safe’ and still be missing the activities you enjoy.
It is natural to have these concerns but if your mood or worries really are troubling you, it may be helpful to speak to someone you trust, including a professional working with you or your GP. The information you find most reassuring or helpful can be written down and left somewhere where you can find it again easily when you’re feeling worried.
If you’re feeling unsafe or a risk to yourself, however, you should go to A&E or call 999. There are also a number of helplines – including the Samaritans (on 116123) which is open 24 hours a day.
This is one of five blogs in a series on living in the new ‘normal’ with a brain injury, based on a webinar produced for ABI London (ABIL). See below for links to other articles in the series. Dr Keith G Jenkins is consultant clinical neuropsychologist at St Andrew’s Healthcare and chair of Headway East Northants. Dr Jenny Brooks is a consultant clinical psychologist working independently and a director of The ABI Team. For any questions about this topic email firstname.lastname@example.org.
Repeated head injuries linked to depression – study
Repeated head impacts may be associated with depression symptoms and worse cognitive function later in life, new research suggests.
It’s well established that a traumatic brain injury (TBI) can cause memory and cognitive problems, as well as depression, but now, researchers have looked at the consequences of repetitive head impacts.
They found that people exposed to repetitive head impacts may be more likely to experience difficulties with cognitive functioning and depression years later.
The researchers analysed data from the Brain health Registry on 13,000 adults, five per cent of whom reported having had repetitive head impacts through contact sports, abuse or military service.
They were asked about depressive symptoms and completed cognitive tests.
The paper, by researchers at Boston University and the University of California, San Francisco, reveals that participants who’d had repetitive head impacts and TBI reported greater depression symptoms than those who hadn’t.
Repetitive head injuries were a stronger predictor of depression than TBI, and those who had a history of repetitive head impacts and TBI with loss of consciousness reported the most depressive symptoms.
“The findings underscore that repetitive hits to the head, such as those from contact sport participation or physical abuse, might be associated with later-life symptoms of depression.
“It should be made clear that this association is likely to be dependent on the dose or duration of repetitive head impacts and this information was not available for this study,” said Michael Alosco, associate professor of neurology at BU School of Medicine (BUSM).
Those who’d experienced repetitive head impacts or TBI also performed worse in some of the cognitive tests.
“It should be noted that not all people with a history of repetitive hits to the head will develop later-life problems with cognitive functioning and depression,” says Study author Robert Stern, professor of neurology, neurosurgery and anatomy & neurobiology at BUSM.
“However, results from this study provide further evidence that exposure to repetitive head impacts, such as through the routine play of tackle football, plays an important role in the development in these later-life cognitive and emotional problems.”
The researchers point out, however, that one limitation of the research is that researchers didn’t have data on the extent of participants’ injuries.
Last year, BUSM researchers found that longer someone was exposed to tackle football, the higher the risk of developing the degenerative brain disease chronic traumatic encephalopathy.
For every year of exposure to the sport, footballers had a 30 per cent increased chance of having the disease.
City dwellers “more likely to die in hospital” after stroke – US study
Compared to those living in urban areas, stroke patients treated at rural hospitals were one third less likely to undergo a procedure to remove a blood clot that caused the stroke and were more likely to die of stroke before leaving the hospital.
Researchers examined national data on almost 800,000 adults hospitalised after a stroke between 2012 and 2017.
In their paper, published in the American Stroke Association’s Stroke journal, the researchers warn that this urban-rural divide may be getting worse. This gap, the paper states, could be caused by the slower take-up of newer treatments and technologies, and because rural hospitals are less well-resourced and have poorer access to specialist care. Rural hospitals may also be more likely to lack specialised clinical support, such as dedicated stroke units.
Other causes for poorer stroke care could be a lack of clinical expertise in urban areas, due to difficulties attracting and retaining experienced staff, and poorer access to emergency services and longer responses to emergency calls due to distance.
“The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications,” said Gmerice Hammond, author of the study and a cardiology fellow at Washington University School of Medicine.
“Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities.”
The study had some limitations, including a lack of data on the severity of patients’ strokes, or factors that would determine whether a patient received advanced therapies, sich as the size of the clot and where it is located.
Karen Joynt Maddox, senior author of the study and assistant professor of medicine at Washington University School of Medicine, calls the differences in care, and the lack of improvement over the five-year period, ‘striking’.
“Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren’t receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren’t eligible by the time they arrived?
“Those questions can’t be answered with administrative data, but they’re very important to look into so that we can develop effective solutions.”
One charity’s challenging move to online group sessions
Since lockdown began in March, many people recovering from brain injuries have had to adapt to remote sessions with health workers.
But it’s not just outpatients that have seen a change. One neuropsychologist in York is trying to sustain momentum with her support group, but navigating the new online world with patients has brought its challenges.
Just before lockdown, Diana Toseland, consultant clinical neuropsychologist, was celebrating. Her charity, Café Neuro York, became officially registered. Café Neuro is a social support network that allows people with long term neurological conditions in York to learn new skills, help others and learning to be mindful, after they’re discharged from health services.
Group members were meeting face-to-face for morning and evening meetings, and once a month on Thursday evenings there was an interactive presentation for members to enjoy. When lockdown began, Toseland wanted to continue her twice-weekly sessions online.
But adjusting hasn’t been easy – Toseland had built up a loyal user base, but sessions were very much based offline. Adjusting hasn’t been easy.
“People need this in York. People with a neurological condition need ongoing support,” Toseland says. “People with brain injuries found it helpful to come along to meet people without having to explain – they can just be who they are. It’s about what people can do, not about their condition or disability.
Since lockdown, Toseland has been struggling to know how to support people.
“I’ve got up to speed with Zoom. This week we had six people call in, but their difficulties are quite profound and they’re finding it hard to get onto Zoom. Some call in late because they forget or find it difficult, others call in with help from families.”
Toseland has found there are many technical difficulties to overcome before the sessions can begin.
“You need so many things – good internet connection, distraction-free environment, working microphones and speakers.
“One woman managed to set it up herself, her career before the injury was IT, but then she didn’t have sound. Then she tried headphones, which worked, but then she took them off and couldn’t get the microphone on the computer to work without the headphones – she was the most successful in that meeting.
“Another has poor signal so she has to sit under a tree in her garden, which means she can only do it when the weather’s good.”
Once the call is up and running, Toseland says some members find it difficult to navigate the conversation, which has entirely different unspoken social rules than offline conversations.
“They’ve found it difficult because you can’t have two people having a conversation, it’s got to be one person at a time, which requires intense concentration. People can’t sustain that level of attention long enough to fully participate in the conversation.
“Some go quiet, it leaves people with headaches, it’s fraught with disaster. They might dominate the conversation and not pick up on cues; one finds it’s too much stimulation, so she closes her eyes.”
But Toseland hopes to continue the groups, as when it does work, it works well.
“On the other hand, for those who have joined it, they’ve used it as a bit of a lifeline.”
But Toseland is looking forward to getting meetings back into the real world. She’s been runnin Café Neuro for over a year and a half, and she’s seen more progress in some members than they ever made coming to her clinical practice.
“It’s made a difference in ways I couldn’t have predicted, and an impact wider and quicker than I could’ve possibly hoped for,” she says.
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