SciLine interviewed: Dr. Inger Burnett-Zeigler, an associate professor of psychiatry and behavioral sciences at Northwestern’s Feinberg School of Medicine. In her clinical practice, she focuses on mood and anxiety disorders, stress management, interpersonal relationships, and overall wellness. Her research investigates strategies to improve access to and engagement in mental health treatment, particularly among underserved populations.
What does the research say about how adult mental health typically fares in winter, and what factors cause seasonal mental health changes?
INGER BURNETT-ZEIGLER: So we know that a number of people can experience significant changes in their mood during the winter months. And those changes can be associated with decreased sunlight, fewer opportunities to get outside and engage, which can lead to feeling more sluggish, feelings of isolation and loneliness with other – feelings of loneliness and isolation, which can contribute to the low mood and symptoms of depression. For some individuals, they may experience seasonal affective disorder, which does impact a small proportion of the population – about 1% to 2% of the population – whereby they experience these changes in their mood during the winter months – so about December through February.
Indeed, this winter might be particularly challenging for a lot of folks. We have been isolating. We have been sheltering in place for at least the last nine months. And even for those that were able to engage with friends and loved ones somewhat safely over the summertime, within the restrictions that COVID-19 had put in place, those opportunities are even more challenging, as the winter months preclude individuals from being able to spend time outside, exercise outside, have picnics in the park, as I was often doing over the summer. And so we know with that, with those fewer opportunities to engage, more people will be feeling lonely, more people will be feeling isolated, and that can lead to increased risk of depression. And indeed, I’ve already seen a number of patients in my clinical practice reporting experiences with increased loneliness and isolation and, additionally, a lot of anxiety about what that’s going to look like this upcoming winter.
What kind of mental health issues may result from the stress of the pandemic, and how long might they persist?
INGER BURNETT-ZEIGLER: The stress of the pandemic is a stressor to the vast majority of the world. A lot of that is due to concerns about health and well-being, not only for the individual, but also their family members.
But additionally, there are increased concerns about housing, about employment stability, about finances, and some of those socioeconomic concerns can disproportionately impact racial and ethnic minority populations. And so when we think about those stressors as a whole – health, finances, employment, housing, even transportation, as it pertains to the risk one may face getting to and from work and other places that they are required to be – that’s a really added burden of stress that has now shifted from being an acute stressor, so a finite period of time, to a more chronic stressor as the pandemic continues to wane on. So it’s really important that we work with people to talk about how to manage those stressors, manage the factors that are in their control as best that they can, even though we’re still in the midst of the pandemic, such that when some of these restrictions start to be lifted, mental health is preserved.
In terms of stress and mental health, does the pandemic affect racial and ethnic minorities differently?
INGER BURNETT-ZEIGLER: We know that racial and ethnic minorities have been disproportionately impacted by the COVID pandemic. They’ve been infected at higher rates and have experienced a higher number of deaths related to COVID-19. In addition to that, we know that racial and ethnic minorities are more likely to be in essential worker positions that place them in higher risk for exposure – so jobs working in health care, jobs working in the service industries, jobs working in transportation. And these same individuals may also be in shared living environments where they’re not only facing risk when they are going out to do their day-to-day activities, but the added stress as it relates to potentially infecting their loved ones that they may cohabitate with. To add on, we know that racial and ethnic minority populations are already disproportionately impacted by the burden of stress related to the social and economic factors, even outside of the pandemic.
So when you combine the additional stressors that have surfaced due to the pandemic, we do know that racial and ethnic minority populations are likely to carry a disproportionate burden of stress, anxiety and potentially depression due to the pandemic.
Are there evidence-backed strategies you would suggest to help adults support their mental health as the pandemic continues?
INGER BURNETT-ZEIGLER: Some strategies that we know are really important, in terms of maintaining mental health and wellness in the context of the pandemic, begin with maintaining as much of a routine as you can on a daily basis. Now that people are working from home and not only managing their work, in addition to child care and other responsibilities, we know that routines for a lot of folks have fallen by the wayside. Work is creeping into the evening and maybe even into the routine even into the weekends. Exercise and healthy eating routines may have fallen by the wayside. So as best as you can, trying to maintain that same routine that you had outside of the pandemic can be really important in terms of maintaining mental health and wellness.
Additionally, keeping some good boundaries in place – you know, this is an opportunity, maybe not to add additional things to your plate, but to find spaces where it might be the healthiest thing to do is to say no, such that you have that extra space and time to take care of yourself. And then finally, what I might say is the most important is offering yourself some compassion and kindness. This has been a particularly rough year for a lot of people. A lot of people are facing quite a heavy load of stress and burden, related to the multiple responsibilities that they have to manage. And so just recognizing that all of us are doing the best that we can, and, you know, this is maybe not the time to hold ourselves to a higher standard, but allow ourselves grace and compassion with whatever it is that we’re able to accomplish on that particular day.
Is remote counseling an effective option for those who are avoiding in-person contact?
INGER BURNETT-ZEIGLER: The pandemic has certainly opened up a new opportunity in terms of virtual therapy. In my clinical practice, prior to the pandemic, virtual therapy was not an option that was available to the clinicians and patients, and now it has become one that is unlikely to go away once the pandemic starts to become resolved.
And I think that virtual therapy provides increased access to a lot of individuals who previously may have experienced barriers in terms of the time necessary to get to a therapy appointment, perhaps child care barriers, and just trying to squeeze in that therapy time in the context of an otherwise busy day. And so to that end, in some ways, virtual therapy is making access to mental health services more accessible to a lot of individuals. And I think that, in terms of the quality of therapy, there’s still a lot of value to be found in virtual therapy, and the research studies indeed have shown comparable outcomes for face-to-face therapy, as are those for virtual therapy.