It's springtime in New York City: Covid-19 vaccination rates are increasing, infection rates are slowly starting to ebb, and patients are returning to their primary care doctors' offices.
As expected, chronic conditions like diabetes and high blood pressure have worsened for many patients, but some also display the mental health effects of chronic stress-which appears more pronounced in women and mothers.
"It's like the dam has broken, and everything is suddenly coming out," says Arthi Reddy, MD, assistant professor of medicine at CUMC within the Columbia University Vagelos College of Physicians and Surgeons and an internist with Columbia's Morningside primary care practice.
"Women are expected to be the pillars of the household. Moms who were already used to juggling kids, a job, and aging parents were suddenly burdened by a host of other stressful situations and tasks. Physicians are just now dealing with the sequelae of this trauma and stress, including uncontrolled diabetes, hypertension, and, not surprisingly, anxiety and depression."
Reddy, who has two school-age children and is married to another busy physician, has first-hand experience with pandemic-related stress. "I'm familiar with many of the same challenges as my patients, like helping my kids with remote learning while carrying on with my own work. I'm open with my patients about my own anxiety. It's a relief to my female patients when they learn that I'm going through the same thing as they are."
The CUIMC Newsroom spoke with Reddy about the ways women and moms can reduce stress and how primary care physicians can help. Here are excerpts from the conversation.
Primary care is the new front line for mental health care.
It's a relief to see many of my patients returning to the doctor's office for regular checkups and other health care needs. But on many occasions, I've had patients walk into my office and burst into tears, telling me it's the first time in the past year that they've allowed themselves to cry.
Mothers are used to putting other family members first, so even if they are adept at seeking mental health care for a child that is struggling, they may be more reluctant to get therapy or medication for their own mounting anxiety or depression.
More of my female patients are starting to release their pandemic-related stress, and it's heartening that many are beginning to ask for help. But because there's so much demand right now, someone who is seeking therapy for the first time can have difficulty accessing mental health care quickly. Primary care doctors are trained to provide mental health support until patients can begin receiving care from a psychiatrist, psychotherapist, or other mental health professional.
Mental health problems and sedentary habits go hand-in-hand.
Being stuck at home during the pandemic means that many of my patients have experienced weight gain, leading to new chronic conditions or exacerbating existing ones like diabetes, hypertension, high cholesterol, and joint problems.
But stress and isolation also make these conditions worse, increasing cortisol levels which, in turn, exacerbate weight gain and chronic conditions that are difficult to notice when you're by yourself.
A lot of my patients are coping with the anxiety and isolation by drinking more, smoking, and not exercising or eating healthy. Many of my patients feel guilty about their weight gain and their inability to manage their health. It's difficult to make healthful choices when your brain isn't working as well as it should, but it all starts with mental health.
In one study, nearly a third of women reported an increase in mental health challenges during the pandemic, compared with just 10% of men.
You're not alone.
I have anxiety and depression, and I have used medication for decades to help me manage my mental health. I think that's given me insight into what people are going through, because I've been there and I have experience with treatment. When I tell some of my patients that I take medication for my anxiety and depression, I think they feel relieved that they're not the only moms falling apart.
For the last year, we have all tried to normalize the extreme pressure of the pandemic. Women don't even realize they're being crushed under the weight of it because it's been like this for so long.
But it's not normal to be overwhelmed.
Stop and question and tell yourself, "I'm not supposed to be feeling like this, I need treatment." Don't put it aside for next year when things are better.
Start with your yearly physical and your primary care doctor. And it's not just about mammograms, and it's not just about pap smears, it's about addressing mental health concerns as well.
My own family went through a stressful time during the pandemic; my husband is also a doctor, we were both working full time, and our two kids were at home doing remote learning, which wasn't easy. We came out of it, and I think that was largely due to the fact that I am under treatment for my mental health.
Get enough sleep and exercise.
I advise my patients-especially women who are feeling the effects of stress-to get at least 7 hours of sleep and carve out 15 to 20 minutes a day for physical activity. I've been following this advice religiously. It's the best self care I can think of, especially for moms. I joke to my patients that I will walk over my bleeding, hungry, crying children to get to bed on time. Everyone in my family knows Mom turns into a cyclops if you disturb her sleep schedule.
I also tell my patients that it's important to deal with the physical deconditioning that may have occurred while they were sedentary during the pandemic. Many people have more pain because they haven't been walking around and their muscles have atrophied. Weight gain can also stress the joints, especially for those with arthritis.
Physical therapy can help reduce the pain caused by this inactivity and can be a good way to get started with exercise again. I recommend that my patients getting 15 to 20 minutes of exercise a day, if possible.
I am a firm believer that sticking to these basic habits can go a long way to keep your body and mind healthy, but if you're still feeling anxious or depressed, see your primary care physician.
