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May 11, 2021

Mental Health and Cognition

May is Mental Health Awareness Month: What’s cognition got to do with it?

This article provides information about ongoing scientific research and does not provide any medical advice.

This month is mental health awareness month, so we're asking, What effect has the pandemic had on mental health? What effect does mental health have on cognition? And, how does mental health awareness month help?

Finland is one among several countries with high rates of Seasonal Affective Disorder (SAD) that are consistently ranked among the happiest in the world by the annual World Happiness Report. The report takes into account various elements of wellbeing, including mutual trust, safety, confidence in government, access to education and healthcare, and self-realization. All of these are, in one way or another, connected to mental health. And while SAD is prevalent in these northern nations, Finland (#1 in the happiness rankings for the sixth year in a row), Denmark (#2), and Iceland (#4) have robust healthcare systems that include mental health treatment. Not only do these countries’ policies make mental health treatments accessible to all, but they de-stigmatize them.

Countries around the world have in recent years come to understand how stigma plays a role in mental health challenges and are working to undo negative associations with accessing mental health treatment. Among them is the United States where May is Mental Health Awareness Month and which, in 2021, is more relevant to many of us than ever before.

Over a year ago, when the worldwide pandemic arrived, it threatened our health and left 1 in 3 Americans with the loss of someone to covid-19. In many cases that grief has been compounded by having had to work harder or not being able to work enough. Others have struggled to balance additional demands at home, and still others have languished as their lives were put on hold. All of these scenarios come with mental health challenges, but some may be harder to recognize than others. And, the idea that “someone else has it worse” can influence our decision to seek mental health treatment. Mental Health Awareness Month is intended to overcome the reluctance to care for our psyches as well as our bodies which are, after all, intimately connected.

Loneliness has soared during the pandemic, affecting young people in particular. It can be difficult to solve for, since it may seem surmountable through willpower; that is, it may be perceived as a weakness to admit to feelings of loneliness. But the feeling of being socially isolated is associated with a complex set of effects, some of which are mutually reinforcing and which may need a professional to help sort out. For instance, loneliness is closely associated with depression, which “can impair your attention and memory, as well as your information processing and decision-making skills. It can also lower your cognitive flexibility (the ability to adapt your goals and strategies to changing situations) and executive functioning (the ability to take all the steps to get something done),” according to the Harvard Health blog. And, the more isolated a person is, the more they are likely to perceive social threats even where there are none, like being laughed at or disrespected by strangers. Loneliness can lead to a self-protective frame of mind that, ironically, may further isolate a person.

Stress, like loneliness, is an everyday occurrence that, when it becomes chronic, can have a constellation of associated affects. Chronic stress has immediate, short-term effects on cognition, like those described by people who experience burnout at work or at home: they have difficulty focusing on their daily tasks, have lower executive control, and have more inhibition errors (or, responding appropriately in the moment, which helps with following through on goals).

Stress produces cortisol, a hormone whose presence in large amounts is neurotoxic (ie. poisonous to neurons). That’s why in the long term, there is a clear correlation between high levels of cortisol and problems in the hippocampus. The hippocampus is involved in emotion production and regulation, learning, and memory formation, and it’s one of the brain areas most affected by Alzheimer’s Disease. And, as we’ve discussed previously on our blog, post-traumatic stress disorder (PTSD)—which often manifests as a sense of constant or impending danger—is associated with dissociative disorders and other cognitive consequences. Thus, understanding when stress becomes chronic—something you experience most of the time for a long while—, or when it passes into the realm of PTSD, is critical to seeking help and forestalling some of the long term symptoms.

Perhaps the most difficult of pandemic-related experiences to sort out is when feelings of grief pass from the expected to the pathological—something a person should seek treatment for. It used to be that the Diagnostic and Statistical Manual of Mental Disorders (DSM) suggested no interference with the grief process for two months following the death of a loved one. Now, though, it allows for a person who is consumed by grief to be evaluated for complicated grief disorder, which is associated with heart disease, high blood pressure, and even a higher incidence of cancer. Whether or not the natural response to the death of a loved one has crossed over into pathology can be a tricky needle to thread, but if a person is persistently so overwhelmed by grief as to be unable to function, their grieving process may be something for which they should seek treatment.

Here are some national organizations in the United States that cater to mental health concerns (including substance abuse) and offer resources for accessing care, plus the numbers for hotlines and text support if you or someone you know is in immediate need: https://www.nimh.nih.gov/health/find-help/index.shtml https://www.nami.org/Get-Involved/Awareness-Events/Mental-Health-Month https://www.4help.org/ (Hotlines for immediate need) https://www.cdc.gov/mentalhealth/tools-resources/individuals/index.htm https://www.mentalhealth.gov/ https://www.thenationalcouncil.org/mental-health-month/ https://www.mhanational.org/mental-health-month

Here are sites linking to resources in the UK and Canada (which also celebrate Mental Health Awareness Week in May): https://mentalhealthweek.ca/ https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week

References: https://worldhappiness.report/blog/in-a-lamentable-year-finland-again-is-the-happiest-country-in-the-world/ https://www.yalemedicine.org/conditions/stress-disorder https://www.ptsd.va.gov/professional/treat/care/toolkits/police/policeworkRecognizingPtsd.asp https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.154.5.616 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548359/#:~:text=Hippocampus%20is%20a%20complex%20brain,of%20neurological%20and%20psychiatric%20disorders. Parletta N, Milte CM, Meyer B (2013). Nutritional modulation of cognitive function and mental health, Journal of Nutritional Biochemistry, 24(5):725-743 Marin, M.-F., et al. Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory (2011), doi:10.1016/j.nlm.2011.02.016 https://pubmed.ncbi.nlm.nih.gov/18201122/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752489/#R17 https://www.health.harvard.edu/blog/sad-depression-affects-ability-think-201605069551 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752489/ https://news.harvard.edu/gazette/story/2021/02/young-adults-teens-loneliness-mental-health-coronavirus-covid-pandemic/ https://www.nytimes.com/interactive/2021/03/05/us/covid-deaths.html#:~:text=One%20in%20three%20Americans%20has,people%20the%20pandemic%20left%20behind. https://www.researchgate.net/profile/Carol-Ott-2/publication/10796566_The_Impact_of_Complicated_Grief_on_Mental_and_Physical_Health_at_Various_Points_in_the_Bereavement_Process/links/581888a408ae6378919e4134/The-Impact-of-Complicated-Grief-on-Mental-and-Physical-Health-at-Various-Points-in-the-Bereavement-Process.pdf

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