Latest / Morning Medical with Dr. Chow / Rising Youth Depression, Cold & Flu Season, and Pandemic Substance Use Trends

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Rising Youth Depression, Cold & Flu Season, and Pandemic Substance Use Trends · Morning Medical with Dr. Chow

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Good morning and welcome to another episode of Morning Medical with Dr.
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Chow.
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I'm Dr.
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Chi-Ming Chow, and today, we're diving into some pressing health issues affecting young
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people today.
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Our first story is about the rising diagnoses of depression and anxiety among kids, teens,
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and young adults.
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This was especially evident during the COVID-19 pandemic, according to a recent cohort study
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conducted in Southern California.
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The study analyzed data from 1.7 million participants and found some alarming trends.
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The overall incidence of clinically diagnosed depression increased by 55.6% from 2017 to
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2021.
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To put that in perspective, it went from 1.35% to 2.10%.
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Similarly, the prevalence of clinically diagnosed depression rose by 60%, jumping from
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2.55% to 4.08%.
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Both these trends were statistically significant with a P-value of less than 0.001.
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When it comes to anxiety without depression, the incidence increased by 31.1%, from 1.77% to
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2.32%, while the prevalence rose by 35.2%, from 3.13% to 4.22%.
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Again, these trends were statistically significant with a P-value of less than 0.001.
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Dr.
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Anny H.
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Xiang and her co-authors from Kaiser Permanente Southern California published these findings in
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the JAMA Network Open.
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Dr.
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Sid Kumar, another co-author, mentioned that there was already a youth mental health crisis
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before the pandemic, but the demand for psychiatric services surged with the onset of
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COVID-19.
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The mean incidence and prevalence of depression were significantly higher during the pandemic
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compared to before it.
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However, the increase in incidence rate from 2020 to 2021 was not significantly higher than
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the increase from 2017 to 2019.
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On the other hand, the prevalence rate increase during the pandemic was significantly greater
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than before the pandemic, with a P-value of 0.004.
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For anxiety without depression, the mean incidence and prevalence were also
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significantly higher during the pandemic.
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The rates of change in both incidence and prevalence were significantly greater during
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the pandemic than before it.
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Specifically, the incidence rate change was 0.39% per year during the pandemic compared to
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0.17% before.
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The prevalence rate change was 0.61% per year during the pandemic compared to 0.31% before,
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both with a P-value of less than 0.001.
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Dr.
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Kumar explained that the study aimed to better understand the increased demand that clinicians
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were experiencing, focusing on youths because their lives were completely disrupted.
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From ages 5 through 15, children go through huge developmental changes, and each person
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responds to changes in their environments differently.
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The study authors aimed to develop infrastructure that would best address the
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needs of these populations.
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Interestingly, the incidence of depression was highest among the two oldest age groups, 14 to
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17 and 18 to 22.
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It was also more prevalent among females, American Indian or Alaska Native participants,
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white participants, those with higher household incomes, those with obesity, and those with a
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history of comorbidities.
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Similarly, the increase in the incidence of anxiety without depression was highest in the
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18-to-22 age group, females, white participants, and those with higher household
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incomes, underweight individuals, and those with a history of comorbidities.
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One interesting point Dr.
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Kumar made was the impact of body image issues during the pandemic.
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When kids are home all day and looking at themselves on video in virtual classes, their
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self-consciousness is heightened, especially in that age group.
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This could contribute to the rise in both depression and anxiety.
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When asked why white participants had more diagnoses of depression and anxiety, Dr.
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Kumar pointed out that there is more stigma around seeking help for mental health issues in
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some races compared to others.
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This could explain the higher rates among white participants.
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As for the implications for practice, Dr.
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Kumar and his colleagues aim to catch these problems early, while patients are still
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sitting in a pediatrician or primary care office.
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The goal is to prevent the burden of illness from continuing.
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The study included all members of Kaiser Permanente Southern California aged 5 to 22
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from 2017 to 2021.
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Of the 1.7 million unique members, 78% were members for more than one year.
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The mean age was about 14, and 51% were male.
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Each study year, roughly 50% were Hispanic, 23% were white, 8% were Asian, and 8% were Black.
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Most participants had an annual household income of fifty thousand to ninety-nine
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thousand dollars, 39-50% were of normal weight, 18-19% had obesity, and 7-9% had comorbidities.
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The authors noted that because all participants lived in Southern California, these results may
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not be generalizable to the rest of the country.
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However, the study provides valuable insights into the mental health crisis among young
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people.
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That wraps up this segment.
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Stay tuned as we discuss what Canadians can expect this cold and flu season.
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As temperatures drop and more Canadians head indoors, the familiar sniffles, aches, and
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pains may soon follow, signaling the arrival of cold and flu season.
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In Canada, flu season typically runs from November to April, and while anyone can catch
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the flu, the virus can sometimes lead to severe complications — even death, which is why
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experts stress the importance of the annual flu shot.
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In preparation, some provinces are rolling out this year’s influenza shot over the next few
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weeks, beginning with vulnerable groups before expanding to the general public.
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The dominant strain this year is expected to be influenza H3N2, with some H1N1 and influenza B
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circulating as well, though not in excessive amounts, according to Gerald Evans, an
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infectious disease specialist at Queen’s University in Kingston, Ontario.
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"We have a fair bit of data from South America, Australia, and New Zealand showing it’s an H3N2
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year," he said, adding that what happens in the Southern Hemisphere usually lays the groundwork
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for predicting which viruses are out there by the time they make their way north.
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H3N2 is a form of influenza A and tends to cause more severe illness, particularly in
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older adults, young children, and those with weakened immune systems.
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It is not just influenza that Canadians need to worry about — fall and winter also bring a rise
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in other respiratory illnesses, including rhinovirus, which is the common cold,
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respiratory syncytial virus, and COVID-19.
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Here is a look at what may be in store for this season.
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Based on trends from countries in the southern hemisphere, this year’s influenza season in
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Canada will overall be considered “average,” Evans said.
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In countries like Australia, the flu season was not early, running as usual from May to
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September, with an increase in cases during June and July.
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This pattern may indicate that Canadians could experience a peak in flu cases in late December
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and January, Evans explained.
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"So our expectation would be a very typical season, starting in late December and early
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January, but it can be as late as February in March.
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And sometimes we see second waves," he said.
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But the onset of influenza season can be unpredictable, as Evans noted that it is often
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influenced by travel patterns.
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If there is an increase in travel from the southern hemisphere, it could lead to an
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earlier introduction of the virus.
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Kevin Chan, a pediatric emergency doctor based in London, Ontario, said that respiratory
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illnesses like respiratory syncytial virus typically start around later October and early
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November, depending on the year, and can spike very quickly.
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"What the Australians saw was they had a typical respiratory system season with
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influenza A, B, and COVID.
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But one of the interesting things that they saw in Australia was that if you got sick with one
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virus, you were actually more prone to getting sick with other viruses," he warned.
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While influenza caused some illnesses and deaths in the southern hemisphere, the rates
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remained relatively average for what is typically expected, Evans said.
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But these numbers were significantly overshadowed by the continuing effects of
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COVID-19, he added.
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"COVID was still accounting for most of the more severe cases, hospitalizations, and
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deaths, particularly in Australia," he said.
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Canadians can expect a few key trends regarding COVID-19 this flu season, he said.
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Although the summer wave of COVID-19 appears to have peaked, the decline is slow.
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And with colder weather forcing more people indoors, he said we should anticipate a rise in
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cases.
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"But the availability of new vaccine formulations by the end of September could help
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mitigate the impact of COVID-19 during the winter months," he said.
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The best way to protect yourself from respiratory illnesses is by getting vaccinated,
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according to the Public Health Agency of Canada.
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Vaccines are available for influenza, respiratory syncytial virus, and COVID-19, but
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their availability may vary depending on several factors such as age and location.
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The flu shot is recommended for almost everyone who is six months of age and older, Public
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Health Agency of Canada said.
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It protects against three or four different strains of the flu virus each season.
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Receiving the annual vaccine helps protect you in several ways, Public Health Agency of Canada
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stated.
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It reduces the risk of severe illness from flu-related complications, safeguards those
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around you by lowering the likelihood of spreading the virus, and decreases the overall
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burden on the health-care system during the respiratory virus season.
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"When it comes to influenza, it really is the flu shot that’s going to help to keep you with
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a milder illness," Evans said.
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"Influenza is a pretty nasty infection when you get it.
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And what the flu shot does is it helps to make that a lot less severe, especially in very
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high-risk individuals.
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So those are very young and the very old, as well as some people who have underlying cardiac
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or respiratory diseases.
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It can be the difference between surviving an episode of flu in the hospital versus dying,"
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he added.
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The flu and COVID-19 are caused by different viruses.
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This means that the flu vaccine will not protect you against COVID-19, Public Health
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Agency of Canada warned.
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Starting in the fall of 2024, the National Advisory Committee on Immunization strongly
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recommends the most recently updated COVID-19 vaccines for previously vaccinated and
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unvaccinated individuals at increased risk of COVID-19.
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Two updated messenger RNA vaccines, both targeting the KP.2 strain, are authorized for
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fall 2024 for those six months of age and over.
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Moderna’s SpikeVAX is available for those six months of age and over, and Pfizer’s Comirnaty
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shot is available for those twelve years of age and over.
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When it comes to respiratory syncytial virus protection, vaccines are now available for
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older adults and pregnant individuals.
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Depending on the province, families with infants and high-risk children two years old or
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younger will be able to access a publicly funded respiratory syncytial virus vaccine.
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This fall and winter, Ontario, Quebec, and Nunavut will offer the newer monoclonal
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antibody nirsevimab — approved by Health Canada in the spring of 2023 — to all babies going
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through their first respiratory syncytial virus season.
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"I think if we can get in front of the peaking — that should start in late October and early
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November — if we can get the vaccines out by the beginning of October, I think we should
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prevent a big amount of the respiratory diseases from coming to our hospitals," Chan
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said.
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Aside from vaccines, Evans emphasized that the most fundamental way to protect yourself,
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especially during respiratory season, is regular hand washing.
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"I always say it’s an easy thing to do, and certainly alcohol-based hand rubs work well,"
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he said.
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"Washing your hands is another important attribute to do to reduce your risk for
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infections."
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Think allergy season is over?
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Not so fast, says Dr.
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Leana Wen, a CNN wellness expert and emergency physician.
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Although spring is traditionally associated with allergies, the crisp air brought on by
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autumn's cooler weather does not necessarily mean everyone can take a breath of relief.
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For many with allergies, fall is peak season, now probably compounded by a warming planet.
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Allergy season is starting earlier and lasting longer, which scientists attribute to a variety
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of causes, including the climate crisis.
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As temperatures stay warmer for longer and the first frost gets delayed, plants that release
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allergens have more time to grow.
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What is more, higher levels of carbon dioxide in the atmosphere due to fossil fuel use and
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emissions further drive plant growth, generating more pollen.
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According to the United States Centers for Disease Control and Prevention, more than one
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in four adults in the United States had seasonal allergies in 2021.
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Warming temperatures mean trees bloom earlier, pollen season lasts longer, and pollen grains
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are more likely to make you sick.
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Common triggers for fall allergies include ragweed, which grows wild just about everywhere
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in the United States.
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One plant can release one billion grains of pollen.
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Ragweed season typically begins in August and peaks in September but can last into November.
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Other plants that can trigger fall allergies include burning bush, cocklebur, pigweed,
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sagebrush, and tumbleweed.
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Molds can also cause seasonal allergies.
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In the fall, mold can accumulate in fallen leaves and bales of hay as well as indoors in
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damp places.
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Common symptoms of fall allergies can include a runny or stuffy nose, sniffling, sneezing,
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watery eyes, and coughing.
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Dr.
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Wen points out that allergies tend to follow a seasonal pattern and get worse at certain times
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of the year.
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The symptoms persist for at least a week, usually longer.
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A lot of people experience the same symptoms year after year.
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Some symptoms that correlate more with allergies than colds are itchiness in the nose
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and throat and red and watery eyes.
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With respiratory viruses also prevalent in colder weather, how can people distinguish
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between seasonal allergies and a virus?
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Dr.
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Wen says there is no straightforward answer.
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Respiratory infections can also follow a seasonal pattern and are typically more common
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in the winter compared with the spring and fall, which are classic allergy season.
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One key distinguishing factor is the presence of a fever.
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Seasonal allergies do not cause fevers.
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They also tend not to cause total-body symptoms like body aches and fatigue.
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And while people with allergies could develop a cough, the presence of a cough should make
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someone think of respiratory infections.
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People who have had allergies before often know what works to treat them.
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Relief with allergy medications is a good sign that the symptoms are due to allergies.
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People can also take tests for various viral infections.
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There is no lab test for many cold viruses, but there is for flu, COVID-19, and respiratory
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syncytial virus.
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Some hospitalized patients can also receive a viral panel that includes a broader array of
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other respiratory viruses.
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The United States government has just made another round of home COVID-19 tests available
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for free.
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It is a good idea to sign up for the free tests while we have the chance.
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Some people want to find out exactly what is triggering their allergies.
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They should contact their primary care provider for a referral to a specialist trained in
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allergy and immunology.
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That clinician can perform a skin prick test, where they put a small drop of different
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allergic triggers on your skin to see whether there is a reaction.
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They may also recommend a blood test looking for antibodies to the allergen.
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Spring and fall tend to be peak allergy seasons because that is when a lot of pollens get
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released, but there are other triggers as well.
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One to mention is dust mites, which are microscopic organisms that feed off house dust
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and air moisture.
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They are a common type of indoor allergen and can cause year-round symptoms.
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Dr.
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Wen herself has an allergy to dust mites and a very significant allergy to ragweed.
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So while she has some allergy symptoms year-round, they get especially bad in the
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fall.
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Another category to highlight is food allergies.
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Nearly six percent of adults and children have food allergies, according to the United States
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Centers for Disease Control and Prevention.
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These are different from seasonal allergies and can cause severe, even life-threatening
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reactions.
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There are a variety of treatments that can help control seasonal allergies.
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To begin with, people should try to reduce exposure to the allergen.
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If the issue is ragweed, limit time outside when the pollen count is high, which is
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typically in the mornings through early afternoons.
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Change clothes when coming indoors from outdoor activities.
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Keep windows and doors shut in the house and close the windows of the car while driving.
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Dry laundry indoors rather than hanging on a clothesline outdoors.
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Medication can include antihistamine pills and nasal sprays to help with stuffiness.
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There are many over-the-counter options as well as some that are available by prescription
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only.
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People with severe symptoms may benefit from immunotherapy, also called allergy shots.
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It is always advisable to check with your physician or other health care provider before
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starting any new medication treatment.
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Some people respond well to over-the-counter options, while others may need a prescription
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medication or a combination of therapies.
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Keep in mind that just because a medicine is available over the counter does not necessarily
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mean there are fewer side effects.
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Diphenhydramine, an antihistamine, is sedating and can be very dangerous when taken in large
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quantities.
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And many nasal decongestants have interactions with other medications and are not meant to be
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used long-term.
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How many alcoholic drinks did you have last week?
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If you answered "none," you're in the majority, according to a new Statistics Canada report.
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The 2023 Canadian Community Health Survey found that over half of Canadians aged 18 and over
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reported they did not consume any alcoholic beverages in the past week.
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Interestingly, this is not a new trend.
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While the findings are similar to those from 2015-2016, with 53 percent of respondents
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saying they had not consumed any alcohol in the past week, the 2023 data comes after years
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marked by the COVID-19 pandemic, which saw an increase in drinking among many Canadians.
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The survey provides a nuanced look at drinking behaviors across different demographics.
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For instance, nearly twice as many men (20 percent) as women (11 percent) reported
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consuming seven or more drinks in a week, which is the level of alcohol consumption linked to
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the highest risk of alcohol-related harms.
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On the other end of the spectrum, women had a higher rate of abstinence, with 59 percent
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saying they had no alcohol in the past week, compared to 49 percent of men.
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The survey also showed that younger people are drinking less than older age groups.
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For example, 67 percent of those aged 18 to 22 reported no alcohol consumption in the past
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week, compared to 51 to 57 percent in other age groups.
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Geographical differences also emerged.
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Quebec had the highest proportion of people (18 percent) who said they had seven or more drinks
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in the last week, compared to the national average of 15 percent.
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Conversely, Quebec also had a lower proportion of people (47 percent) who said they had not
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consumed any drinks in the past week.
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Rural areas also saw higher levels of drinking, with 19 percent of people reporting seven or
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more drinks, compared to 14 percent in urban areas.
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Income also played a role in alcohol consumption.
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Twice as many people in the highest income households (22 percent) drank seven or more
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drinks a week compared to those in the lowest income households (11 percent).
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Among those in the lowest income bracket, 67 percent reported not drinking any alcohol in
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the past week, higher than the 41 percent in the highest income quintile who reported no
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alcohol consumption.
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Occupational differences were noted as well.
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People working in trades (23 percent) and those in the arts (22 percent) reported drinking
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seven or more drinks at higher levels than the national average.
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Meanwhile, a decline in alcohol sales for the second consecutive year was noted, with volume
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falling by 1.1 percent in 2022-2023.
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Interestingly, while alcohol consumption is declining, cannabis use is on the rise.
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Recreational cannabis sales by provincial authorities increased by 15.8 percent year over
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year.
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Canadians spent a total of 4.7 billion dollars in the 2022-2023 fiscal year, a 0.6 billion
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dollar jump from the previous year.
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This works out to every Canadian of legal age spending 150 dollars per year on cannabis
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products, a number that has been steadily increasing since recreational cannabis was
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legalized in 2018.
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So what does this mean for Canadians?
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For one, it indicates a shift in substance use preferences.
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It also highlights the importance of understanding the broader social and economic
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factors that influence these behaviors.
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Whether it's the impact of the pandemic, changing social norms, or economic conditions,
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these trends offer valuable insights for public health initiatives.
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That's all for today's episode of Morning Medical with Dr.
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Chow.
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Thanks for joining me.
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Until next time, stay healthy and take care.