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Make Your Mood Bloom: Mental Health Benefits of Gardening

March 10, 2023 | IBX insights Team

Since the days of the visionary nurse Florence Nightingale (1820-1910), people have used gardens to promote healing and reduce stress. What is it about a garden that lifts our spirits, and how can gardening improve our mental health?

Studies show that observing nature or even images of natural scenes have positive effects on our mood and mental health. Patients who can see plants from their hospital rooms need less pain medication and have fewer surgical complications. Hospital courtyard gardens lift the spirits of patients, visitors, and staff.

Gardening is great for your mind and your body. Activities like digging and weeding build strength and dexterity. They can also increase focus and decrease anxiety and depression. Outdoor gardening exposes you to sunlight, which increases vitamin D levels. This can help lower your blood pressure and heart rate.

Even Better with Others

While gardening offers a lot of personal benefits, it doesn’t need to be a solitary activity.

Working with neighbors to beautify a park, school, or other outdoor space can increase community pride. It can also restore social connections that may have been lost during the pandemic.

Community vegetable gardens are growing in popularity. They provide nutritious food for people who live in food deserts or are struggling with food insecurity. And growing food is good for you, too. Studies show people who grow food tend to make healthier food choices.

“Gardening is an all-ages activity, but it’s a great activity for seniors,” says geriatrician and Independence Blue Cross Medical Director for Government Markets Heidi J. Syropoulos, M.D. “Most people think of gardening as an outdoor activity. But gardening is also watering houseplants, growing fresh microgreens on a kitchen windowsill, or tending strawberry bushes on your porch. You get physical and mental health benefits from plants, regardless of whether they are indoors or outside.”

No Green Thumb Necessary

Some people have a talent for growing plants. If that’s not you, don’t worry. Gardening websites and home and garden centers can help you find your inner green thumb.

Seed mats make it easy to grow flowers or veggies. These thin sheets have seeds woven into them. You put the sheet in dirt, cover it with soil, and water as directed. In a few weeks, you have a beautiful garden. If you need something easier, mini-cactus blooms can brighten your space and your mood.

A Local Tradition

In our region, the Pennsylvania Horticultural Society (PHS) promotes horticulture – the science and art of growing fruits, vegetables, flowers, and plants – to advance the health and well-being of the people of Philadelphia. The PHS plans and oversees the Philadelphia Flower Show, which is the largest, longest-running horticultural event in the country. In addition to working throughout the year to maintain free public gardens in more than 250 neighborhoods, PHS offers educational activities for gardeners of all levels.

Gardening improves your mental and physical health. Whether it provides a creative outlet, a chance to strengthen community ties, or a way to brighten your home and mood, the benefits of gardening keep blossoming.

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.

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Making Sure the Kids Are Alright

March 10, 2023 | IBX Insights Team

It’s a question parents, teachers, and researchers alike are asking. The COVID-19 pandemic robbed many teens and young adults of precious learning and socializing time. Add to that the challenge of not having enough mental health providers to meet the demand for counseling, and you’ve got a serious problem.

According to the Harvard T.H. Chan School of Public Health, the pandemic led to a decline in kids’ overall mental health. But that impact varies, depending on factors including age, family circumstances, and preexisting conditions.

Results from a 2021 National Survey on Drug Use and Health showed that nearly half of kids ages 12 to 17 who had a major depressive episode (MDE) in the past year said the pandemic negatively impacted their mental health either “quite a bit or a lot.” That’s concerning because only 12.4 percent of their peers without an MDE reported similar levels of impact.

Not a New Problem

Although the pandemic may have put a spotlight on teen mental health, rates of depression and anxiety in children have risen steadily in the last ten years. Many experts think this trend is unlikely to improve without rethinking how we approach teen mental health care. As a result, the U.S. Preventive Services Task Force now recommends regular anxiety screenings for children ages 8 to 18 and regular depression screenings for adolescents ages 12 to 18.

The Power of School Connection

According to the Centers for Disease Control and Prevention, one of the most important factors in boosting students’ emotional resilience is “school connectedness.” This is the feeling of being supported and belonging at school. Students who felt connected to adults and peers at school were significantly less likely to report feelings of sadness or hopelessness.

Experts believe that students can benefit from multiple support systems in school. But given the shortage of available counselors, only about half of U.S. public schools offer mental health assessments, and even fewer offer treatment services.

In Philadelphia’s public schools, the STEP Program provides mental and behavioral health and social services to students and families. The school district works with the Mayor’s Office of Education, Community Behavioral Health, Drexel Community Partners, and the Department of Human Services to provide this support.

At the state level, Pennsylvania recently made $190 million available for school mental health and safety programs for the 2022‒23 school year. Districts that applied by August could receive a base grant of $100,000 for safety and security improvements, with another $100,000 for mental health programs and training. Additional funding may be available based on population.

“What we need is to build capacity through all of the systems that are part of children’s lives — in families, in schools, in the education of everybody who interacts with children,” says psychologist Ann Masten, Ph.D., a professor of child development at the University of Minnesota.

Focusing on Student Mental Health at Girard College

Youth from underserved communities are less likely to receive mental health care services. To address this disparity, the Independence Blue Cross Foundation is funding a multi-year pilot initiative to provide access to mental health care for every student at Girard College. Girard College is an independent, five-day boarding school in Philadelphia. It serves approximately 300 students in first through twelfth grades from families with limited financial resources. More than 80 percent of the student population identifies as African-American.

This innovative care model integrates school support with telehealth services provided by Children’s Hospital of Philadelphia. “The pandemic amplified the urgent need for access to mental health care as young people were faced with additional difficulties such as school closures, family stress, social isolation, and economic challenges,” said Foundation Executive Director Heather Major. “A key goal of this collaboration is to create a replicable model for bringing mental health services into schools in a sustainable way.”

The pandemic showed us students of all ages need greater access to mental health care. “The focus needs to shift up toward preventive care and secondary and early intervention,” says Archana Basu, research scientist and clinical psychologist at Massachusetts General Hospital. Independence Blue Cross will continue to support efforts to improve access to mental health care for youth in the community.

If you or someone you know may be experiencing anxiety or depression, please seek help. If you don’t know where to begin, visit ibx.com/knowyourmind. If you are having suicidal thoughts, please call the National Suicide Prevention Lifeline by dialing 988.

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The Intersection of Heart and Mental Health

February 21, 2023 | mindPHL

Our body is an integrated system, so every part of it affects the whole. When we injure a limb or develop back pain, we promptly seek medical care, and we may share the details with our friends and coworkers. But when our mental health is compromised, we often keep quiet and hope things will somehow get better.

However, mental health problems don’t just affect our emotional well-being. “All our body’s systems are interconnected,” says Victor Caraballo, MD, vice president of Quality Management and chief safety officer at Independence Blue Cross. “It’s important to recognize that your brain’s moods, emotions, and functions can affect your physical health. And, just as importantly, your physical health affects your brain.”

Heart Disease Can Affect Mental Health

Heart disease is the leading cause of death for both men and women in the United States. When someone has a stroke or heart attack, they may experience many different emotions, such as depression and anxiety. They may even develop post-traumatic stress caused by physical pain, fear of death or disability, or even financial concerns related to the cost of their care. They may withdraw from their usual activities because they’re worried about triggering another cardiac event. Or they may be embarrassed that they cannot perform at their previous level.

“Any major event that causes stress to your body can lead to anxiety or depression, and cardiac arrest is a big one,” Dr. Caraballo says. “Get ahead of it. Treat it early. Address the symptoms.”

Mental Health Issues Can Affect Heart Health

Just as heart problems can affect someone’s mental health, mental health disorders can lead to heart trouble. Depression, anxiety, and long-term stress have all been shown to negatively impact heart health. These conditions can cause increased heart rate and blood pressure and reduce blood flow to the heart, which in turn can lead to heart disease.

In addition, people who are depressed or anxious may be more likely to smoke, drink, or use substances; have an inactive lifestyle; or fail to take prescribed medications. All of these actions can negatively affect heart health. Veterans who suffer from post-traumatic stress disorder, people who have experienced adversity in childhood, and people who face discrimination or live in underserved communities also have a higher risk for high blood pressure and heart disease.

Treating Mental and Heart Health Holistically

In light of the connection between cardiovascular and mental health, the Centers for Disease Control and Prevention recommends that health systems create integrated teams of behavioral health and cardiology professionals. These teams can work together to teach patients about the relationship between mental health and heart health. The agency also recommends making mental health screenings a part of comprehensive care after a major heart disease event.

Individuals experiencing mental health struggles should seek counseling or other support from family, friends, and other people who have shared experiences.

“Unfortunately, some specialists, and even primary care providers, are afraid to start the mental health conversation because they don’t feel equipped to effectively treat it,” Dr. Caraballo says. “We need better training and resources for both providers and patients.”

“When we don’t feel well mentally, we don’t feel well physically, and the other way around,” he adds. “That’s why exercising, eating well, and maintaining a positive outlook is so critical. The synergies of feeling well physically can help us feel better mentally.”

Resources for Support

The American Heart Association offers an online support network where people can share their medical stories, offer insights and tips, and Healthy For Life^® Educational Experiences.

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.

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Loneliness is a Serious Condition Among Seniors

February 14, 2023 | IBX Insights Team

In Japan, 65 percent of seniors live with their children, and in Italy, about 39 percent do. But in the United States, the figure is only about 20 percent, despite a rise in multi-generational households in recent years.

It’s just one of many factors that cause approximately one-quarter of Americans aged 65 and older to be socially isolated. People over age 50 are more likely to experience the risk factors for social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and reduced vision and hearing abilities.

It’s not surprising that being lonely is associated with higher rates of anxiety, depression, and suicide. However, a substantial body of evidence shows that social isolation also poses a major risk for physical problems including premature death — a risk level that’s comparable to having high blood pressure, smoking, or being obese.

Social isolation — a lack of social connections — is associated with a 50 percent increased risk for dementia. And loneliness among heart failure patients was associated with higher risks of death, hospitalization, and emergency department visits.

Pandemic Fallout

“Senior isolation was a tremendous problem during the pandemic,” notes geriatrician Heidi J. Syropoulos, MD, medical director of Government Markets at Independence Blue Cross (Independence). “It affected people who would never have considered themselves socially isolated before — whose children visited them all the time, or who perhaps had a caregiver that took care of their finances, or brought them a meal once a week, or went grocery shopping for them.”

“During the pandemic, some of those things still happened, but the affected individuals did not see those caregivers. They just dropped off the groceries or a meal at the front door and then left. So social isolation definitely increased during the pandemic. I think it’s gone back down a little bit now, but not to where it was before.”

Technology has helped bridge the loneliness gap to some degree, as seniors have become accustomed to using computers and other devices to keep in touch with family, friends, and health care providers. However, there’s no substitute for face-to-face social contact. For this reason, many local houses of worship and community service organizations are working to fill the gap to help seniors build relationships and maintain their quality of life.

Local Supports Deliver Connection

If you’re feeling socially isolated, the World Health Organization offers three key pieces of advice:

Get in touch with friends by either meeting them in person or contacting them by phone or through social media.
Do the things you enjoy, like engaging in a hobby or spending time outdoors.
Reach out to local services that can connect you to new people, communities, or professional help.

The Philadelphia Corporation for Aging, for one, provides Community & Connection programs at 28 PCA-supported senior centers in the City of Philadelphia. They also offer health and wellness programs, volunteer support, and job training services that keep seniors active and engaged. To learn more, call the PCA Helpline at 215-765-9040 Monday through Friday, 8:30 a.m. to 5 p.m., except for major holidays.

In Montgomery County, the Senior Adult Activities Center helps seniors continue to be active, creative, healthy, and engaged in the community. Other resources include three Meals on Wheels programs, two senior centers, and an inter-generational art center — the Ambler Senior Adult Activity Center.

Similar organizations and services exist in Bucks, Chester, and Delaware counties.

Isolation can take a devastating emotional, cognitive, and physical toll over time. If you are an older adult, any steps you can take to maximize your social interactions will have a huge benefit.

If you or someone you know may be experiencing anxiety or depression, depression, please seek help. If you don’t know where to begin, visit ibx.com/knowyourmind. If you are having suicidal thoughts, please call the National Suicide Prevention Lifeline by dialing 988.

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The Power of Talk: Erasing the Stigma of Suicide

January 11, 2023 | IBX Insights Team

Jason was happily married and a proud father of three who seemed to have everything to live for. So, his family was shocked when he died by suicide. They had no idea he had been struggling with depression.

Because admitting mental illness still carries a stigma in many circles, Jason’s story is not unique. The highest proportion of suicides in America is among middle-aged white men. They die by suicide almost four times more often than women, accounting for 69 percent of U.S. suicide deaths in 2020. But the number of Black teens of both sexes who have attempted suicide rose 73 percent between 1991 and 2017, and suicide is the second leading cause of death for youth between ages 12 and 18.

“Generally, when people don’t talk about depression or suicidal feelings, it’s because they don’t feel safe,” says H. Jean Wright II, PsyD, Deputy Commissioner of Philadelphia’s Behavioral Health and Justice Division and Department of Behavioral Health and Intellectual disAbility Services.

“Often people say there were no signs,” Dr. Wright says. “That’s an indication we may be having conversations, but it isn’t specific, so we don’t always realize the person is reaching out or feeling out whether this a safe person. They might be talking about challenges, but not saying, ‘I’m feeling depressed.’ They may not name it, and most of us are not looking to hear it, so we don’t pick up on hints. So, a lot of times, paying attention to changes in behavior is more of a red flag.”

Of course, being able to detect changes in someone’s personality or other common symptoms of depression, such as changes to their sleeping or eating habits, requires a close relationship.

Learn to Recognize the Signs

Mental Health First Aid can help teach us what to look for and what to say. Philadelphia was the first big city to bring the program to scale by offering it widely, with the goal being to teach people the signs and symptoms of behavioral health challenges, including mental illness and substance use disorder, so that people in need can be referred for professional help. The class is both online and in person, with versions tailored to people who work with veterans, children and youth, public safety, colleges/universities, and faith-based organizations.

When talking with someone about suicide, be genuine and lead with concern, Dr. Wright says. “Use ‘I’ statements – ‘I’m concerned’ and back it up with examples: ‘Normally, we have coffee together, and I haven’t seen you coming in. Is there something you’d like to share with me? I just want you to know I care about you, and I’m here to talk.’ They might be testing the waters to see who is willing to go down the road with them. Then you have to be there when they need you.”

Bringing up the topic of suicide isn’t likely to introduce the idea to a person in pain. “They’re actually relieved that people bring it up,” Dr. Wright says. “I wouldn’t go there immediately. Start with concern, and the next questions might lead up to it. Ask, ‘Have you thought about suicide? If they respond with a ‘yes,’ then ask, do you have a plan? Do you have the means to carry it out?’” You’re assessing how serious the plan is and whether they have the means to carry out a plan. If so, then you know it’s an emergency.

Public Discussion Helps Erase Stigma

Public conversations are also important because they can encourage and give strength to people who might not have close personal relationships. One study of the effectiveness of an anti-stigma social marketing campaign in California found that social media posts led more individuals to interpret their symptoms of distress as requiring treatment.

Fortunately, stigma around seeking help for mental illness is lower among younger people. A 2020 national survey found that 90 percent of teens and young adults experiencing symptoms of depression are researching mental health issues online, and most are seeking out other people’s health stories through blogs, podcasts, and videos.

Numerous celebrities, from Michael Phelps and Demi Lovato to Dwayne “The Rock” Johnson and Lady Gaga, are sharing their struggles with depression, highlighting the issue and helping to spread the message that depression can affect anyone — even those who seem to have it all.

“Suicide is not a respecter of a person’s age, race, or religion — it impacts all of humanity,” Dr. Wright says. Families, organizations, and faith communities can all be safe spaces to talk. “People need to know it’s okay to not be okay.”

If You Need Help

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide and Crisis Lifeline toll-free at 1-800-273-TALK, (8255) or call or text the new 988.

Useful Links

For more information about self-care strategies for mental health and where to find help, visit ibx.com/knowyourmind.

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Act to Curb Election Anxiety

October 28, 2022 | IBX Insights Team

Feeling anxious about the upcoming midterm elections? You’re not alone. Prior to the 2020 U.S. presidential election, more than two-thirds of Americans surveyed reported that the election was a significant source of tension in their lives. People across the political spectrum felt anxious, including 76 percent of Democrats, 67 percent of Republicans, and 64 percent of Independents.

Take Action and Vote!

“The best action to take for election anxiety? Volunteer, talk to people about the issues that matter most to you, and vote!” says clinical psychologist Tamar E. Chansky, Ph.D.

The American Psychological Association offers the following additional evidence-based advice:

Uncertainty is stressful, so don’t dwell on things you can’t control. Avoid imagining worst-case scenarios.
Focus on what you can control. Monitor your media consumption, and limit highly charged content.
Engage in activities or issues that are meaningful to you.
Stay socially connected. Spend time with friends and family.
Stay physically active.
Realize that you might not know the election results right away. Keep busy with other activities and social support, so you aren’t continually checking for “bad news.”

Recognizing Tension

Stress affects us in a variety of ways. “We notice it in our bodies, the tension in our shoulders,” said Robert Bright, MD, a psychiatrist at the Mayo Clinic, of the stress leading up to the October 2020 presidential election. “Sometimes people get GI [gastrointestinal] upset or headaches. People have trouble sleeping. There’s a lot of sleep disturbance going on right now — tossing, turning, and worrying, and not being able to get to sleep — or having bad dreams about the election.”

Dr. Bright added that television, radio, and social media ads flood us with catastrophic messages about the candidates that heighten our sense of anxiety and can feel overwhelming. “And it affects our emotions after a while. So, we start getting irritable and short, and snapping at people, not trusting people, seeing people as [either] the other or as the same. And that starts affecting our relationships at home. It starts affecting our work.”

“Our stress level is something we need to take seriously,” says Dr. Chansky. “Many of us never got that much-needed re-set from the earlier years of the pandemic. And we’re also still dealing with ongoing COVID cases, climate crises, war, and disruption. Even if these events don’t seem to be affecting us directly, we’re still processing them — and our emotional and physical resources are being strained.”

Check Your Facts and Have Hope

“Compartmentalization is a key skill for emotional well-being,” Dr. Chansky says. “Particularly when something is causing us ongoing stress, it doesn’t help to think about it all the time. But it does serve us to address it at designated times — what we may think of as ‘worry appointments.’

“At those times, write out your feelings about the election and fact-check them against what you know,” Dr. Chansky advises. Choose to have hope, she suggests, even if it’s not your natural inclination. Hope is not about imagining a particular election outcome. Rather, it’s a way of life and a continual commitment to not give up.

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.

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Talking to Kids About Gun Violence

July 28, 2022 | IBX Insights Team

Like many U.S. cities, Philadelphia is struggling with a rising tide of gun violence. During this calendar year alone, there were 957 nonfatal and 242 fatal shootings in the city as of July 4, 2022. One hundred and five of these cases involved children under age 18.

These shootings take their toll on the mental health of our children. Research suggests that concern about school violence or shootings may be a risk factor for developing anxiety disorders.

In an article written for the Children’s Hospital of Philadelphia (CHOP), Faculty Member Aditi Vasan, M.D., MSHP writes, “As a pediatrician, I have often seen children come into the hospital or clinic with mental health-related symptoms, including depressed mood, anxiety, and symptoms of post-traumatic stress disorder, in the days and weeks following a shooting near their home or school.”

Children as young as two years old can be aware of gun violence, says Julie Campbell, LCSW, Trauma Services Director at the Children’s Crisis Treatment Center in Philadelphia. But because children are often exposed to gun violence on television and in video games, it can be hard for them to understand what it means when a person is shot.

It’s heartbreaking to watch a child struggle with the stress and anxiety that gun violence can provoke. But it’s not always easy to know how to respond, or what to say. Campbell encourages parents to take their cues from their kids, listening closely to what they know and what they fear, and responding at a level they can understand. “If we ask an open-ended question and then pause to listen deeply, the communication is much more meaningful and more likely to continue,” Campbell says.

Parents shouldn’t shy away from taking the lead to start the conversation, Campbell adds. And both parents and educators can help reassure children by talking about the safety measures that are in place to protect them.

Additional tips to help parents manage their children’s anxiety include:

Stay connected. After a first conversation, check in with your child every few days to see if they’re still feeling anxious.
Encourage kids to reach out to the adults around them if they’re worried or upset.
Turn the television off, especially if the news is replaying violent incidents.
Spend family time together. Have a game night or movie night so children feel that home is a safe and good place to be.
Support your child’s wellness, including helping them get enough exercise and sleep. Lack of sleep can make children more irritable and less able to manage their emotions.
Teach your child relaxation strategies such as deep breathing. A “4-7-8 breathing” exercise made popular by Dr. Andrew Weil has been found effective in managing anxiety and helping people fall asleep. Sesame Street offers several excellent video demonstrations of this breathing technique for children, including Learn to Belly Breathe with Rosita and Common and Colbie Caillat Sing Belly Breathing with Elmo.
Teach your child positive self-talk. “When we’re thinking fearful thoughts, we can hit the pause button in our brain and change them to positive thoughts, such as ‘I’m home, I’m safe, I know how to ask for help,’” Campbell says.
Maintain your own self-care. Getting support for yourself will trickle down to your children and make you more emotionally available for them.

Pediatricians can also be allies in helping support kids, Campbell notes. They are trained to talk to families about exposure to trauma and to detect signs of anxiety. Children might not have the words to express their feelings. But sleep problems, changes in eating habits, or complaints of headaches and stomach aches provide clues to problems that providers can address, she says. “Medical care is not just about your body, it’s also about your emotional health.”

The Importance of Violence Prevention

It’s a tragedy that gun violence has become so commonplace that we need strategies for helping our children manage the resulting anxiety. While we must provide them with this support, we also mustn’t accept this level of violence as a fact of life.

Greg Deavens, president and CEO of Independence Blue Cross, issued this statement on May 18, 2022: “Philadelphia – like so many other cities across the country – is experiencing an epidemic of gun violence. These senseless crimes destroy families and communities and take a toll on our collective mental well-being.” He added, “Independence strongly condemns all acts of violence, and we pledge to always be a force for positive change.”

Useful Links

If You Need Help

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

For more information about self-care strategies for mental health and where to find help, visit ibx.com/knowyourmind.