Emerging from the COVID-19 pandemic: Mental Health and Resilience for Children, Teens, and Adults

David C. Wang, ThM, PhD

Penner Chair for the formation of emotionally healthy leaders

Fuller Theological Seminary

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Research on COVID & Mental Health

• 8000% increase in suicide hotline usage (Bharath, 2020)
• Quarantine and home isolation during COVID-19 associated with increased anxiety, loneliness, insomnia, decreased concentration, and anger/irritability (Sadeghmoghadam, Khoshkhoo, & Saadati, 2020)
• Increase in parental stress, associated with child abuse and neglect (Griffith, 2020)
• 25% increase in domestic violence calls, 30% increase in child custody cases, 24% increase in family disputes compared to March/April of 2019 (Vega, 2020)

Research on COVID & Mental Health

• Research on 2003 SARS Outbreak: 44% of SARS survivors developed PTSD, with 82% still having PTSD symptoms several years later (Hong et al, 2009)
• Survey of nine US Public research universities nationwide found that prevalence rates of major depressive disorder more than doubled and that anxiety disorders was up 50% compared to Spring 2019 (Chirikov et al., 2020)

Mental Health of Pastors & Seminary Students

Mental health near peak of COVID-19 (Fall 2020)

Depression (Fall 2020) – 51.1%; PHQ-9

• 29.9% (mild depression)
• 11.6% (moderate depression)
• 7.0% (moderately severe depression)
• 2.6% (severe depression)

Anxiety (Fall 2020) – 43.1% anxiety; GAD-7

• 26.7% (mild anxiety)
• 11.6% (moderate anxiety)
• 4.8% (severe anxiety)

PTSD (Fall 2020) – PC-PTSD-5

• 43.4% of total sample reported experiencing a traumatic, life-threatening event in their lifetime
• 33.7% of total sample endorsed sufficiently significant trauma symptoms to be considered for a potential diagnosis of PTSD

POTENTIAL SYMPTOMSDURING COVID-19

Potential Symptoms�

QUESTION:

• What symptoms have you been feeling or observing (among your family, friends, and community) during the past few years through COVID-19?

Flight, Fight, Freeze Response

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Flight response (avoid, run away from threat):

• Feeling like I’m not all here (dissociation)

Flight, Fight, Freeze Response

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Flight response (avoid, run away from threat):

• Feeling like I’m not all here (dissociation)

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Fight response (fighting off the threat):

• Overcontrol, micromanaging ourselves or others
• Angry outbursts when this overcontrol is derailed

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Flight, Fight, Freeze Response

Flight response (avoid, run away from threat):

• Feeling like I’m not all here (dissociation)

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Fight response (fighting off the threat):

• Overcontrol, micromanaging ourselves or others
• Angry outbursts when this overcontrol is derailed

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Freeze response (staying still, hiding, playing dead):

• Feeling so overwhelmed that we can’t mobilize ourselves to do anything
• The only thing we can do is ‘veg out’ and hide from the world

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Developmental Impact

What is a trauma?

A traumatic event is characterized by the following:

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• The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

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• The person's response involved intense fear, helplessness, or horror.

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[Q:] In what ways does trauma make its presence felt presently (throughout COVID-19) within the context of Asian-American families?

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[Q:] In what ways does historical and intergenerational trauma also make its presence felt within the context of Asian-American families?

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Understanding Trauma

“Trauma is what does not go away. It persists in symptoms that live on in the body, in the intrusive fragments of memories that return. It persists in symptoms that live on in communities.”

-Shelly Rambo (2010)

trauma

• Acute trauma: a single event that lasts for a limited amount of time

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• Chronic trauma: multiple traumatic events that happen over an extended period of time

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• Complex trauma: chronic trauma that was caused by those whom the survivor depended on for survival and safety

Types of

Examples of traumatic events

• Domestic Violence
• Sexual Assault
• Child Maltreatment
• Combat Trauma
• Natural Disaster
• Motor Vehicle Accident
• Traumatic Loss
• Medical Trauma
• Historical/Collective Trauma

Prevalence of Trauma

• Around the World
• 70% of people have been exposed to some type of traumatic event in their lifetime
• On average, there are 4.5 traumatic events per person
• 14.7% of traumatic experiences involved sexual violence
• 8.4% of traumatic experiences involved physical violence

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(World Health Organization)

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Pandemic Exacerbates Anti-Asian Discrimination

Rayna Wuh, 2021 [Columnist]

Research on Asian Racial Experiences

– Dr. Kenneth Wang (Fuller Seminary)

I have never really experienced racism

Getting asked where I'm really from

There were a few instances mocking my facial features

a stream of internalized messages about being

nerdy, unattractive, having a small penis,

having small eyes, being weak, being not good

at sports, etc

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An older white man stared at me and wouldn’t take no for answer and said that he and I would make beautiful Eurasian babies.

Someone behind me on the street behind me said they liked Asian food but not Asian people

I was in a therapy session ... I was sharing a stressful incident that I had encountered in my dorm hall. The first thing the White counselor proceeded to ask was, "What race is she?" I responded, slightly confused, "I think she is Chinese... why do you ask?" The counselor then immediately replied, "Are ALL Chinese people like that?" When the counselor saw the frozen, uncomfortable look on my face, she quickly added, "No, I'm asking because my sister-in-law is Chinese."

Double Consciousness

“It is a peculiar sensation, this double consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of the world that looks on in amused contempt and pity. One ever feels his twoness, -- an American, a Negro; two souls, two thoughts two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.”

(W.E.B. Du Bois, Souls of Black Folks, 1903)

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What is a trauma?

Trauma is… [when] “severe emotional pain cannot find a relational home in which it can be held.”

- Stolorow (2007, p. 10)

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A relational home is a context in which painful emotional experiences can be shared, understood, and ‘held’ by oneself and others

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[Q:] Within the Asian-American context (which is diverse), how do people respond to trauma? How to Asian-Americans relationally hold their trauma?

What can we do?

The Crucial role of Social Support

• Social support is one of the most powerful determinants of facilitating or impairing recovery from trauma (Feeny, Rytwinski, & Zoellner, 2014)
• Some traumatic events are more socially acceptable (or shameful) than others
• Looking at this critically from the perspective of cultural assumptions of religious communities (e.g., Asian-American, Christian)

What can we do?

The Crucial role of Social Support

• Lack of social support, and especially the presence of negative support (e.g., blame) one of the strongest predictors of PTSD and a strong impediment to recovery (Brewin, Andres, & Valendine, 2000)
• Lack of social support more strongly predicted PTSD than other factors such as prior trauma history, prior mental illness, and even severity of the traumatic event itself. (Zoellner, Foa, & Brigidi, 1999)

Social Support & Trauma

Definition of Social Support:

• “…those social interactions or relationships that provide actual assistance or a feeling of attachment to a person or group that is perceived as caring or loving” (Hobfoll & Stephens, 1990, p.45)
• Social support can be positive (makes us feel loved) or negative (makes us feel unloved or isolated)

Social Support & PTSD

Small Group Discussion:

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• What kind of helpful or unhelpful social reactions to trauma and/or emotional hurt (from friends and relatives and church members) have you observed or heard about?

Social Support & Trauma

Negative Social Support:

• Reactions that are intended or perceived as critical, dismissive, blaming, or grossly insensitive.
• Example: (following sexual assault) “At least he didn’t use a weapon—you’re lucky,” “It’s over, try to put it behind you.”
• “God’s ways are higher than our ways,” “Whatever is true, whatever is pure…think of such things”
• Indifference (changing the topic, failing to acknowledge the impact of the trauma)
• Encouraging avoidance
• “Just stop thinking about it.”

Social Support & PTSD

Negative Social Support:

• When both positive and negative social support are present, negative social reactions are stronger predictors of PTSD (Andrews et al., 2003)
• Common negative reactions
• Blame—survivors are culpable or responsible for the event itself or for one’s reaction to it
• Doubt—questioning the accuracy of a victim’s description of events or whether they were as ‘traumatic’ as described
• Criticism— “stop talking about it—it’s over!”

Social Support & PTSD

Negative Social Support:

• Invalidation/Indifference to the trauma may actually be more damaging than overtly negative social reactions because the latter are easier to dismiss as wrong or misguided (Pruitt & Zoellner, 2008)
• Suppress natural coping responses (e.g., talking about what happened, trying to make sense of what happened, emotional processing, etc…).
• Stops reaching out; “I should be able to move on”
• Enhances negative self-appraisals (self-blame, negative self-esteem, precursors to depressed mood)

Social Support & PTSD

Positive Social Support:

• Removing negative social support alone is not adequate (the lack of social support is related to increased risk for PTSD).
• Higher levels of social support associated with better health outcomes (Cohen & Wills, 1985), and less severe PTSD (Galea et al., 2008).
• Reduces the impact of the stressor, facilitates an adaptive view of their trauma, related to post-traumatic growth (Prati & Pietrantoni, 2009)
• “I know it’s hard, and I am impressed by how you have dealt with the situation”

What do you think about these phrases?

What do you think about these phrases?

What do you think about these phrases?

WHAT DO YOU THINK?

“I’ll pray for you.”

Lament & Accompaniment

Responses that are grounded in lament and accompaniment:

• Communicate presence
• Don’t offer premature solutions or judgments
• Don’t minimize the pain

��Lament & Accompaniment

Responses that are grounded in lament and accompaniment:

• Acknowledge the emotions of the survivor
• Allow the survivor a voice in what they need
• Continue long-term

Questions? Comments?