December Newsletter
Mental Health and the Holidays
Many factors can trigger mental health challenges during the holidays including less sunlight, changes in diet or routine, alcohol at parties, increased time commitments, pressure on strained relationships, and the inability to be with friends or family. As prevention practitioners, there are many tools we can use and approaches we can take to promote mental health during the holidays.
 
It is also important to understand the data about where risk is lower during the holidays. The idea that suicides occur more frequently during the holiday season is a long perpetuated myth. The Annenberg Public Policy Center has been tracking media reports on suicide since 2000. A recent analysis found that 50% of articles written during the 2009–2010 holiday season perpetuated the myth. However, the CDC’s National Center for Health Statistics reports that the suicide rate is, in fact, the lowest in December. The rate peaks in the spring and the fall. This pattern has not changed in recent years. The holiday suicide myth supports misinformation about suicide that might ultimately hamper prevention efforts. See https://www.cdc.gov/violenceprevention/suicide/holiday.html for more information.
 
The resources below outline ways we can mitigate the risks for mental health problems during the holidays by recognizing trauma triggers, supporting sobriety and recovery, managing holiday blues, self-screening for mental health problems, identifying signs and treatment options for Seasonal Affective Disorder, and finding treatment for substance use disorders.
 
Recognizing Holiday Triggers of Trauma
During the holiday season, the need for a trauma-informed approach is critical. This resource describes tools for recognizing and managing trauma triggers during the holidays.

Staying Sober and in Recovery During and Through the Holidays
F or many in recovery, the holidays can be a challenging time. The strategies in this article can help people maintain recovery over the holidays.
 
National Alliance on Mental Illness: Tips for Managing the Holiday Blues
There are certain things you can do to help avoid the holiday blues. Ken Duckworth, M.D., NAMI’s medical director, shares advice for managing your health—both mental and physical—during the holiday season.

Mental Health America-Mental Health Screening Tools
This resource includes screening tools for depression (English and Spanish), anxiety (English and Spanish), psychosis, bi-bipolar, eating disorder, PTSD, addiction, and work health. A parent version and youth version are also available. Following screening, this tool provides information and resources to discuss the results with a provider.

Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Learn the signs and symptoms, risk factors, and treatment options
 
New Treatment Finder Launched by the Substance Abuse and Mental Health Services Administration
SAMHSA recently launched Findtreatment.gov , a new, improved, modern, and easily accessible means of finding treatment for millions of Americans struggling with substance use disorder. Please take some time to visit this site and spread the word!
What's Happening Around the Region?

Training and Events
Webinar Wednesday: Developing Coalition Action Plans

Date: December 11
Time: 1:00 CT

Civil Operator James Hummel will share his Missouri National Guard Counterdrug expertise with coalitions on how to develop a strategic action plan that will produce desired outcomes and motivate volunteers.
December Peer Sharing Call : Drug Endangered Children

Date: December 12
Time: 1:00 CT

Please join us for our quarterly drug endangered children's peer sharing call. We will be joined by Eric Nation and Stacee Read from the National Alliance for Drug Endangered Children.
Webinar: Drug Endangered Children: A Collaborative Approach

Date: January 29
Time: 2:00 CT

You will gain awareness about drug endangered children and the risks they face and understand the many opportunities (often missed) to identify children living in dangerous drug environments. Learn the benefits of intervention at the earliest possible point to reduce physical and psychological harm to children. Learn what a multidisciplinary collaborative response looks like and how it incorporates the unique resources within a community and applies them in a manner that provides better care for drug endangered children.
Free Self-guided Learning Courses

  • Introduction to Substance Abuse Prevention: Understanding the Basics
  • Marijuana
  • E-Cigarettes and Vaping
  • Early Childhood Development: Toxic Stress and Adverse Childhood Experiences
  • Prevention in Action Series: Teaching the SAPST at a University
  • Minecraft, not Ms. Pac-Man: Transforming Prevention Presentations for Today's Audience
  • Evaluation
  • Social Media and Use of Technology
  • “Talk. They Hear You.” Campaign

Online Courses
All online courses can be accessed at: healtheknowledge.org/courses
 
If you are new to HealtheKnowledge, please log in or set up an account here: healtheknowledge.org/new-user
Check out the Mid America Prevention Technology Transfer Center website for additional resources and training!
Mid-America PTTC
The Mid-America Prevention Technology Transfer Center (Mid-America PTTC) is designed to serve as a prevention catalyst, empowering individuals and fostering partnerships to promote safe, healthy, and drug-free communities across Missouri, Iowa, Nebraska and Kansas. Our services are evidence-based, culturally competent, and locally focused. We provide intensive technical assistance to support organizations' and systems' efforts to implement evidence-based prevention strategies. The Mid-America PTTC also forms partnerships with local and regional stakeholders to ensure that the training needs of the region are identified and met.

The Mid-America PTTC goals are to:
  • Accelerate the adoption and implementation of evidence-based and promising substance misuse prevention strategies.
  • Heighten the awareness, knowledge, and skills of the workforce that addresses substance misuse prevention.
  • Foster regional and national alliances among culturally diverse practitioners, researchers, policymakers, funders, and the local communities.

To learn more about our services:  Mid-America PTTC
Additional Resources: Holiday Self Care for the Prevention Professional
Prevention professionals can be vulnerable to additional pressures this time of year as we deal with increased activity at the state and community level, including enforcement efforts and season specific prevention events. As professional tasks increase, so do the personal obligations placed on us. As prevention providers we cannot care optimally for others unless we first care for ourselves. Our communities deserve our very best which requires us first to engage in self-care and encourage others to do so as well. Below are some self-care tools you can use for yourself and share in your communities. Happy holidays from the staff at Mid-America Prevention Technology Transfer Center! May you be safe and stress free!

  • Reach out. If you feel lonely or isolated, seek out community, religious, or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.

  • Be realistic. The holidays don't have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can't come to your house, find new ways to celebrate together, such as sharing pictures, emails or videos.

  • Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts.
Try these alternatives:
  • Donate to a charity in someone's name.
  • Give homemade gifts.
  • Start a family gift exchange.

  • Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That will help prevent last-minute scrambling to buy forgotten ingredients

  • Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt.
Try these suggestions:
  • Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks.
  • Get plenty of sleep.
  • Incorporate regular physical activity into each day

  • Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
Some options may include:
  • Taking a walk at night and stargazing.
  • Listening to soothing music.
  • Getting a massage.
  • Reading a book.
  • Meditation

  • Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

Don't let the holidays become something you dread. Instead, take steps to prevent the stress and depression that can descend during the most stressful days. Learn to recognize your holiday triggers, such as financial pressures or personal demands, so you can combat them before they lead to a meltdown.
Epi Corner: Monitoring Behavioral Health Indicators Across Seasons: Identifying Risk and Disparities

Iris E. Smith, Ph.D., M.P.H.
One of the most important functions of epidemiology is to monitor behavioral health indicators and identify emerging trends, demographic changes, or contextual risk factors that fluctuate over time. This information can be used programmatically to inform prevention planning by suggesting how prevention resources might be deployed more strategically to maximize impact in a changing environment.
 
For example, seasonal fluctuations have been observed for violence, depression, suicide ideation, and suicide attempts. 1 Behavioral indicators provide a point in time picture of the health of your community. Data on drug treatment and emergency room admissions, temporal or seasonal variations in use patterns and community demographics are some of the indicators you may choose to track. These data may provide early information on changing use patterns, new risk factors, or consequences related to drug use.

For example, there is now substantial research on health outcomes associated with adverse childhood experiences such as physical abuse, emotional abuse, or other trauma. Potential sources of data for tracking risk for ACEs include the National Survey of Children’s Exposure to Violence ( NatSCEV ), the National Intimate Partner and Sexual Violence Survey ( NISVS ), the National Survey of Children’s Health ( NSCH ) and the Youth Risk Behavior Surveillance Survey ( YRBSS ). These data may suggest opportunities for prevention targets and strategies.

Other publicly available national databases include the National Survey on Drug Use and Mental Health (NSDUH) and the Behavioral Risk Factor Surveillance Survey (BRFSS) administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). State and regional data from the most recent NSDUH survey is also available from SAMHSA in Behavioral Health Barometer Reports Volume 5.
In 2015, The National Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor substance abuse and mental health which are summarized in the following table (see Hopkins et al., 2018) 2 . The utility of these indicators are currently being piloted in several states.
Indicator

Adult binge drinking


Youth binge drinking

Alcohol-related crash deaths


Mortality from liver disease and cirrhosis

State excise taxes on alcohol

Drug overdose mortality, all drugs

Hospitalizations attributable to or associated with drugs with potential for abuse and dependence; all drugs together and each specified drug


Prescription opioid sales per capita


Drug or alcohol dependence or abuse in the last year summary

Prevalence of use of selected prescription and illicit drugs

Suicide rate


Hospital discharges for mental disorders

Emergency department visits for intentional self-injury

Self-reported youth suicide attempts

Depressive episodes in the past year

Serious adult mental illness in the past year

Any adult mental illness in the past year

Frequent mental distress (>14 out of 30 days)
Data Source





State specific vital statistics death files



State-specific vital statistics death files

Hospital discharge database maintained by jurisdiction agency





National Survey on Drug Use and Health ( NSDUH )


NSDUH


State specific vital statistics files


Hospital discharge database maintained by jurisdiction agency

Emergency department visit data maintained by jurisdiction agency

Youth Risk Behavior Survey (YRBSS)


NSDUH

NSDUH


NSDUH


Behavioral Risk Factor Surveillance System (BRFSS)
Monitoring behavioral health indicators will also help you identify disparities based on demographics, geography, and other factors. As we approach the height of the holiday season, data from previous years can help you anticipate high risk times, behaviors and other social/environmental factors that may lead to elevations in use or consequences during this holiday season.

References
  1. Galvao PVM, Souza e Silva, Passos da Silva CMF (2018). Temporal Distribution of Suicide Mortality: A Systematic Review. Journal of Affective Disorders 228, pg. 132-142.
  2. Hopkins RS, Landen M & Toe M. (2018). Development of Indicators for Public Health Surveillance of Substance Abuse and Mental Health. Public Health Reports 133(5), pg.523-531.
  3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention (2019). Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence.
  4. Merrick MT, Ford DC, Ports KA (2019). Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention- 25 States, 2015-2017. Morbidity Mortality Weekly Report (MMWR), 5 November 20
  5. Council of State and Territorial Epidemiologists (CSTE). Recommended CSTE Surveillance Indicators for Substance Abuse and Mental Health. Substance use and mental health subcommittee, Atlanta, Georgia. (2017 Revision). Retrieved from http://www.cste.org/members/group.aspx?id=87616
Iris E. Smith, Ph.D., M.P.H.
Iris Smith is Associate Professor Emeritus of Emory University’s Rollins School of Public Health where she has taught graduate courses in Program Evaluation, Substance Abuse, Social Determinants of Health, and the Mental Health Capstone course. In addition to teaching Iris also served as principal or co-investigator for numerous studies on the prenatal effects of alcohol and other drugs and treatment and interventions with substance abusing women, including a treatment demonstration grant for pregnant and parenting addicted women and their children (1979-1999). From 2004-2011 she was Co-investigator for the Emory Prevention Research Center and from 2007 to 2010 she served as the lead evaluator for the Atlanta Clinical Translational Science Institute.