Transcription:
Addressing the Mental Health Needs of COVID-19 Survivors

Melanie:  Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're discussing mental health concerns in people that have had COVID-19 as well as mental health implications with the diagnosis of any disease. Joining me is Dr. Eric Larson. He's the Director in Psychology and Brain Injury at Northwestern Medicine Marianjoy Rehabilitation Hospital.

Dr. Larson, it's a pleasure to have you join us. This is a really great topic and something that I think we're going to learn more about as the time goes. But before we get into that, Marianjoy Rehabilitation Hospital through Northwestern Medicine is a leader in providing the most innovative rehabilitation solutions available. And I know that you deliver it with compassion and caring spirit. Tell us about the unique role that you and your team of psychologists play when you're supporting patients as they adjust to their disability. This is such an important job that you have.

Dr Eric Larson: Well, I think that one of the great things about the approach that Marianjoy takes to helping the patients that come here is that they understand that there's a need for holistic care. In addition to the physical therapy, occupational therapy, and speech therapy that's standard for rehab, they also want to provide interventions from other disciplines. We have a really deep bench of psychologists. We have nine psychologists here to work in a 125-bed hospital. It allows us to really get in and provide some extensive support that you might not see at other facilities. And because of that, I think that people feel supported they are able to make gains they might not be otherwise able to make.

Melanie: So important as we said. So why is it so critical to address some of these comorbid complications like depression and anxiety in inpatient rehab patients? As people get devastating diseases or devastating injuries, this can be so hard to deal with. Tell us a little bit about why it's so important and what you do really.

Dr Eric Larson: Well, one of the things that I think gets a little bit tricky is that when patients are in rehab, their success is largely contingent on how well they engage with the therapy that the doctors order for them. So they really need to participate in those sessions and they need to push themselves a little bit. And I feel like one of the ways that psychology really adds to the team is that they help the patients maintain their engagement, that psychology provides some assistance and keeping people motivated and helping them recognize they are part of the team. They play a key role in planning the work that we're going to do together. And we need to make sure that they see the results of their efforts and stay in the game.

Melanie: Well, also you're really addressing the mental and emotional aspects related to their injury itself while you're rehabilitating them and trying to get them to engage in their own rehabilitation. So that must be pretty challenging in that way as people have to adjust to so many different things.

Dr Eric Larson: Yeah. And I think that kind of is the core issue, is that there's so much adjustment that's happening, so many changes. Sometimes we're getting people who are just realizing they're going to start a new lifetime with a disability that they didn't use to have. And one of the things that's kind of exciting to watch is there's a change that occurs when people are starting to realize that they can still find quality of life, that there are still things that they care about, that they historically have been the reason they get up in the morning and they're still present in their life and they can still pursue them. And the psychology kind of partners with them to help them get to a place where things they didn't used to think were possible, now are possible.

Melanie: Dr. Larson, one thing I found interesting is sometimes psychology, and this is no offense against you, play a sidelined role among medical professionals. But during this pandemic and the mental health epidemic that we have seen because of COVID-19, do you feel in your opinion that this has really underscored the importance of psychology services in rehabilitation and in other aspects of the medical community?

Dr Eric Larson: Absolutely. The thing that's kind of interesting is that some of the psychologists working on the COVID units and helping some of the physicians that are here at Marianjoy, they've suddenly found themselves in constant contact with the MDs. They're looking for a lot of input. They want to hear the kinds of things we have to say about how to manage some of these more complicated cases.

I have one psychologist that says, "The attending on my unit has me on speed dial now because she wants to hear how I can help out with these different cases." And that's good news for us. In the past, we haven't always had that kind of close partner relationship, but now we do. And we're happy to step up and provide that additional help.

Since we've been here at Marianjoy, psychologists have seen all of the COVID patients that we had. And although initially there was some concern about whether or not we would need to do it over telemedicine, we made a case that our patients need that face-to-face contact. And so we got clearance from infection control to start meeting in the patient's rooms, being present. Sometimes they've been struggling with a sense of isolation, so having that face-to-face contact is so important.

And I think it paid off. We saw some really good outcomes. We saw some people who had been feeling isolated and confused and upset before they got here. And they kind of turned things around for themselves while they were with us. And they landed on their feet.

Melanie: That's very encouraging. Now, as we know COVID has sort of caused a worldwide stress, Dr. Larson, that most of us have not experienced before. Fear of contracting it and ventilators. I mean, we've seen a lot in the media and heard a lot about what our healthcare workers have gone through. What can you tell us about the long-term impact on the mental health of COVID survivors and what have you seen are the most common clinical diagnoses for people in this regard?

Dr Eric Larson: Well, you're right. I think that all of us have had to adjust over the past few months even beyond the people with COVID itself, the general public has had a tremendous stress. It's been a tremendously stressful experience for them. There's stats that came out from the National Institute of Mental Health that there might be as much as 31% of the general population, not just people with COVID, but the general population that's experiencing significant mental health problems at this point, which is twice the prevalence that we were seeing before COVID. But then in people who've actually had COVID itself, there's also an elevated prevalence when they compare to other diagnoses, other people that are getting rehab, they don't seem to have quite as frequent or as severe distress as what we're seeing in people with COVID.

The kinds of things that happen most frequently are anxiety, as you might expect. There's also a pretty substantial prevalence of insomnia. I think that sometimes some of pain problems that have happened might contribute to that. You know, if people have had problems with breathing, I think that's also something that can make it hard for them to get a good night's sleep.

But then the other big thing that we're taking a look at here at Marianjoy with some special projects that are underway is to get us a better understanding of some of the cognitive changes that can happen. We do see a fair number of people that have symptoms of delirium while they're here. And so psychology has taken on the role of trying to provide reassurance and reorientation to these patients, so they know what's really going on so they don't feel under threat as well as consulting with the rest of the team to know how to help patients when they are confused and they don't understand what's going on.

And I think that caught some of us by surprise. We weren't necessarily expecting such a large percentage of these patients oftentimes with respiratory symptoms to become disoriented, like someone with a neurological problem.

Melanie: Well, as we think of the mental health implications of the diagnosis of any disease or injury or condition, Dr. Larson, can be devastating, right? And you've just been discussing how COVID has affected that. So, first of all, tell us, is it different in your opinion, because it's been exacerbated for people at Marianjoy, right? They've suffered some sort of an injury, they're in rehabilitation, and now compounding that with COVID, is really adding to the whole stress that's going on. Tell us about clinical management of these kinds of cases and how you've been dealing with that.

Dr Eric Larson: Well, it's interesting. The standard care for medical management of someone with COVID is often described as supportive care. There's not a cure. What we need to do is keep the patients safe, prevent different complications or hospital-acquired conditions from complicating their recovery. And I think that's essentially the same thing that the mental health providers do when they're with these patients who are going through this tremendously stressful experience.

We aren't going to be able to remove the problem that brought them here. And we don't have a pill that's going to resolve all the distress that they're experiencing because of that medical problem. What we can do is provide a supportive environment and keep them involved in their rehabilitation and participating in their therapies, provide encouragement and that supportive care allows the patients themselves to recover. It's not that we are the healing agent, the patients are going through the healing process themselves, and we prevent the kinds of complications that can occur if someone is very, very depressed or very, very anxious, and it prevents them from participating in the therapies that keep them strong.

Melanie: Dr. Larson, Marianjoy is partnering with some other hospitals affiliated with Northwestern Medicine to create a database that will allow MRH and other participating hospitals to publish research about COVID-19 and rehabilitation. Will any of these studies that have a psychiatric component or is MRH doing any research you want other providers to know about the psychiatric side effects of COVID?

Dr Eric Larson: Yeah, we have this project underway now. It's pretty exciting. There's a graduate student who's doing her dissertation on exactly what you just described. We're trying to get a sense of what are some of the psychiatric comorbidities that occur with COVID and how does delirium in particular impact outcome.

One of the things I'm very interested in is finding out more about patient's perceptions of what's happening as they're going through rehabilitation. Are they able to recognize the progress that they're making or do they feel like they're just spinning their wheels? And we do have some instruments that we're using to collect patient-reported outcomes, their own observations of where they are. And I think that this is going to provide us with some new insights about how people with COVID get better that will also help us understand how everybody gets better. I think that patient perception of what is happening during the recovery process is key. And I'm hoping that as we get more data about this, we'll be able to teach other clinicians how to manage patients as they're going through that, how to manage those perceptions, how to help them understand what's happening, so they continue to participate and maximize their recovery.

Melanie: Well, I hope you'll join us again to update us as you do learn more from that fascinating research. It's really important, especially now. And before we wrap up, Dr. Larson, COVID-19 patients aren't the only ones who've suffered during this pandemic. As we've said, there's been sort of a mental health epidemic, right? But tell us a little bit about what you've seen as far as the state of mental health among healthcare and essential workers. I know last summer, it was crazy the things that we were hearing. Tell us what you've seen now, how they have gotten through this and what else you would like other providers to know about the rehabilitation treatment for COVID-19 survivors.

Dr Eric Larson: Rehab is a tough job. It's tough for the patients, it's tough for the staff when you see patients that are struggling, when they are facing new realities that may be with them for the rest of their life and learning how to adjust to them and adapt to them. And for some of the people on our staff, I feel that you can handle the stressors that I just described if it comes at a pace that's manageable, if there's not a tremendous influx of patients all at once, that you're able to kind of establish a rhythm that carries you through.

What caught some of our staff off guard a little bit was the large numbers of people that were coming through and the magnitude of the pain and the distress that they were having all at once. Since things have kind of started slowing down again, our staff is starting to bounce back. But I think that while that was occurring, we learned that we had to intentionally take care of ourselves and take steps to stay strong and to be accessible to our patients when they needed us. We had to find things that would give us the energy to get back in the game and not be so concerned about our own welfare or the welfare of our families, that we can actually hear what the patient is saying.

When we're aware of our own issues and our own needs and we're addressing those, I think that we're going to give better care to our patients. And I think that that's one of the things that even now as we're possibly on the other side of COVID, as we're getting to a place where we don't have quite as many inpatients coming through the hospital who are confronting a life-threatening illness and not sure of what recovery looks like, the one thing that we're going to carry with us going forward is the recognition that we need to partner with each other and support each other. We need to keep each other on speed dial, like one psychologist was telling me, and we also need to be very, very aware of our own needs and reach out to each other as professionals to get the support that we need and to help each other as we provide the best care we can to our patients.

Melanie: Thank you so much, Dr. Larson. What an interesting topic. So much to investigate there. Thank you again for joining us.

To refer your patient or for more information, you can visit our website at marianjoy.org to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate, review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.