As the days become shorter during winter months, many behavioral health professionals find that their patients are experiencing a setback in their treatment progress. Clinicians must consider whether the setback might be an expected treatment response resulting from the gloom of winter or the pending holiday season rather than the effectiveness of treatment itself.
Seasonal affective disorder (SAD) can be triggered in patients at this time of year, raising depression scores even in patients who are otherwise making progress. While SAD is estimated to occur in approximately 3 percent of the general U.S. population every year, it affects up to 20 percent of people with major depressive disorder and about 25 percent of people with bipolar disorder.
According to Tridiuum data, at this time last year, more than 50 percent of intakes demonstrated moderate to severe depression, and in 2019, more than 52 percent of intakes did so.
In addition, a second winter dealing with COVID-19, combined with SAD, may pack a double whammy for some patients, leading to even greater seasonal changes in mood or levels of depression. Results of the Stress in America Survey, released last month, found that more than one-third of adults said it has been more stressful to make day-to-day decisions (36 percent) and major life decisions (35 percent) compared with their lives before the pandemic.
Tracking treatment progress on an ongoing basis can be one of the best tools to help mental health professionals provide quality care for their patients. When measurement-based care is used in a continuum, such tracking can identify when a seasonal low is expected or when it might reflect the need to refine treatment to better achieve patient progress. Progress rarely follows a straight line, so it’s up to the clinician to make informed decisions on how to address the ups and downs.
Holiday stress influences mental health
Many factors can influence the mental health of patients at this time of year. For example, the expectations of family and social norms are often at an annual high around the holidays, creating stress or concerns over disappointing others. Many patients will put increased pression on themselves to find the perfect gift, cook the perfect meal, or host the ideal holiday party.
Memories and past trauma can also surface during holiday time with family, triggering a possible setback in progress. For those without family or who have recently lost a loved one, feelings of loneliness can be heightened. As winter’s colder, darker days progress, nearly all of us feel the need to hunker down at home under a blanket every now and then.
But for some patients, the lower level of natural sunlight they experience in the late fall and winter months can affect quality of life. According to clinical criteria, those experiencing SAD will present with major depression seasonally during more than one year, and symptoms typically include sleeping too much, overeating, a loss of interest in activities, and struggling to focus at work and home. One study by researchers at the National Institute of Mental Health found that up to 44 percent of patients with SAD went on to develop nonseasonal major depression.
Treatment success isn’t always linear
Taking the time to track patient treatment progress using outcome measures is a well-established precept of high-quality mental healthcare. Particularly with seasonal depression, successful behavioral health treatment is not always linear, so tracking patient-reported symptoms can help providers identify changes in behavioral health needs and adjust their current treatment path appropriately.
Tracking can also lead to better patient outcomes, according to a meta-analysis published earlier this year. Researchers found that when outcome measures were routinely administered by the practitioner and reviewed with the patient to inform clinical decision-making, patients reported decreased depression severity and improved medication adherence.
Measurement-based care can also help providers evaluate clinical effectiveness and demonstrate the impact of their services. For example, sharing longitudinal assessment data with patients can help them realize when they are making more progress than they might perceive. The data can also provide clinicians with data points for a discussion around whether a setback may be temporary due to the holiday season or the gloomy weather, or if something bigger is at play.
Further, conducting routine screenings around a patient’s risk for suicide, self-harm, and harm to others at this time of year is warranted. Loneliness around the holidays or anxiety related to family interactions can be catalysts that patients find difficult to manage. Provider alerts from these risk assessments allow clinicians to quickly adjust treatment appropriately.
Care adjustments can include taking steps toward emergency care for imminent suicide or harm to others, recommending a higher level of care, such as intensive outpatient or residential, or encouraging more frequent outpatient or virtual care appointments if needed. Risk assessment results can also be important information to help with coordinating with a patient’s larger care team.
As clinicians view patient progress in context, SAD and holiday stress must be considerations. With measurement-based care data at their fingertips, care providers can better respond to patient needs.