News

The full impact on students’ mental health as a result of the Covid-19 pandemic has yet to be assessed.

Much work has been done by educational facilities to prepare students and to reconsider course delivery methods in light of COVID-19 restrictions and precautions. However, there is still uncertainty for students about what this next year will look like.

Beginning a new chapter at College or University can be exciting, however the pandemic may mean that, instead of getting involved in campus life, many will start a new course at home, with classes on-line. So, university or college life might look a little different this year. Even the ways students make friends and socialise have had to adapt to comply with local Northern Ireland restrictions and social distancing guidelines.

Many student societies, clubs and sports groups are still operating – some online rather than in person - and are a great way to socialise and have fun. Attending induction courses and receptions run by your department is another opportunity for getting to know people on your course who you already have something in common with. For further information on your local clubs, groups and societies visit http://www.nus-usi.org.

For some, remote study and socialising may be welcomed; however for others this may be a challenge.

It is important that students are aware of their mental wellbeing and that taking care of their mental health is as important as looking after their physical health. Having good mental health means feeling positive, and being able to cope with everyday pressures and able to form and maintain healthy relationships.

A certain level of stress is entirely normal. However some students may feel pressured to achieve good results and this can have a significant impact on how they feel. First year students at universities and further and higher education colleges may find that transition from school to third level education causes additional stress. Some will find the course they have chosen to study stressful!

It’s important to recognise changes in emotions, thoughts and behaviours. Signs of a potential mental health problem include:

• change in mood;

• disturbed sleep;

• disturbed eating patterns;

• lack of care for personal appearance or personal responsibilities;

• unusual behaviour;

• recurrent physical symptoms;

• increased use of alcohol or other drugs;

• thinking/talking about not wanting to live.

The Public Health Agency works with Universities and FE colleges to raise awareness among students of the importance of looking after your mental health, and of ways to help maintain a good mental wellbeing.

Mind Your Head: A Student Guide to Mental Health is a booklet developed by PHA and designed by students which is distributed each year to colleges and universities.

Some students may already use, or may turn to, unhealthy coping behaviours in times of stress or unease. The following can help ensure healthy coping instead:

• getting enough rest;
• making time for self, family and friends ­ and talking;
• cultivating and encouraging optimism in self and in others;
• exercising regularly, preferably in company;
• limiting alcohol intake and avoiding cigarettes and other drugs.

Talking about feelings can really make a difference. Support for students who feel that they can’t talk to anyone they know or who would prefer to talk to someone anonymously includes helplines such as Samaritans and Lifeline - both are available 24 hours a day and free to call from landlines and mobiles

A range of other helpful local organisations and websites also exist across Northern Ireland to offer support. More information can be found at www.mindingyourhead.info. In response to the pandemic, a comprehensive online hub of resources has been developed to provide a range of advice and information on factors affecting mental health. The COVID Wellbeing hub can be accessed via the same Minding Your Head website

 

What we know about the association of smoking with the COVID-19 virus, and how we in the PHA can support smoking cessation during the pandemic

Dr Claire Neill, Specialty Registrar in Public Health Medicine, Elaine Wilmot, Health Intelligence Manager, and Kelly McCartney, Health Improvement Manager, Public Health Agency

Our knowledge about COVID-19 is constantly on the increase, thanks to ongoing research in this area. Early evidence suggested that smokers may be more susceptible to serious illness from COVID-19, and may also be at increased risk of contracting the virus if they are exposed, due to repeated hand to mouth movements giving the virus more opportunities to enter the body.[i]  We explore some of the emerging evidence in this area, and explain why there has never been a more important time to give up smoking and how we, in the Public Health Agency (PHA), can help support this.

What does the evidence say about COVID-19 and smoking?

The World Health Organization (WHO) has completed an analysis of 35 peer reviewed studies on the association of smoking with COVID-19.[ii]  The review found that smokers are more likely to develop severe disease from COVID-19 than non-smokers, and in hospitalised patients with COVID-19, smoking was also associated with increased severity of illness and death.

A smaller study, quoted by Public Health England (PHE) in response to the findings, suggested that smoking was a significant predictor of disease severity, with smokers being 14 times more likely to develop severe respiratory disease than non-smokers.[iii]

An additional review comparing current smokers with both ex-smokers and non-smokers included 19 studies and a total of 2,473 people with COVID-19 infection.[iv]    The review found that current smokers are more likely to develop severe complications associated with the infection, when compared with former smokers and people who have never smoked.

It is an important time to consider giving up smoking, not only to reduce your risk of contracting COVID-19, but also to reduce the risk of severe disease associated with the infection.

How can we support smoking cessation during the COVID-19 pandemic?

Stopping smoking can be difficult, and we know that this is particularly the case during times of stress. Additionally, face-to-face support for smoking cessation has not been as accessible during lockdown, and the associated loss of routine or boredom may even exacerbate relapses for ex-smokers, or increased smoking behaviour in those who smoke. 

The PHA commission approximately 600 specialist ‘Stop Smoking’ services across Northern Ireland, and smokers can access these services via a range of local settings including GP practices, pharmacies, hospitals, and community or voluntary groups. These services are specifically designed for smokers who are motivated and ready to quit, and who are prepared to set a quit date.

Services are provided by specialist practitioners who have received specific training to carry out this role.  Smokers can avail of intensive treatment over the course of 6-12 weeks through a combination of pharmacotherapy and behavioural interventions which have proven to be the most effective mechanism to help smokers to quit. ⁵

Smokers are more than four times more likely to quit using this approach and to date the provision of specialist Stop Smoking Services in Northern Ireland has supported nearly 300,000 smokers to quit smoking.

In addition to specialist support, smokers interested in quitting are also able to request a ‘Quit Kit’ from the PHA’s stop smoking website. The website has been created with the involvement of smokers and ex-smokers to support people in their quit attempt. The site has information on the benefits of quitting, stop smoking aids and the current support available.

Please visit www.stopsmokingni.info for more information and to have the best chance of success in becoming smoke free.

Duane Farrell, CEO, Relate NI and Danny Sinclair, PHA

 

This week, with schools back, and after almost six months of upheaval, it’s no surprise that settling back in will take some time and adjustment.

It may still feel overwhelming and even daunting to our children and young people. As adults we may be feeling the same!

Think back to how suddenly this experience came upon us. Our children didn’t get to say goodbye to their teachers and friends and there were no ‘traditional’ end of term celebrations. It is understandable therefore that they may feel uncertain about what to expect at school.

There is the usual annual change in teacher and classroom, coupled with entirely new concepts such as staggered drop off and pick up times, break and lunch times. Access to familiar equipment and resources is likely to be less than what our children are used to. Different class groups may be not even encountering each other, never mind mixing.

As parents, what we have in common with our children’s schools is that we are all trying to navigate the ‘new normal’ as safely, effectively and calmly as possible.

So how can we support our children as they adjust?

Routine

Lockdown likely meant getting out of our usual routine.  Children may have been going to bed later and waking up later. A good sleep routine is particularly important. There are guidelines on the amount of sleep children need, and they may be surprising.

Prepare as much as possible in advance, for example, school uniforms laid out, lunches made etc. Being organised is key!

Help your child know what to expect

Your child’s school may have sent you information on new routines and an insight into what school life will now look like. Indeed this could be adapting day by day as the school tries out new arrangements. A strong home-school partnership is beneficial for our children’s wellbeing alongside their learning.

Use the information from school to help your child know what to expect. Preparing children prevents surprises and can help them to feel a sense of safety and security.

Ask them how they are feeling

Every child will have had a different experience of lockdown, some will be excited about being back to school while some will be feeling anxious. Talk to them openly about how they feel and reassure them that it is normal to feel a mix of emotions. Be honest about some of your own worries but also include a focus on what you are looking forward to.  

Ask your child about what they enjoyed about their day or what they found difficult. This can encourage them to open up and share their feelings.

Look after ourselves and each other

Looking after ourselves is so important. Try and take time for yourself. Remember that we are all human and doing the best we can. Tune into your own feelings, worries and concerns and have someone you can talk to openly. Most importantly be kind to yourself and others.

Harness the power of exercise in managing stress and anxiety.  Perhaps as a family you could set goals, for example to go for a family walk, bike ride etc. once or twice a week. Physical activity releases endorphins, otherwise known as ‘happy hormones’. It can also offer children a better outlook on life by building confidence and increasing self-esteem and cognitive skills.

Most importantly, remember this is a new phase for us all, including our schools. We are all learning as we go along, and there may be more change and adjustment along the way. Maintain a focus on the positives when you can and reach out for support, including from your child’s school, when you need it.

 

Further information and support

Information on Family Support Services in Northern Ireland

www.relateni.org/covid19relationshipsupport

PHA/NCB article - Family Time During COVID-19

PHA/Relate article on Relationships, household conflict and helpful strategies

Parentline are available to support parents – freephone 0808 8020 400

Sarah Arnold, Senior Surveillance and Information Scientist in Health Protection, Dr Lynsey Patterson, Head of Health Protection Surveillance, and Dr Claire Neill, Specialty Registrar, Public Health Agency.

Many terms that were unknown to the average person before 2020 have, through the COVID-19 pandemic, become commonplace. Before this year, few people knew what the role of an epidemiologist was. Now, they’re leading press conferences and appearing on breakfast television shows.

With that in mind, there’s still a lot of terminology used daily in news reports and online articles that are difficult to understand. Notable examples of this include incidence and prevalence. Often these words are used interchangeably however, when it comes to surveillance and epidemiological analyses these words have both distinct meanings and purpose.

To help understand the difference between incidence and prevalence, epidemiologists often refer to the familiar concept of water entering and leaving a bath.

Let’s take the term prevalence first and define it in the context of disease. The prevalence is the number of individuals with the disease either at a specific point in time (the point prevalence) or over a specified time period (the period prevalence). 

The key concept about the prevalence is that it includes both new and existing cases of disease. If we refer to our bathtub, the prevalence is the amount of water in the bathtub at a specified point in time.

As we all know, this quantity is not static and we can easily add more water, by turning on the tap, as well as lose water through evaporation or by opening the plug. Turning back to our disease model, the filled bath represents the total number of cases at a point in time which can change (through evaporation or releasing the plug) as individuals recover from the disease or if they unfortunately pass away.

Therefore, the prevalence of a disease in a population is influenced by a number of parameters: the number of new cases (turning on the tap), the speed of recovery – which is influenced by disease severity and treatment options (evaporation) and the number of people that lose their lives to the disease (releasing the plug).

Expressing the prevalence as a raw numbers makes it difficult to compare as it doesn’t take into account different population sizes or risk profiles eg a higher proportion of older people, or people with particular co-morbidities. Therefore, we often express the prevalence as a rate using the population as a denominator.

Turning to COVID-19, the prevalence of COVID-19 in Northern Ireland is the total number of active cases in the country at a specific time. While it is relatively straightforward to identify new cases of disease (through laboratory testing), knowing if an individual is recovered is more challenging particularly for mild cases who self-manage their illness at home.

Therefore, the prevalence of COVID-19 in Northern Ireland is estimated using different assumption about the proportion of the population reporting symptoms. In the latest weekly report, as of 16 August 2020, the prevalence of active cases is estimated to be 31 per 100,000 population assuming 50% of cases have no symptoms. This changes to 18 per 100,000 if only 15% have no symptoms and 77 per 100,000 if 80% of cases experience no symptoms.

The prevalence is an extremely useful measure in public health, particularly for service planning, as it allows us to understand the burden on the health and social care system at a particular point in time. It is more often used for chronic diseases, such as diabetes, because of the challenges of monitoring recovery and deaths for infectious diseases. Measurements of prevalence do have their limitations though, not least because they are influenced by many other factors of the disease. This is where the incidence can be extremely useful.

The incidence of disease is the number of new cases during a specified time period. It is used to describe how quickly the disease occurs in the population and is therefore used to identify increasing transmission and influence decision making about what public health interventions are required to slow this down. The incidence can be presented as a proportion, for example using the population as a denominator, or as a rate such as person-time, which requires individuals are followed up over time.

The former is commonly used in surveillance as we often don’t have access to detailed individual level data that would be available, for example, in a specialised cohort study. Going back to the bathtub, water entering the bath through the tap reflects the addition of new cases of disease to the population, the incidence. If the incidence is high, the water will be gushing into the bathtub whereas if it’s low, water may enter the bathtub a drip at a time.

In terms of COVID-19, the incidence can be observed using the number of positive cases identified using laboratory data. The most recent monthly bulletin shows that there were 387 new cases in the most recent week. As with the prevalence, to facilitate comparisons we express this number as a rate per 100,000 population (an incidence proportion). The most recent estimate of the incidence rate is 20.3 per 100,000 population.

The limitation with this value is that it may potentially underestimate the total incidence if those with very mild symptoms (or none at all) won’t be tested and therefore won’t be represented in the observed value. To account for this, an estimate of incidence is derived which uses the assumption (from the University of Southampton) that there are 1.3 individuals infected for every laboratory confirmed case. Using this methodology, it is estimated the weekly incidence is actually 36 per 100,000 people in Northern Ireland (source: weekly bulletin up to 16 August 2020).

Prevalence and incidence are two highly important measures of disease used in epidemiology. We have used the analogy of water entering and leaving a bathtub to try and explain these terms and their limitations. For this reason, both measures are necessary to give a better understanding of the disease. Decisions made during this pandemic have relied on both the incidence and estimated prevalence of the disease and will continue to be used to inform the provision of appropriate public health advice and support measures such as either relaxing or strengthening local restrictions.

Danny Sinclair, PHA discusses relationships, household conflict and helpful strategies with Elaine Hoey, Clinical Lead at Relate NI.

It is natural that the current upset to normal life may be affecting our entire household, although this could be in a positive or negative way! The relationships between us are so important, as we navigate stormy seas, so we must look after each other. Tips for nurturing relationships, recommended by The Mental Health Foundation are:

• Give time – connect with your family and friends
• Be present – set time aside to not be distracted by work, or your phone, or other interests
• Listen – really listen, and try to focus on the other person’s needs in that moment
• Let yourself be listened to – be honest about how you feel, and let yourself be heard and supported by others
• Recognise unhealthy relationships – these can make us unhappy – recognising this is important, and lets us move forward and find solutions.

Conflict, despite strong relationships, will still occur. Household strains can create and exacerbate conflict between siblings, in parenting, and particularly in areas such as schoolwork and behaviour. Some of the more common sources of conflict are highlighted below, along with suggested strategies to help manage them.

Parenting disagreements

It can be usual for one parent to take the lead on day to day parenting decisions, whereas this may have shifted during lockdown. It can be difficult to agree on issues such as screen time, sugar and snacks, and whether to maintain the ‘pre lockdown’ bed time routine.

 Strategies for managing parental disagreement include:

• Reflect on the bigger picture – looking back, what do you want your children to remember about this time?
• Try to relax on the specifics. Continued conflict negatively impacts a child. Compromises and flexible solutions can often be found instead.
• Nurture each other. Rather than criticising each other, take the opportunity to soothe and connect – we are all in this together after all.

Schoolwork

Managing your child’s education can be stressful, especially if they experience learning challenges.

Strategies here include:

• Prioritise certain material or subjects. Decide early on when to hold your child accountable, and when to let things go.
• Use reward systems – rewards can increase intrinsic motivation when tasks give a sense of accomplishment. Don’t set the bar too high, or leave it too long to make the reward. Bear in mind that our children want our time and a reward can be doing something fun together.

Behaviour challenges

Many of us are exhausted by now. For parents with children who display challenging behaviours, such as intense tantrums, aggression, defiance or emotional outbursts, each day can feel like a marathon.

Strategies here include:

• Manage your demands. It is normal to make requests of your child, but it is easy to run in to double figures in a day! If you are in double figures, do scale back.
• Ignore mildly negative behaviours, often labelled as ‘attitude’. You likely have little control over ‘attitude’. If your child is complying, even with some grumpiness, consider it a win.
• If ignoring annoying behaviour is too painful, use positive instruction. Instead of ‘stop doing that in here’, try ‘please go outside to play’.
• Punishment is easy to overuse and can often exacerbate the issue being tackled. Rewards for positive behaviour can be more effective than punishing ‘bad’ behaviour.

Sibling conflict:

While siblings can be a great comfort and company to one another, there can also be sibling disputes, with parents struggling to know how and when to get involved.

Strategies include:

• Allow siblings to resolve their own conflict where possible.
• Multiple siblings ‘ganging up’ on a single sibling should not be allowed.
• Do not let children be physically aggressive. Be consistent, tackle this firmly and keep your own emotions out of the equation when doing so.

These strategies aim to help ensure a healthy and harmonious home. Should you need more information on healthy relationships during COVID-19:

 

www.relateni.org/images/RelateNI-HealthyRelationships.pdf 

 

www.relateni.org/covid19relationshipsupport

 

Information on Family Support Services in Northern Ireland

 

PHA/NCB article - Family Time During COVID-19

 

For support specifically for parents, freephone Parentline on 0808 8020 400.