The Mental Health First-Aid That You’ll Hopefully Never Need
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Take Your Mental Health As Seriously As General Health!
Sometimes, health and productivity means excelling—sometimes, it means avoiding illness and unproductivity. Both are essential, and today we’re going to tackle some ground-up stuff. If you don’t need it right now, great; we suggest to read it for when and if you do. But how likely is it that you will?
- One in four of us are affected by serious mental health issues in any given year.
- One in five of us have suicidal thoughts at some point in our lifetime.
- One in six of us are affected to at least some extent by the most commonly-reported mental health issues, anxiety and depression, in any given week.
…and that’s just what’s reported, of course. These stats are from a UK-based source but can be considered indicative generally. Jokes aside, the UK is not a special case and is not measurably worse for people’s mental health than, say, the US or Canada.
While this is not an inherently cheery topic, we think it’s an important one.
Depression, which we’re going to focus on today, is very very much a killer to both health and productivity, after all.
One of the most commonly-used measures of depression is known by the snappy name of “PHQ9”. It stands for “Patient Health Questionnaire Nine”, and you can take it anonymously online for free (without signing up for anything; it’s right there on the page already):
Take The PHQ9 Test Here! (under 2 minutes, immediate results)
There’s a chance you took that test and your score was, well, depressing. There’s also a chance you’re doing just peachy, or maybe somewhere in between. PHQ9 scores can fluctuate over time (because they focus on the past two weeks, and also rely on self-reports in the moment), so you might want to bookmark it to test again periodically. It can be interesting to track over time.
In the event that you’re struggling (or: in case one day you find yourself struggling, or want to be able to support a loved one who is struggling), some top tips that are useful:
Accept that it’s a medical condition like any other
Which means some important things:
- You/they are not lazy or otherwise being a bad person by being depressed
- You/they will probably get better at some point, especially if help is available
- You/they cannot, however, “just snap out of it”; illness doesn’t work that way
- Medication might help (it also might not)
Do what you can, how you can, when you can
Everyone knows the advice to exercise as a remedy for depression, and indeed, exercise helps many. Unfortunately, it’s not always that easy.
Did you ever see the 80s kids’ movie “The Neverending Story”? There’s a scene in which the young hero Atreyu must traverse the “Swamp of Sadness”, and while he has a magical talisman that protects him, his beloved horse Artax is not so lucky; he slows down, and eventually stops still, sinking slowly into the swamp. Atreyu pulls at him and begs him to keep going, but—despite being many times bigger and stronger than Atreyu, the horse just sinks into the swamp, literally drowning in despair.
See the scene: The Neverending Story movie clip – Artax and the Swamp of Sadness (1984)
Wow, they really don’t make kids’ movies like they used to, do they?
But, depression is very much like that, and advice “exercise to feel less depressed!” falls short of actually being helpful, when one is too depressed to do it.
If you’re in the position of supporting someone who’s depressed, the best tool in your toolbox will be not “here’s why you should do this” (they don’t care; not because they’re an uncaring person by nature, but because they are physiologically impeded from caring about themself at this time), but rather:
“please do this with me”
The reason this has a better chance of working is because the depressed person will in all likelihood be unable to care enough to raise and/or maintain an objection, and while they can’t remember why they should care about themself, they’re more likely to remember that they should care about you, and so will go with your want/need more easily than with their own. It’s not a magic bullet, but it’s worth a shot.
What if I’m the depressed person, though?
Honestly, the same, if there’s someone around you that you do care about; do what you can to look after you, for them, if that means you can find some extra motivation.
But I’m all alone… what now?
Firstly, you don’t have to be alone. There are free services that you can access, for example:
- US: https://nami.org/help
- Canada: https://www.wellnesstogether.ca/en-CA
- UK: https://www.samaritans.org/
…which varyingly offer advice, free phone services, webchats, and the like.
But also, there are ways you can look after yourself a little bit; do the things you’d advise someone else to do, even if you’re sure they won’t work:
- Take a little walk around the block
- Put the lights on when you’re not sleeping
- For that matter, get out of bed when you’re not sleeping. Literally lie on the floor if necessary, but change your location.
- Change your bedding, or at least your clothes
- If changing the bedding is too much, change just the pillowcase
- If changing your clothes is too much, change just one item of clothing
- Drink some water; it won’t magically cure you, but you’ll be in slightly better order
- On the topic of water, splash some on your face, if showering/bathing is too much right now
- Do something creative (that’s not self-harm). You may scoff at the notion of “art therapy” helping, but this is a way to get at least some of the lights on in areas of your brain that are a little dark right now. Worst case scenario is it’ll be a distraction from your problems, so give it a try.
- Find a connection to community—whatever that means to you—even if you don’t feel you can join it right now. Discover that there are people out there who would welcome you if you were able to go join them. Maybe one day you will!
- Hiding from the world? That’s probably not healthy, but while you’re hiding, take the time to read those books (write those books, if you’re so inclined), learn that new language, take up chess, take up baking, whatever. If you can find something that means anything to you, go with that for now, ride that wave. Motivation’s hard to come by during depression and you might let many things slide; you might as well get something out of this period if you can.
If you’re not depressed right now but you know you’re predisposed to such / can slip that way?
Write yourself instructions now. Copy the above list if you like.
Most of all: have a “things to do when I don’t feel like doing anything” list.
If you only take one piece of advice from today’s newsletter, let that one be it!
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Beating Sleep Apnea
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Healthier, Natural Sleep Without Obstruction!
Obstructive Sleep Apnea, the sleep disorder in which one periodically stops breathing (and thus wakes up) repeatedly through the night, affects about 25% of men and 10% of women:
Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study
Why the gender split?
There are clues that suggest it is at least partially hormonal: once women have passed menopause, the gender split becomes equal.
Are there other risk factors?
There are few risk other factors; some we can’t control, and some we can:
- Being older is riskier than being younger
- Being overweight is riskier than not being overweight
- Smoking is (what a shock) riskier than not smoking
- Chronic respiratory diseases increase risk, for example:
- Asthma
- COPD
- Long COVID*—probably. The science is young for this one so far, so we can’t say for sure until more research has been done.
- Some hormonal conditions increase risk, for example:
- Hypothyroidism
- PCOS
*However, patients already undergoing Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea may have an advantage when fighting a COVID infection:
What can we do about it?
Avoiding the above risk factors, where possible, is great!
If you are already suffering from obstructive sleep apnea, then you probably already know about the possibility of a CPAP device; it’s a mask that one wears to sleep, and it does what its name says (i.e. it applies continuous positive airway pressure), which keeps the airway open.
We haven’t tested these, but other people have, so here are some that the Sleep Foundation found to be worthy of note:
Sleep Foundation | Best CPAP Machines of 2024
What can we do about it that’s not CPAP?
Wearing a mask to sleep is not everyone’s preferred way to do things. There are also a plethora of surgeries available, but we’ll not review those, as those are best discussed with your doctor if necessary.
However, some lifestyle changes can help, including:
- Lose weight, if overweight. In particular, having a collar size under 16” for women or under 17” for men, is sufficient to significantly reduce the risk of obstructive sleep apnea.
- Stop smoking, if you smoke. This one, we hope, is self-explanatory.
- Stop drinking alcohol, or at least reduce intake, if you drink. People who consume alcohol tend to have more frequent, and longer, incidents of obstructive sleep apnea. See also: How To Reduce Or Quit Drinking
- Avoid sedatives and muscle relaxants, if it is safe for you to do so. Obviously, if you need them to treat some other condition you have, talk this through with your doctor. But basically, they can contribute to the “airway collapses on itself” by reducing the muscular tension that keeps your airway the shape it’s supposed to be.
- Sleep on your side, not your back. This is just plain physics, and a matter of wear the obstruction falls.
- Breathe through your nose, not through your mouth. Initially tricky to do while sleeping, but the more you practice it while awake, the more it becomes possible while asleep.
- Consider a nasal decongestant before sleep, if congestion is a problem for you, as that can help too.
For more of the science of these, see:
Cultivating Lifestyle Transformations in Obstructive Sleep Apnea
There are more medical options available not discussed here, too:
American Sleep Apnea Association | Sleep Apnea Treatment Options
Take care!
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Brain Benefits in 3 Months…through walking?
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Keeping it Simple
Today’s video (below) is another Big Think production (can you tell that we love their work?). Wendy Suzuki does a wonderful job of breaking down the brain benefits of exercise into three categories, within three minutes.
The first question to ask yourself is: what is your current level of fitness?
Low Fitness
Exercising, even if it’s just going on a walk, 2-3 times a week improves baseline mood state, as well as enhances prefrontal and hippocampal function. These areas of the brain are crucial for complex behaviors like planning and personality development, as well as memory and learning.
Mid Fitness
The suggested regimen is, without surprise, to slightly increase your regular workouts over three months. Whilst you’re already getting the benefits from the low-fitness routine, there is a likelihood that you’ll increase your baseline dopamine and serotonin levels–which, of course, we love! Read more on dopamine here, here, or here.
High Fitness
If you consider yourself in the high fitness bracket then well done, you’re doing an amazing job! Wendy Suzuki doesn’t make many suggestions for you; all she mentions is that there is the possibility of “too much” exercise actually having negative effects on the brain. However, if you’re not competing at an Olympic level, you should be fine.
Fitness and Exercise in General
Of course, fitness and exercise are both very broad terms. We would suggest that you find an exercise routine that you genuinely enjoy–something that is easy to continue over the long term. Try browsing different areas of exercise to see what resonates with you. For instance, Total Fitness After 40 is a great book on all things fitness in the second half of your life. Alternatively, search through our archive for fitness-related material.
Anyway, without further ado, here is today’s video:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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I’m a medical forensic examiner. Here’s what people can expect from a health response after a sexual assault
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An estimated one in five women and one in 16 men in Australia have experienced sexual violence.
After such a traumatic experience, it’s understandable many are unsure if they want to report it to the police. In fact, less than 10% of Australian women who experience sexual assault ever make a police report.
In Australia there is no time limit on reporting sexual assault to police. However, there are tight time frames for collecting forensic evidence, which can sometimes be an important part of the police investigation, whether it’s commenced at the time or later.
This means the decision of whether or not to undergo a medical forensic examination needs to be made quite quickly after an assault.
I work as a medical forensic examiner. Here’s what you can expect if you present for a medical forensic examination after a sexual assault.
fizkes/Shutterstock A team of specialists
There are about 100 sexual assault services throughout Australia providing 24-hour care. As with other areas of health care, there are extra challenges in regional and rural areas, where there are often further distances to travel and staff shortages.
Sexual assault services in Australia are free regardless of Medicare status. To find your nearest service you can call 1800 RESPECT (1800 737 732) or Full Stop Australia (1800 385 578) who can also provide immediate telephone counselling support.
It’s important to call the local sexual assault service before turning up. They can provide the victim-survivor with information and advice to prevent delays and make the process as helpful as possible.
The consultation usually occurs in a hospital emergency department which has a designated forensic suite, or in a specialised forensic service.
The victim-survivor is seen by a doctor or nurse trained in medical and forensic care. There’s a sexual assault counsellor, crisis worker or social worker present to support the patient and offer counselling advice. This is called an “integrated response” with medical and psychosocial staff working together.
In most cases the victim-survivor can have their own support person present too.
Depending on what the victim-survivor wants, the doctor or nurse will take a history of the assault to guide any medical care which may be needed (such as emergency contraception) and to guide the examination.
Sexual assault services are always very aware of giving victim-survivors a choice about having a medical forensic examination. If a person presents to a sexual assault service, they can receive counselling and medical care without undergoing a forensic examination if they do not wish to. https://www.youtube.com/embed/CGlbTgia0Ek?wmode=transparent&start=0 Sexual assault services are inclusive of all genders.
Collecting forensic samples
Samples collected during a medical forensic examination can sometimes identify the perpetrator’s DNA or intoxicating substances (alcohol or drugs that might be relevant to the investigation). The window of opportunity to collect these samples can be as short as 12 hours, or up to 5–7 days, depending on the nature of the sexual assault.
In most of Australia, an adult who has experienced a recent sexual assault can be offered a medical forensic examination without making a report to police.
Depending on the state or territory, the forensic samples can usually be stored for 3 to 12 months (up to 100 years in Tasmania). This allows the victim-survivor time to decide if they want to release them to police for processing.
The doctor or nurse will collect the samples using a sexual assault investigation kit, or a “rape kit”.
Collecting these samples might involve taking swabs to try to detect DNA from external and internal genital areas and anywhere there may have been DNA transfer. This can be from skin cells, where the perpetrator touched the victim-survivor, or from bodily fluids including semen or saliva.
The doctor or nurse carrying out the examination do their best to minimise re-traumatisation, by providing the victim-survivor information, choices and control at every step of the process.
The victim-survivor can usually have a support person with them. Monkey Business Images/Shutterstock How about STIs and pregnancy?
During the consultation, the doctor or nurse will address any concerns about sexually transmitted infections (STIs) and pregnancy, if applicable.
In most cases the risk of STIs is small. But follow-up testing at 1–2 weeks for infections such as chlamydia and gonorrhoea, and at 6–12 weeks for infections such as syphilis and HIV, is usually recommended.
Emergency contraception (sometimes called the “morning after pill”) can be provided to prevent pregnancy. It can be taken up to five days after sexual assault (but the sooner the better) with follow-up pregnancy testing recommended at 2–3 weeks.
Things have improved over time
When I was a junior doctor in the late 90s, taking forensic swabs was usually the responsibility of the busy obstetrics and gynaecology trainee in the emergency department, who was often managing multiple patients and had little training in forensics. There was also usually no supportive counsellor.
Anecdotally, both the doctor and the patient were traumatised by this experience. Research shows that when specialised, integrated services are not provided, victim-survivors’ feelings of powerlessness are magnified.
But the way we carry out medical forensic examinations after sexual assault in Australia has improved over the years.
With patient-centred practices, and designated forensic and counselling staff, the experience for the patient is thought to be empowering rather than re-traumatising.
Our research
In new research published in the Australian Journal of General Practice, my colleagues and I explored the experience of the medical forensic examination from the victim-survivor’s perspective.
We surveyed 291 patients presenting to a sexual assault service in New South Wales (where I work) over four years.
Some 75% of patients reported the examination was reassuring and another 20% reported it was OK. Only 2% reported that it was traumatising. The majority (98%) said they would recommend a friend present to a sexual assault service if they were in a similar situation.
While patients spoke positively about the care they received, many commented that the sexual assault service was not visible enough. They didn’t know how to find it or even that it existed.
We know many victim-survivors don’t present to a sexual assault service or undergo a medical forensic examination after a sexual assault. So we need to do more to increase the visibility of these services.
The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.
Mary Louise Stewart, Senior Career Medical Officer, Northern Sydney Local Health District; PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Where Nutrition Meets Habits!
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Where Nutrition Meets Habits…
This is Claudia Canu, MSc., INESEM. She’s on a mission to change the way we eat:
Often, diet is a case of…
- Healthy
- Easy
- Cheap
(choose two)
She wants to make it all three, and tasty too. She has her work cut out for her, but she’s already blazed quite a trail personally:
❝Nine months before turning 40 years old, I set a challenge for myself: Arrive to the day I turn 40 as the best possible version of myself, physically, mentally and emotionally.❞
~ Claudia Canu
In Her Own Words: My Journey To My Healthy 40s
And it really was quite a journey:
- September: Changes That Destabilize
- October: Looking for Focus
- November: New Habits
- December: Analyzing The First Results
- January: Traveling & Perfectionism
- February: Habits & Goals
- March: Connection, Cravings, & Organization
- April: Physical & Emotional Changes After 7 Months
- May: Reflections & Considerations
- June: Challenge Is Over
For those of us who’d like the short-cut rather than a nine-month quasi-spiritual journey… based on both her experience, and her academic and professional background in nutrition, her main priorities that she settled on were:
- Making meals actually nutritionally balanced, which meant re-thinking what she thought a meal “should” be
- Making nutritionally balanced meals that didn’t require a lot of skill and/or resources
- That’s it!
But, easier said than done… Where to begin?
She shares an extensive list of recipes, from meals to snacks (I thought I was the only one who made coffee overnight oats!), but the most important thing from her is:
Claudia’s 10 Guiding Principles:
- Buy only fresh ingredients that you are going to cook yourself. If you decide to buy pre-cooked ones, make sure they do not have added ingredients, especially sugar (in all its forms).
- Use easy and simple cooking methods.
- Change ingredients every time you prepare your meals.
- Prepare large quantities for three or four days.
- Store the food separately in tightly closed Tupperware.
- Organize yourself to always have ready-to-eat food in the fridge.
- When hungry, mix the ingredients in the ideal amounts to cover the needs of your body.
- Chew well and take the time to taste your food.
- Eat foods that you like and enjoy.
- Do not overeat but don’t undereat either.
We have only two quibbles with this fine list, which are:
About Ingredients!
Depending on what’s available around you, frozen and/or tinned “one-ingredient” foods can be as nutritional as (if not more nutritional than) fresh ones. By “one-ingredient” foods here we mean that if you buy a frozen pack of chopped onions, the ingredients list will be: “chopped onions”. If you buy a tin of tomatoes, the ingredients will say “Tomatoes” or at most “Tomatoes, Tomato Juice”, for example.
She does list the ingredients she keeps in; the idea that with these in the kitchen, you’ll never be in the position of “oh, we don’t have much in, I guess it’s a pizza delivery night” or “well there are some chicken nuggets at the back of the freezer”.
Check Out And Plan: 10 Types Of Ingredients You Should Always Keep In Your Kitchen
Here Today, Gone Tomorrow?
Preparing large quantities for three or four days can result in food for one or two days if the food is unduly delicious
But! Claudia has a remedy for that:
Read: How To Eliminate Food Cravings And What To Do When They Win
Anyway, there’s a wealth of resources in the above-linked pages, so do check them out!
Perhaps the biggest take-away is to ask yourself:
“What are my guiding principles when it comes to food?”
If you don’t have a ready answer, maybe it’s time to tackle that—whether Claudia’s way or your own!
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Eat Dirt – by Dr. Josh Axe
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Dr. Axe describes leaky gut as “a serious disease with a silly name”, and hopes for people to take increased intestinal permeability (as it is otherwise known) seriously, because it can be found at the root of very many diseases, especially inflammatory / autoimmune diseases, which obviously also has significant implications for dementia (of which neuroinflammation is a fair part of the pathogenesis) and cancer (which has been described as largely a matter of immune dysfunction).
He starts strong, albeit anecdotally, with the story of his own mother’s battle with cancer and other diseases, and how her health did a U-turn (for the better) upon taking care of her gut as per the methods described in this book. Dr. Axe doesn’t go so far as to claim the gut-healthy protocol cured her cancer, but makes the (very reasonable) argument that it was a major contributory factor, especially as it was the main input variable that changed.
The book describes the various things that can go wrong with our gut and why, and for each of them presents a solution.
Some of it is as you might guess from the title—live a little dirtier, because the ubiquity of antimicrobials is leaving our immune system slack and maladjusted, causing it to varyingly a) turn on us b) not rise to the occasion when an actual pathogen arrives c) often both. Other matters of consideration include normal gut health nutrition (prebiotics and probiotics, skipping inflammatory foods), matters of medication (especially those that harm the gut), nutraceuticals such as Boswellia serrata, and even stress management.
He provides a program so that the reader can follow along step-by-step, and even a chapter of recipes, but the greatest value in the book is the explanation of gut pathology—because understanding that is foundational to recognizing a lot of things (and he does provide diagnostic questionnaires also, which are helpful).
Bottom line: if you’d like to improve almost any aspect of your health, then your gut is almost always an excellent place to start, and this book will set you on the right path.
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Intermittent Fasting In Women
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Does intermittent fasting differ for women, and if so, how?❞
For the sake of layout, we’ve put a shortened version of this question here, but the actual wording was as below, and merits sharing in full for context
Went down a rabbit hole on your site and now can’t remember how I got to the “Fasting Without Crashing” article on intermittent fasting so responding to this email lol, but was curious what you find/know about fasting for women specifically? It’s tough for me to sift through and find legitimate studies done on the results of fasting in women, knowing that our bodies are significantly different from men. This came up when discussing with my sister about how I’ve been enjoying fasting 1-2 days/week. She said she wanted more reliable sources of info that that’s good, since she’s read more about how temporary starvation can lead to long-term weight gain due to our bodies feeling the need to store fat. I’ve also read about that, but also that fasting enables more focused autophagy in our bodies, which helps with long-term staving off of diseases/ailments. Curious to know what you all think!
~ 10almonds subscriber
So, first of all, great question! Thanks for asking it
Next up, isn’t it strange? Books come in the format:
- [title]
- [title, for women]
You would not think women are a little over half of the world’s population!
Anyway, there has been some research done on the difference of intermittent fasting in women, but not much.
For example, here’s a study that looked at 1–2 days/week IF, in other words, exactly what you’ve been doing. And, they did have an equal number of men and women in the study… And then didn’t write down whether this made a difference or not! They recorded a lot of data, but neglected to note down who got what per sex:
Here’s a more helpful study, that looked at just women, and concluded:
❝In conclusion, intermittent fasting could be a nutritional strategy to decrease fat mass and increase jumping performance.
However, longer duration programs would be necessary to determine whether other parameters of muscle performance could be positively affected by IF. ❞
~ Dr. Martínez-Rodríguez et al.
Those were “active women”; another study looked at just women who were overweight or obese (we realize that “active women” and “obese or overweight women” is a Venn diagram with some overlap, but still, the different focus is interesting), and concluded:
❝IER is as effective as CER with regard to weight loss, insulin sensitivity and other health biomarkers, and may be offered as an alternative equivalent to CER for weight loss and reducing disease risk.❞
As for your sister’s specific concern about yo-yoing, we couldn’t find studies for this yet, but anecdotally and based on books on Intermittent Fasting, this is not usually an issue people find with IF. This is assumed to be for exactly the reason you mention, the increased cellular apoptosis and autophagy—increasing cellular turnover is very much the opposite of storing fat!
You might, by the way, like Dr. Mindy Pelz’s “Fast Like A Girl”, which we reviewed previously
Take care!
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