The holiday season is meant to be filled with joy, connection and celebration of rituals. Many people, however, are starkly reminded of their grief this time of year and of whom – or what – they have lost.

The added stress of the holiday season doesn’t help. Studies show that the holidays negatively affect many people’s mental health.

While COVID-19-related stressors may have lessened, the grief from change and loss that so many endured during the pandemic persists. This can cause difficult emotions to resurface when they are least expected.

I am a licensed therapist and trauma-sensitive yoga instructor. For the last 12 years, I’ve helped clients and families manage grief, depression, anxiety and complex trauma. This includes many health care workers and first responders who have recounted endless stories to me about how the pandemic increased burnout and affected their mental health and quality of life.

I developed an online program that research shows has improved their well-being. And I’ve observed firsthand how much grief and sadness can intensify during the holidays.

Post-pandemic holidays and prolonged grief

During the pandemic, family dynamics, close relationships and social connections were strained, mental health problems increased or worsened, and most people’s holiday traditions and routines were upended.

Those who lost a loved one during the pandemic may not have been able to practice rituals such as holding a memorial service, further delaying the grieving process. As a result, holiday traditions may feel more painful now for some. Time off from school or work can also trigger more intense feelings of grief and contribute to feelings of loneliness, isolation or depression.

Sometimes feelings of grief are so persistent and severe that they interfere with daily life. For the past several decades, researchers and clinicians have been grappling with how to clearly define and treat complicated grief that does not abate over time.

In March 2022, a new entry to describe complicated grief was added to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which classifies a spectrum of mental health disorders and problems to better understand people’s symptoms and experiences in order to treat them.

This newly defined condition is called prolonged grief disorder. About 10% of bereaved adults are at risk, and those rates appear to have increased in the aftermath of the pandemic.

People with prolonged grief disorder experience intense emotions, longing for the deceased, or troublesome preoccupation with memories of their loved one. Some also find it difficult to reengage socially and may feel emotionally numb. They commonly avoid reminders of their loved one and may experience a loss of identity and feel bleak about their future. These symptoms persist nearly every day for at least a month. Prolonged grief disorder can be diagnosed at least one year after a significant loss for adults and at least six months after a loss for children.

I am no stranger to complicated grief: A close friend of mine died by suicide when I was in college, and I was one of the last people he spoke to before he ended his life. This upended my sense of predictability and control in my life and left me untangling the many existential themes that suicide loss survivors often face.

How grieving alters brain chemistry

Research suggests that grief not only has negative consequences for a person’s physical health, but for brain chemistry too.

The feeling of grief and intense yearning may disrupt the neural reward systems in the brain. When bereaved individuals seek connection to their lost loved one, they are craving the chemical reward they felt before their loss when they connected with that person. These reward-seeking behaviors tend to operate on a feedback loop, functioning similar to substance addiction, and could be why some people get stuck in the despair of their grief.

One study showed an increased activation of the amygdala when showing death-related images to people who are dealing with complicated grief, compared to adults who are not grieving a loss. The amygdala, which initiates our fight or flight response for survival, is also associated with managing distress when separated from a loved one. These changes in the brain might explain the great impact prolonged grief has on someone’s life and their ability to function.

Recognizing prolonged grief disorder

Experts have developed scales to help measure symptoms of prolonged grief disorder. If you identify with some of these signs for at least one year, it may be time to reach out to a mental health professional.

Grief is not linear and doesn’t follow a timeline. It is a dynamic, evolving process that is different for everyone. There is no wrong way to grieve, so be compassionate to yourself and don’t make judgments on what you should or shouldn’t be doing.

Increasing your social supports and engaging in meaningful activities are important first steps. It is critical to address any preexisting or co-occurring mental health concerns such as anxiety, depression or post-traumatic stress.

It can be easy to confuse grief with depression, as some symptoms do overlap, but there are critical differences.

If you are experiencing symptoms of depression for longer than a few weeks and it is affecting your everyday life, work and relationships, it may be time to talk with your primary care doctor or therapist.

A sixth stage of grief

I have found that naming the stage of grief that someone is experiencing helps diminish the power it might have over them, allowing them to mourn their loss.

For decades, most clinicians and researchers have recognized five stages of grief: denial/shock, anger, depression, bargaining and acceptance.

But “accepting” your grief doesn’t sit well for many. That is why a sixth stage of grief, called “finding meaning,” adds another perspective. Honoring a loss by reflecting on its meaning and the weight of its impact can help people discover ways to move forward. Recognizing how one’s life and identity are different while making space for your grief during the holidays might be one way to soften the despair.

When my friend died by suicide, I found a deeper appreciation for what he brought into my life, soaking up the moments he would have enjoyed, in honor of him. After many years, I was able to find meaning by spreading mental health awareness. I spoke as an expert presenter for suicide prevention organizations, wrote about suicide loss and became certified to teach my local community how to respond to someone experiencing signs of mental health distress or crisis through Mental Health First Aid courses. Finding meaning is different for everyone, though.

Sometimes, adding a routine or holiday tradition can ease the pain and allow a new version of life, while still remembering your loved one. Take out that old recipe or visit your favorite restaurant you enjoyed together. You can choose to stay open to what life has to offer, while grieving and honoring your loss. This may offer new meaning to what – and who – is around you.

If you need emotional support or are in a mental health crisis, dial 988 or chat online with a crisis counselor.

Mandy Doria, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.

But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.

Who missed out?

We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.

Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.

How stark are the differences?

Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.

People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.

Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.

Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.

Why are people missing out?

COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.

Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.

Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.

Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.

Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.

Care should go those who need it

Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.

But all Australians who are eligible for antivirals should have the same chance of getting them.

These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.

Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.

People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.

All those at-risk groups have been more likely to miss out on antivirals.

It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.

A 3-step plan to meet patients’ needs

The federal government should do three things to close these gaps in preventive care.

First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.

Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.

Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.

COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.

In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.

Peter Breadon, Program Director, Health and Aged Care, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.