‘Tis the season. The holidays are a time of celebration, togetherness and giving. This is the season to be jolly, to share in revelry, to reflect on the year now ending and to welcome the one to come.
That of course is the expectation and for many it is the season for good cheer when we embrace the holiday spirit and cherish time spent with loved ones. But for others, the holidays can instead be marked by loneliness and anxiety – feelings which left unaddressed can lead to depression, cause great suffering and even lead to suicide. (Notably, research confirms that, contrary to common belief, suicide rates do not increase during the holidays, but the mental health issues that arise at this time of year can linger and grow worse in the spring and summer.)
This holiday season has the potential to be particularly problematic for Americans’ mental health. Although the latest government statistics point to inflation easing, financial stress – a source of anxiety year-round for many – remains acute. A recent study by Beyond Finance found that 57% of Americans are concerned about paying for gifts this year and 68% expect holiday spending to worsen their stress levels.
Other important holiday stressors include social anxiety, either from being alone or with family members; the grief and loss of loved ones, particularly those associated with joyous holiday memories; difficult family dynamics like divorce; and even discord during a time of polarizing politics. Is it any wonder then that many might be more prone to feelings of depression and anxiety as we approach the holiday season?
Fortunately, there are a number of valuable tools and strategies proven to help individuals effectively navigate the holiday blues. Reminding ourselves of these tips and the challenges they help address is the first step to identify and aid those who may need assistance confronting the unintended mental health challenges the holidays can bring.
Be mindful of the warning signs of major depressive disorders and take action.
Holiday induced mental health issues can manifest themselves in many ways, but several conditions and behaviors are stark warning signs. These include physical warning signs like changing sleep patterns, the loss of appetite or overeating, increased drug and alcohol use and noticeable changes in overall behavior.
Other manifestations can be less visible, but are nonetheless equally important warning signs. These include persistent negative thoughts, mood changes and irritability, incessant worrying, a diminished spiritual life and of course suicidal thoughts. If you witness any of these signs, ask the individual if they feel depressed or overwhelmed. If you observe two or three of these symptoms simultaneously, it may indicate the onset of depression, for which professional help should be sought as soon as possible.
The appropriate treatment path may differ from individual to individual for depression, depending on the symptoms and severity. Interventions may include virtual or in-person support from primary care and behavioral health providers, Employee Assistance Programs, peer support systems and enrollment in programs offered by community-based groups that provide counseling or direct assistance with food, childcare and other issues that impact emotional health. In all cases, those who suffer from a depressive disorder should be informed of the 988 Suicide and Crisis Lifeline and the direct access to counselors it delivers 24/7/365.
Help patients proactively address holiday related stress and anxiety early.
Even in the absence of a major depression disorder, it is imperative that providers encourage patients to proactively take steps to prevent holiday-inspired mental health issues and address any issues that arise. Motivational interviewing, in which questions help patients self-identify the issues facing them and potential solutions, is particularly helpful at this time of year. Proven strategies and ideas to incorporate in motivational interviews may include:
- Remind patients that depression and anxiety can follow a seasonal pattern. It is well-known among physical and behavioral health professionals that many people, particularly those in colder climates, experience depression in the late fall and winter. Many patients do not know, however, that what was formerly known as seasonal affective disorder is a real health issue caused by a lack of sunlight, as former United States Surgeon General Boris D. Lushniak noted. Just knowing that they may be suffering from a recognized condition can be a powerful therapeutic stress reliever for many patients.
- Encourage patients to share their feelings with friends and family if the holidays cause them stress and discomfort. For many people, the first step to address the holiday season’s impact on mental health is to acknowledge any discomfort it causes. Patients who experience depression or anxiety should consider informing friends and family who may be supportive that they find the holidays difficult and are sad or struggling.
- Discuss holiday spending. As providers we aren’t financial advisors, but we can help patients who are feeling financial stress by proactively discussing the impact that holiday spending can have on mental health. In this way, we can help alleviate the significant anxiety many feel when they receive gift-related bills in the new year.
- Help patients remember what they love about family members who cause friction. Holiday gatherings can be stressful, but during these times of division, it is more important than ever to remind patients to find common ground and agree to disagree. An inquisitive conversation that prompts patients with questions can help them identify what they love.
- Prompt patients to think of physical activity and self-care. It always makes sense to ask questions about how well patients are able to follow healthy habits and what gets in the way of them. In this way, you can help people self-identify skills they can use to improve.
Ask patients what the holiday season means to them. Asking what makes the season more meaningful, and less meaningful, helps patients put the holidays in perspective. Remember, too, that not all patients are Christians. What makes this time of year special for so many differs from person to person. The holidays are best enjoyed when individuals find ways to effectively manage its hectic nature, the travel, the parties, the exchange of gifts and other aspects of the season that, while valued and well-meaning, have the potential to burden us emotionally. Motivational interviewing techniques that use questions to help people figure out the answers that make the most sense for them is the best approach to ensure mental health at a special time of year.
Dr. Steven Pratt is the senior medical director overseeing the employer segment at Magellan Healthcare, where he is responsible for clinical oversight of utilization management, case management and a unique disability management program. Previously, he served as the executive medical director of behavioral health for the Minnesota Department of Human Services. Dr. Pratt also held executive leadership positions at United Health Group. He received his medical and bachelor’s degrees from the University of Minnesota.