Activity Transcript

Hansa Bhargava, MD: Hello, I'm Dr Hansa Bhargava, chief medical officer of Medscape Education. Welcome. Today, I'm very excited to have an expert, Dr Gregory Mattingly, who is joining me. Greg, thank you so much for being here.

Gregory W. Mattingly, MD: Glad to be here.

Dr Bhargava: Before we start, would you mind telling us a little bit about yourself?

Dr Mattingly: Certainly. I'm a psychiatrist here in St. Louis, Missouri. Came to this never thinking I was going to be in mental health, Hansa. When I was going through my medical school training, I just got excited by what can happen in the brain.

My clinical practice, I've done this for 30 years. I work with a team of doctors, nurse practitioners. We have a research team exploring children, adolescents, and adults that have mental health conditions.

One of my hot topics, as you know, is how do we promote resilience? What is the neurobiology of resilience, what is it that helps all of us to be more resilient? And how do we help our children and the patients we take care of to be more resilient?

Dr Bhargava: Well, thank you so much for joining me. I love that topic. I love it because it's so important today. There's so much going on right now, especially with the mental health of our youth. On that note, can you give us a little bit of context of what is happening out there? What are you seeing in your practice as it pertains to kids and youth?

Dr Mattingly: Certainly. We all know, in the last 2 years, we've had a major disruption for the school environment and the social environment for most of the children we take care of. Many children have lost a year of formal education, of in-person education. They've lost certain developmental milestones, both socially and emotionally for some of my younger children. There's been significant academic gaps for my older children, Hansa.

Those academic gaps occur for the general child who's going in, and they haven't been in person, so maybe they haven't had a lab class, or they haven't had tutoring, or they haven't had that one-to-one connection with the teacher. But it's been even more important for some of the kids that I take care of who are already vulnerable, the kids that already struggle with a little bit of attention-deficit/hyperactivity disorder (ADHD) or a little learning disability; the kids who struggle with a little depression or a little anxiety. These times have been especially vulnerable.

Then even some of the families where maybe it's a single working parent, so they're stressed, they're not able to be there with their child, they can't be the tutor for their child when they've been doing virtual learning.

I think there's increased diversity of needs for kids that already have mental health conditions, but people that already have diverse economic and financial challenges as well.

Dr Bhargava: Yeah, absolutely. You make such a great point. There's cognitive diversity, learning styles that are different, learning differences, and also, of course, underlying mental health issues. Then there's actually, outside, diversity of circumstances, which could be socioeconomic with single parents. Are they living in urban neighborhoods? The list goes on and on. We know that. So absolutely, those populations would be affected much more, I'd imagine.

I'm just going to go back to something you said, the disruption of the pandemic. Can I just ask you, Greg, as a pediatrician myself, I wonder if there was already issues in mental wellness and the resilience even prior to the pandemic, would you agree?

Dr Mattingly: Certainly. It's a well-known fact that, unfortunately, we've been losing the battle to depression. Whereas many other health conditions, cardiovascular disease and things like that, we've been doing better, outcomes with depression have actually been getting worse over the last 10 to 20 years.

So we start talking about, how do we give holistic care? How do we make sure that we're recognizing the people that do need care? How do we build treatment models where they get consistent ongoing care and they don't fall through the gaps in care? Because a lot of our children that have preexisting mental health conditions, we've not been helping them as much as we'd like to, obviously.

Dr Bhargava: Do you think that it's possible to reduce the risk of mental health illness if we focus on prevention strategies, just like resilience?

Dr Mattingly: One hundred percent. You and I have talked about this, but there's a really important article out there that looked at children that were genetically at risk of depression and mood disorders, it runs in their family, and then said, "What are the things we can do to help them to have better outcomes?"

The number 1 predictive factor, number 1, wasn't how rich or poor you were, or how smart, or if you had issues, was the number of positive life events. So if you come to this, and you already had genetic underpinnings for being at risk or being vulnerable, putting in positive life events ...

My simplistic way is, positive life events don't just make you feel good. They give you little puffs of neural growth factors that make nerve cells grow and sprout, that makes your brain more neurally connected, which makes it more resilient when it's put under stress.

So in my community, and we've discussed this, I refer to Boys and Girls Club of St. Charles. I'm their number 1 referral source. I can't help if a kid comes from a single-parent home. I can't help if maybe Mom or Dad have depression or anxiety or ADHD. But I can try to make sure I build in all those positive things I can in that kid's life.

Dr Bhargava: Let's dig into that positive life event. First of all, I would love for you to share the authors of the study, so if our clinicians are watching this, they are able to look at that. That's such a fascinating ...

Did they do functional magnetic resonance images (fMRIs) or MRIs in this study? The second question, I would say, is, what is a positive life event? Is it a trip to Turkey that I've been hoping to put on the radar, or is it my Starbucks?

Dr Mattingly: This was a study that looked at young girls that were in their teenage years, and it followed them into their 20s. They had genetic high risk of depression. They said, "Listen. Let's take a look at the kids that get depression as they become young women. But more importantly, let's take a look at the women who are resilient and don't get depression, even though genetically they're at risk."

As you said, they followed them on all different types of things. They looked at their cognitive function, their emotional function, but they did fMRIs where they looked at neural connectivity.

What they found is the girls that were resilient to depression, that didn't get depression, even though genetically they had the wiring, they had really neurally connected brains on functional MRIs. So, in response to stress, I can recruit more neural tissue. A tough day at school, a tough day at home, a tough day with a friendship, I can recruit cognitive tissue, emotional tissue. The brain can stay resilient.

When they looked at why did some of those girls have such highly neurally connected brains, it was something we've already known, but the study proved it. It was that positive life events that these girls had over time caused nerve cells to grow, caused their neural networks to be more neurally connected, which made these girls more resilient to not getting depression.

I think it's a call to arms for all of us. We've known that good things in life aren't just good. They help you to persevere. They make you motivated to want to do things in the future. They actually make your neural networks more resilient.

Dr Bhargava: I think you make such a great point. Look, that is a great study. It's intuitively what we know, but it's great to have it as evidence.

Let me ask you. We can talk about the signs and symptoms of depression and anxiety and all of that with our clinicians. But before we do that, let's talk a little bit more about prevention strategies, and what we can actually do in the clinical setting to talk to families and patients about that. What are your thoughts about that?

Dr Mattingly: It's a lot of things we've always known, which is balance. Balance is important in life. Not having too much screen time, not being overly extended emotionally or socially, making sure we're having balance in our physical life, we're getting good sleep, we're not staying up so late studying because we want to make a good grade that then we're sleep deprived so we're not emotionally as good as we should be at that point.

So, balance. Balance with exercise, balance with good social connection, balance having a sense of purpose in life, balance taking care of myself on a physical holistic nature, getting good sleep, making sure I exercise, watching my diet, all of those things that come together in a holistic fashion.

It's never been more important. When you look at the brain being stressed or our lives being stressed, these holistic things have an even bigger influence on helping the resilience of the patients we take care of, and our own resilience as caregivers. For you to help somebody else, you got to take care of yourself. So, as you talk about these factors that build resilience in your patients, view your checklist with yourself and your own family, and making sure you're doing them for yourself as well.

Dr Bhargava: I love that. I think it is multifactorial, and we must actually be constantly striving for balance. There's so many facets of balance. You have a great slide that you shared with us. Should we share that with the audience here?

Dr Mattingly: This is a study that we put together, one of my good friends in Australia. This goes back to the holistic nature of these factors around the world, Hansa. I don't care if you're growing up in the inner city of St. Louis, or if you're growing up in rural Kentucky, or out in Boston. These factors tend to help resilience for all of us.

Getting a good night's sleep. If you're sleep deprived, we've all felt it, but having disruptive sleep multiple nights in a row, it's bad for all of us. There was a great study that just came out that said, "What can parents do to help their kids have better sleep?" If you just shifted your sleep time by 1 hour, instead of going to bed at 10:00, let's have you try to go to bed at 9:00, your kids got 45 minutes of more sleep.

So, making sure you set those realistic boundaries for your kids. Sometimes as a parent, you have to set the guardrails. "I can tell you're running thin right now. We got to get you some more sleep, because you're going to function better at school. You're going to do better emotionally. You're going to feel better about yourself. You're going to have more energy. So, let's try to get you to bed at 10:00 instead of 11:00 for the next week or 2. Let's see how we do with that."

Exercise is good for all of us. My take-home is, I want 30 minutes, 3 times a week, of something. I don't care if they're jogging, exercising, doing dance videos, if they're doing sports at school: 30 minutes, 3 times a week, of something.

I'll ask my kids, always, every visit, "Who are your best friends these days? Who do you hang out with? Who do you eat lunch with?" Because I want to make sure they're emotionally and socially engaged.

When it comes to connection, all of my kids in middle school or high school, my rule is they have to be a part of 2 things. Two things. I don't care what those 2 things are. It can be Boy Scouts. It can be orchestra. It can be the football team. It can be the math club. It can be the gaming club. It can be the fantasy club. I don't care what it is, but you have to be a part of 2 things so that you're socially connected, you learn about yourself, and you learn about the reciprocal interactions of social connection.

Dr Bhargava: Excellent tips, excellent tips.

Let me get into a little bit of what our clinicians might be wondering about. What are some of the signs and symptoms that are red flags for you while you're having these discussions? What if a parent said, "Well, I just can't get my son out of the room," for example?

Dr Mattingly: Once again, the kid being detached. If your kids are hanging out in their room by themselves, I think, as a parent, you don't come in and scold that kid. You don't yell at them. Maybe they're already feeling demoralized. Maybe they're struggling with some depression or anxiety.

Come in and say, "Listen. I love you too much to let you sit in here by yourself. Come out here. Let's watch a movie." "I don't want to watch a movie." "Just lay on the couch and be here with us. I love you. I love you too much to let you sit in here by yourself."

Dr Bhargava: I love that. Love that way of framing it. Yep.

Dr Mattingly: Those kind of things. Same thing with limiting screen time. Lots of studies have shown that excessive screen time, it worsens cognition. We all know it. There was a great study that came out of 10 high schools in Los Angeles. The kids that had the highest 10% of social media use had the worst cognitive problems in the group.

You want to keep balance. A little bit is fine. We all like video games or a movie or whatever, but flash social media, flash stimulus tends to degrade the ability to stay focused for long periods of time. So, a little bit, once again, balance. "Hey. An hour of screen time. Now let's go do something. Let's go out and kick a soccer ball around. Let's throw a football around. Let's go for a walk."

So balance, within your life, those things.

Watch those kids that aren't having good sleep. If a kid's sleep is fragmented, you should start worrying. What's going on? Is there anxiety? Is there depression? Is there social issues going on? What's happening there? Is it signs of substance abuse? My kids that started having fragmented sleep, that's something I watch very carefully.

Then obviously, if you start seeing signs of emotional changes. A kid who can't get out of their own head with worry. A kid who's looking down in a way that's not normal. A kid whose temper is flaring in a way that it's not just reactive, but they're stuck that way. They can't seem to modulate it. Those are all warning signs for us, I think, as clinicians.

Dr Bhargava: Those are some excellent points.

Last couple questions here. We're almost at time. My question is, is there some resources that you can point to, Greg, that clinicians can easily tap into, with all these great points that you've made?

Dr Mattingly: Certainly. Once again, most of us live in a community where there's a Boys and Girls Club. Those organizations, for your children that come from single-parent homes or places where there's not a lot of support, most of them provide transportation, mentorship, tutoring, things of that nature. Church youth groups, another great support for a lot of our kids.

The school counselor. Most of our high schools these days have an embedded mental health worker in the counselor. They recognize the importance of mental health. So don't be afraid to have your families reach out and say, "Listen. I'm worried about Jimmy, I'm worried about Susan. What are you seeing at school with them? Are there things we should keep an eye on?"

Then always go back to ... Who's your primary care or your pediatrician? "I'm worried about my son. I'm worried about my daughter. There's some symptoms here that I'm worried about. Is this normal, or should we go see a counselor? Should we see a doctor, a physician? Do we need intervention maybe with medicines?"

Dr Bhargava: Great points.

Lastly, before we finish off, you said something at the very beginning, and that was that resiliency is important not just for our patients and their caregivers, but also for us. What are 2 or 3 things that you would say to the clinicians who are watching this, to make sure that they are taking care of themselves?

Dr Mattingly: Hansa, I'll give you the same tip I give my kids. If you go into school thinking, "This stinks and I don't want to be here," you're probably going to have tough day at school. If you go into school saying, "Listen. I'm going to look forward to 1 thing each day. I'm going to look forward to having lunch with Jimmy. I'm going to look forward to Coach So-and-so who's a lot of fun" ... We need to do the same thing in our own daily lives.

If you go into work thinking, "It's going to be a tough Monday, I don't want to be here," it's going to be a tough Monday. If you go into work thinking, "Hey, I'm looking forward to seeing Tom. I wonder how he is doing? He's a pretty cool guy. I haven't seen him in a while. I wonder what's going on," or, "I look forward to seeing one of my colleagues. I know they just got back from vacation. I can't wait to hear from them," your day's going to be a lot better.

Number...

Dr Bhargava: Go ahead.

Dr Mattingly: Number 2, take care of your own mental health. This has been a time of burnout for a lot of us. If you're not sleeping, if you're struggling with depression, or if you're struggling with anxiety, in the same way it's okay to reach out and help others, it's okay to reach out and ask for help.

Dr Bhargava: Absolutely. I think that that is such a great adaptive tool for all of us. Reframing, shifting perspective. It's essential right now, but just looking forward to 1 thing.

Great. Well, thank you so much. As we finish off, is there anything else you'd like to add, Dr Mattingly, Greg?

Dr Mattingly: Yeah. Let me just say that what we do has never been more needed. When you talk about our sense of purpose, our patients, the mental health needs, it's never been more important. It's never been more needed. It's why each of us have to work together and do this together for our patients. So, thank you for joining us.

Dr Bhargava: Thank you to everyone who has joined us, and thank you, Dr Mattingly, for being here and providing us such great information.

This transcript has not been copyedited.