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WHO releases guidance for mental health in the age of coronavirus

To start, the UN body stated that people should “be empathetic to all those who are affected, in and from any country” as it warned “against stigmatizing anyone who has or had the virus.”

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As WHO and health authorities all over the world act to contain the Covid-19 outbreak, advice on safeguarding mental health was developed by the UN health agency’s Department of Mental Health and Substance Use.

WHO’s guidance targets the general population; healthcare workers; health facility managers; childcare providers; older adults, care providers and people with underlying health conditions; and those who are living in isolation to try and contain the spread of the pandemic.

To start, the UN body stated that people should “be empathetic to all those who are affected, in and from any country” as it warned “against stigmatizing anyone who has or had the virus.” 

It also recommended that people seek information updates only from trusted sources. “The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried”, said WHO. “Get the facts; not the rumors and misinformation”. 

It recommended that people seek information updates only from trusted sources.
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The UN health agency also pointed out the benefits of helping others, including phoning neighbors or community members who may need some extra assistance. This is because “working together as one community can help to create solidarity in addressing COVID-19”.

Others tips were segregated to target specific populations.

Those who help others

  1. People should honor caretakers and healthcare workers… for the role they play to save lives and keep loved ones safe, WHO stated.
  2. The feeling of being “under pressure” by healthworkers is normal while emphasizing that stress is “by no means a reflection that you cannot do your job or that you are weak”. 
  3. Healthworkers should rest sufficiently, eat healthy foods, get physical activity and stay in contact with family and friends.

“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses,” said WHO, with the reminder that “this is not a sprint, it’s a marathon”. 

Those in charge

  1. Protect staff from chronic stress and poor mental health to provide them with the capacities they need to perform their duties. 
  2. Focus on the longer term rather than short-term crisis responses.
  3. Team leaders or health facility managers are encouraged to deliver quality communication and accurate information updates to all staff. 
  4. Consider the benefits of rotating workers from higher- to lower-stress functions, and in partnering inexperienced workers with those who are more experienced, to provide reassurance.
  5. Maintain the buddy system to “provide support, monitor stress and reinforce safety procedures,” WHO stated, advocating for outreach personnel to work in pairs and to “initiate, encourage and monitor work breaks”.

Those with children

  1. Help children find positive ways to express feelings, such as fear and sadness. “Children feel relieved if they can express and communicate their feelings in a safe and supportive environment,” the UN health agency maintained, encouraging that if safe, they be kept close to their parents and family. 
  2. Regular contact with parents should be maintained, such as twice-daily scheduled phone or video calls.

Caring for the vulnerable

  1. Relay clear instructions in a concise, respectful and patient way (pictures may be utilized) when dealing with older adults and people with underlying health conditions who are vulnerable, as they may become more anxious, agitated and withdrawn during the outbreak.
  2. Engage their family and other support networks to provide information and help them practice prevention measures, including handwashing.
  3. When in isolation, stay connected and maintain daily routines, as much as possible. 
  4. Keep things in perspective starting with avoid listening to or following rumors.
“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses.”
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Pregnant, breastfeeding women 

  1. Additionally, the UN Population Fund (UNFPA) recommended that breastfeeding women who become ill should not be separated from their newborns.
  2. While there is no evidence that the illness can be transmitted through breastmilk, UNFPA urged mothers who are infected to wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces.
  3. If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions.

In the end, “mental health and psychosocial support should be made available to affected individuals and their families”.

Health & Wellness

Study finds more severe eating disorders among LGBT individuals

Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options.

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A study published in the International Journal of Eating Disorders finds that eating disorder patients who identify as LGBT have more severe eating disorder symptoms, higher rates of trauma history, and longer delays between diagnosis and treatment than heterosexual, cisgender patients.

“While we know there is a higher prevalence of eating disorders among LGBTQ folks, particularly trans and non-binary folks (with rates estimated to be anywhere from 40% to 70%), our field is in its infancy with researching this health disparity, so I believe research like ours is especially important” said clinical psychologist Jennifer Henretty PhD, CEDS, one of the study’s co-authors who serves as the Executive Director of Clinical Outcomes for Discovery Behavioral Health, Center For Discovery.

Eating disorders are a serious mental health concern: At least 30 million people—of all ages, sexual orientations, and gender-identities—experience an eating disorder in the US alone, and every 62 minutes at least one person dies as a direct result of an eating disorder. In fact, eating disorders have the highest mortality rate of any mental illness.

The most common eating disorders are binge eating disorder, where people regularly eat a large amount in a short period of time; bulimia nervosa, where people regularly eat a large amount in a short period of time and then try to offset the food using harmful behaviors (like vomiting); and anorexia nervosa, where people regularly eat too little due to a fear of gaining weight and thus are malnourished.

The causes of eating disorders are not clear but both biological and environmental factors are thought to play a role. Eating disorders typically begin in adolescence but it appears that the rate of the disorder may be on the rise in middle-aged and even older adults.

The peer-reviewed academic study analyzed data from 2,818 individuals treated in residential (RTC), partial hospitalization (PHP), and/or intensive outpatient (IOP) levels-of-care at a large eating disorder treatment organization; 471 (17%) of the participants identified as LGBT. The facilities were operated by Center for Discovery, a US healthcare provider specializing in the treatment of eating disorders.

Research shows that individuals who identify as lesbian, gay, bisexual, transgender, or other non-heterosexual/non-cisgender identities have significantly higher rates of mental and physical health conditions compared to their heterosexual, cisgender peers.

“LGBT individuals are more likely to experience housing and employment discrimination, and to struggle with multiple mental health challenges related to minority stress; this perfect storm of barriers means eating behaviors are often overlooked,” said Vaughn Darst, RD, who serves as Operations Advisor for Discovery Behavioral Health, Center For Discovery and who also discussed in a TedX talk the complex issue at the intersection of gender, body image, food and identity.

The study found a full 12-month delay in treatment for LGBT patients compared to non-LGBT patients.

“Delays in accessing treatment are especially widespread for transgender and nonbinary individuals with eating disorders. Some of the causes include delayed diagnosis by providers who fail to assess non-cisgender female patients for disordered eating, as well as limited access to trans-affirming treatment options, particularly at the residential level of care” said Darst.

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Health & Wellness

Greater availability of non-alcoholic drinks may reduce alcohol consumption

The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

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People are more likely to opt for non-alcoholic drinks if there are more of them available than alcoholic drinks, according to a study published in the open access journal BMC Public Health.

A team of researchers at the NIHR Bristol Biomedical Research Centre, and the Universities of Bristol and Cambridge, UK found that when presented with eight drink options, participants were 48% more likely to choose a non-alcoholic drink when the proportion of non-alcoholic drink options increased from four (50%) to six (75%). When the proportion of non-alcoholic drink options decreased from four to two (25%), participants were 46% less likely to choose a non-alcoholic drink.

Dr Anna Blackwell, the corresponding author said: “Alcohol consumption is among the top five risk factors for disease globally. Previous research has shown that increasing the availability of healthier food options can increase their selection and consumption relative to less healthy food. To our knowledge, this is the first study to demonstrate that increasing the availability of non-alcoholic drinks, relative to alcoholic drinks in an online scenario, can increase their selection.”

Participants in the study completed an online task in which they were presented with a selection of alcoholic beer, non-alcoholic beer and soft-drinks. The drink selections included four alcoholic and four non-alcoholic drinks, six alcoholic and two non-alcoholic drinks or two alcoholic and six non-alcoholic drinks. 808 UK residents with an average age of 38 years who regularly consumed alcohol participated in the study.

When presented with mostly non-alcoholic drinks, 49% of participants selected a non-alcoholic drink, compared to 26% of participants who selected a non-alcoholic drink when presented with mostly alcoholic drinks. These results were consistent regardless of the time participants had to make their decision, indicating that the findings were not dependent on the amount of time and attention participants were able to devote to their drink choice. The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

Anna Blackwell said: “Many licensed venues already offer several non-alcoholic options but these are often stored out of direct sight, for example in low-level fridges behind the bar. Our results indicate that making these non-alcoholic products more visible to customers may influence them to make healthier choices. The market for alcohol-free beer, wine and spirit alternatives is small but growing and improving the selection and promotion of non-alcoholic drinks in this way could provide an opportunity for licensed venues to reduce alcohol consumption without losing revenue.”

The authors caution that as the study measured hypothetical drink selection online, results may differ in real-world settings. Further studies are needed to determine how the relative availability of non-alcoholic and alcoholic drinks impacts the purchasing and consumption of alcohol in real life.

Alcoholism is a big issue in the LGBTQIA community.

In 2017, a study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Most young people with increased suicide risk only display ‘mild to moderate’ mental distress – study

Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.

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The vast majority of young people who self-harm or experience suicidal thoughts appear to have only mild or moderate mental distress, instead of more obvious symptoms associated with a diagnosable disorder, according to a new study.

As such, measures to reduce suicide risk in young people should focus on the whole population, not just those who are most distressed, depressed or anxious, said Cambridge University researchers during Mental Health Awareness week.

They argue that the small increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders.

“It appears that self-harm and suicidal thinking among young people dramatically increases well within the normal or non-clinical range of mental distress,” said Professor Peter Jones, senior author of the study from Cambridge’s Department of Psychiatry.

He added: “These findings show that public policy strategies to reduce suicide should support better mental health for all young people, not only those who are most unwell. Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.”

The Cambridge researchers conducted the study with colleagues from University College London. It was supported by the Wellcome Trust and the National Institute for Health Research, and is recently published in the journal BMJ Open.

Recent studies suggest a broad range of mental health problems – e.g. depression, anxiety, impulsive behaviour, low self-esteem, and so on – can be taken as a whole to measure levels of “common mental distress” (CMD).

Researchers analysed levels of CMD in two large groups of young people through a series of questionnaires.

They also separately collected self-reported data on suicidal thinking and non-suicidal self-injury: predictive markers for increased risk of suicide – the second most common cause of death among 10-24 year-olds worldwide.

Both groups consisted of young people aged 14-24 from London and Cambridgeshire. The first contained 2,403 participants. The study’s methods – and findings – were then reproduced with a separate group of 1,074 participants.

“Our findings are noteworthy for being replicated in the two independent samples,” said Jones.

CMD scores increase in three significant increments above the population average: mild mental distress, followed by moderate, and finally severe distress and beyond – which often manifests as a diagnosable mental health disorder.

Those with severe mental distress came out highest for risk of suicide. However, the majority of all participants experiencing suicidal thoughts or self-harming – 78% and 76% respectively in the first sample, 66% and 71% in the second – ranked as having either mild or moderate levels of mental distress.

“Our findings help explain why research focusing on high-risk subjects has yet to translate into useful clinical tools for predicting suicide risk,” said Jones. “Self-harm and suicidal thoughts merit a swift response even if they occur without further evidence of a psychiatric disorder.”

The findings point to a seemingly contradictory situation, in which most of the young people who take their own life may, in fact, be from the considerably larger pool of those deemed as low- or no-risk for suicide.

“It is well known that for many physical conditions, such as diabetes and heart disease, small improvements in the risks of the overall population translate into more lives saved, rather than focusing only on those at extremely high risk,” said Jones. “This is called the ‘prevention paradox’, and we believe our study is the first evidence that mental health could be viewed in the same way. We need both a public health and a clinical approach to suicide risk.”

Jones added that “we are surrounded by technology designed to engage the attention of children and young people, and its effect on wellbeing should be seen by industry as a priority beyond profit. At a government level, policies affecting the economy, employment, education and housing, to health, culture and sport must all take account of young people; supporting their wellbeing is an investment, not a cost. This is particularly important as the widespread effects of the Covid-19 pandemic unfold.”

Mental distress is – obviously – a big issue in the LGBTQIA community.

In 2018, for instance, a study found that 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.

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Health & Wellness

Sexual risk behavior is reduced with involvement of parents, healthcare providers

Health care providers and parents have been valuable partners in managing adolescent sexual and reproductive health. But research has been limited concerning the efficacy of “triadic” interventions, or those implemented with parents and providers with the goal of reducing adolescent sexual risk behavior.

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Health care providers and parents have been valuable partners in managing adolescent sexual and reproductive health. But research has been limited concerning the efficacy of “triadic” interventions, or those implemented with parents and providers with the goal of reducing adolescent sexual risk behavior.

Now, a randomized clinical trial carried out under a grant by the National Institutes of Health shows the efficacy of a triadic intervention to postpone adolescent sexual debut and to promote condom use among adolescents aged 11 to 14 years.

Published in Pediatrics, the study – “A Triadic Intervention for Sexual Health: A Randomized Clinical Trial” – was conducted by Vincent Guilamo-Ramos, director of the Center for Latino Adolescent and Family Health (CLAFH) at the Silver School of Social Work at New York University and a nurse practitioner specializing in adolescent sexual and reproductive health care at the Adolescent AIDS Program at Children’s Hospital at Montefiore.

The study’s coauthors include Adam Benzekri (CLAFH); Marco Thimm-Kaiser (CLAFH and the CUNY School of Public Health and Health Policy); Patricia Dittus (Centers for Disease Control and Prevention, Division of STD Prevention); Yumary Ruiz (Purdue University and CLAFH); Charles M. Cleland (NYU Langone), and Dr. Wanda McCoy (Morris Heights Health Center, Bronx, NY).

The researchers evaluated Families Talking Together (FTT), a triadic intervention developed by Dr. Guilamo-Ramos and colleagues designed to reduce adolescent sexual risk behavior and address persistent disparities in unplanned teen pregnancies as well as sexually transmitted infections such as HIV/AIDS.

Adolescents aged 11-14 and their female caregivers were recruited from a Bronx, N.Y., pediatric clinic, and 900 families enrolled in the study. The Families Talking Together intervention consists of a 45-minute face-to-face session for mothers, health care provider endorsement of the intervention content, FTT family communication workbook for families, and a booster phone call for mothers.

To evaluate the FTT intervention, assessments were conducted initially (baseline), three months later, and a year later, asking whether adolescents engaged in vaginal intercourse, made their sexual debut within the past 12 months, and used a condom in their last sexual encounter.

  • At 12-month follow-up, 5.2% of adolescents in the experimental group (those participating in the Families Talking Together intervention program) reported having had sexual intercourse, compared to 18.0% of adolescents in the control groups, who did not receive the FTT intervention.
  • In the experimental group, 4.7% of adolescents reported sexual debut within the past 12 months, compared to 14.7% of adolescents in the control group.
  • In the experimental group, 74.2% of sexually active adolescents indicated using a condom at last sex, compared to 49.1% of sexually active adolescents in the control group.

“The research suggests that the FTT triadic intervention is efficacious in delaying sexual debut and reducing sexual risk behavior among adolescents,” according to the study.

The findings are particularly important since FTT addresses the important role of parents in shaping adolescent sexual and reproductive health while respecting adolescent autonomy and confidentiality in healthcare, making FTT an innovative solution to respond to calls from parents and national health organizations for more parental involvement in adolescent SRH care.

It is worth noting that parenting involving LGBTQIA youth is reported to be harder.

For instance, a 2018 study – which included 44 parents of LGBT teens between the ages of 13 and 17 – noted how parents faced many challenges in trying to educate their teens about sex, including their general discomfort in talking about it, and feeling unable to offer accurate advice about safe LGBT sex.

Meanwhile a 2019 study noted that as it is, parent-child discussions about sexual health and sexual identity are complicated, but this is even more particular with a male teen who identifies as gay, bisexual, or queer (GBQ). The research from the University of Pennsylvania shows that even as parents become savvier in these conversations, departing from gender stereotypes and embracing more accepting attitudes, factors beyond the home will still affect the message parents convey and their child hears.

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Health & Wellness

Regularly attending religious services associated with lower risk of deaths of despair

People who attended religious services at least once a week were significantly less likely to die from “deaths of despair,” including deaths related to suicide, drug overdose, and alcohol poisoning. The challenge: How to also make religion work for LGBTQIA people.

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People who attended religious services at least once a week were significantly less likely to die from “deaths of despair,” including deaths related to suicide, drug overdose, and alcohol poisoning, according to new research led by Harvard T.H. Chan School of Public Health. The study showed that the association between service attendance and lower risk of deaths from despair was somewhat stronger for women in the study than for men.

“Despair is something that can confront anyone dealing with severe difficulties or loss. While the term ‘deaths of despair’ was originally coined in the context of working class Americans struggling with unemployment, it is a phenomenon that is relevant more broadly, such as to the health care professionals in our study who may be struggling with excessive demands and burnout, or to anyone facing loss. As such, we need to look for important community resources that can protect against it,” said Tyler VanderWeele, John L. Loeb and Frances Lehman Loeb Professor of Epidemiology at Harvard Chan School. VanderWeele is also director of the Human Flourishing Program and co-director of the Initiative on Health, Religion and Spirituality at Harvard University.

The study will be published online in JAMA Psychiatry .

Religion may be a social determinant of health, and previous research has shown that attending religious services may be associated with a lower risk of various factors related to despair, including heavy drinking, substance misuse, and suicidality.

For this study, researchers analyzed data from the Nurses’ Health Study II on 66,492 women as well as data from the Health Professionals Follow-Up Study on 43,141 men. Among the women, there were 75 deaths from despair: 43 suicides, 20 deaths from poisoning, and 12 deaths from liver disease and cirrhosis. Among the men there were 306 deaths from despair: 197 suicides, 6 deaths from poisoning, and 103 deaths from liver diseases and cirrhosis.

After adjusting for numerous variables, the study showed that women who attended services at least once per week had a 68% lower risk of death from despair compared to those never attending services. Men who attended services at least once per week had 33% lower risk of death from despair.

The study authors noted that religious participation may serve as an important antidote to despair and an asset for sustaining a sense of hope and meaning. They also wrote that religion may be associated with strengthened psychosocial resilience by fostering a sense of peace and positive outlook, and promoting social connectedness.

“These results are perhaps especially striking amidst the present COVID-19 pandemic,” said Ying Chen, research associate and data scientist at the Human Flourishing Program at Harvard’s Institute for Quantitative Social Science, and first author of the paper. “They are striking in part because clinicians are facing such extreme work demands and difficult conditions, and in part because many religious services have been suspended. We need to think what might be done to extend help to those at risk for despair.”

Other authors from Harvard Chan School include Howard Koh and Ichiro Kawachi. Michael Botticelli of the Grayken Center for Addiction at Boston Medical Center was also a co-author.

Religion is a touchy subject for many LGBTQIA people, obviously.

In the Philippines, for instance – and to contextualize – the Catholic Bishops’ Conference of the Philippines (CBCP) has been one of the staunchest opponents of passing an anti-discrimination law that will protect the human rights of LGBTQI people.

In 2015, it actually gave a “partial support” to the passage of an anti-discrimination bill (ADB). However, this support is limited by CBCP’s desire for it to still be allowed to discriminate, particularly in: 1) determining who should be admitted to priestly or religious formation, who should be ordained and received into Holy Order, or who should be professed as members of religious communities and orders; and 2) for Catholic schools to be allowed to discriminate on who they can admit or retain.

There are benefits, to be sure; as noted, for instance, by an April 2020 study, which found that adults living with HIV – including members of the LGBTQIA community – were more likely to feel higher levels of emotional and physical well-being if they attended religious services regularly, prayed daily, felt “God’s presence,” and self-identified as religious or spiritual.

But churches also continue to be lambasted for not changing with time – perhaps most obvious in the treatment of LGBTQIA people of those with faith.

Fortunately, the number of denominations openly discussing – and even coming up with statements of support of – LGBTQIA issues is increasing.

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Health & Wellness

Covid-19 highlights downside of social distancing

The demands now being made by governments to self-isolate and follow social distancing guidelines are fundamentally at odd with social instincts, and therefore represent a serious challenge for most people.

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When faced with danger, humans draw closer together. Social distancing thwarts this impulse. Professor Ophelia Deroy from Ludwigs-Maximilians Universitaet in Munich (LMU) and colleagues argue that this dilemma poses a greater threat to society than overtly antisocial behavior.

The corona crisis presents countries around the globe with what is perhaps the greatest challenge most have faced since the Second World War. For one thing, the virus constitutes a truly global threat. In the absence of a vaccine, our primary defense against it consists in what is now termed ‘social distancing’ – minimizing our contacts with others in public spaces. In an essay that appears in the journal Current Biology, an interdisciplinary team of authors that includes Professor Ophelia Deroy, who holds a Chair in the Philosophy of Mind at LMU and is affiliated with the Munich Neuroscience Center, underline the dilemma posed by measures designed to promote social distancing.

“Hazardous conditions make us more – not less – social,” Deroy says. “Coping with this contradiction is the biggest challenge we now face.”

Seen from this point of view, the current problem lies not in egoistic reactions to the crisis or a refusal to recognize the risks, as images of banks of empty shelves in supermarkets or throngs of strollers in the public parks would have people believe.

Deroy and her co-authors Chris Frith (a social neurobiologist based at University College London) and Guillaume Dezecache (a social psychologist at the Université Clermont Auvergne) argue that such scenes are not representative. They emphasize that people instinctively tend to huddle together when faced with an acute danger – in other words, they actively seek closer social contacts. Studies in the fields of neuroscience, psychology and evolutionary biology have already shown that we are not as egoist as some disciplines think. They continue to produce evidence which demonstrates that threatening situations make us even more cooperative and more likely to be socially supportive than we usually are.

“When people are afraid, they seek safety in numbers. But in the present situation, this impulse increases the risk of infection for all of us. This is the basic evolutionary conundrum that we describe,” says Dezecache.

The demands now being made by governments to self-isolate and follow social distancing guidelines are fundamentally at odd with social instincts, and therefore represent a serious challenge for most people.

“After all,” says Deroy, “social contacts are not an ‘extra’, which we are at liberty to refuse. They are part of what we call normal.”

The essay’s authors therefore contend that, because social distancing stands in opposition to our natural reaction to impending hazards, our social inclinations – rather than antisocial reactions to rationally recognized threats – now risk exacerbating the danger.

How then might we escape from this dilemma? According to Deroy, people need to revise what the Internet can offer.

The argument goes as follows: In the pre-pandemic world, the Internet and social media were often looked upon as being decidedly unsocial. But in times like the present, they provide an acceptable and effective alternative to physical contact – insofar as they enable social interactions in the absence of physical contiguity. Social media make it possible for large numbers of people to reach out virtually to neighbors, relatives, friends and other contacts.

“Our innate inclinations are cooperative rather than egoistic. But access to the Internet makes it possible for us to cope with the need for social distancing,” says Chris Frith.

“How well, and for how long, our need for social contact can be satisfied by social media remains to be seen,” says Deroy.

But she and her co-authors do have two important recommendations for policy-makers.

First of all, they must acknowledge that the demand for social distancing is not only politically highly unusual : It runs counter to the evolved structure of human cognition. Secondly, nowadays, free access to the Internet is not only a prerequisite for freedom of speech. In the present situation, it is also making a positive contribution to public health.

“This is an important message, given that the most vulnerable sections of society are often those who, owing to poverty, age and illness, have few social contacts,” says Deroy.

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