Chronic disease and poor mental health are both prevalent conditions that share a complicated relationship. While the two have been shown to be highly correlated, scientists are still exploring exactly how.

The link is believed to be bi-directional, meaning both contribute to one another. Research by the CDC shows nearly one-third of patients diagnosed with diabetes also experience depression, while those with depression are at higher risk of developing a chronic condition, according to the National Institute of Mental Health.

The relationship is often attributed to behavioral factors, such as diet and exercise. But scientists say physiological changes due to depression and chronic disease could also play a role. "For a long time... it was thought that whatever happens in the body stays in the body," said Dr. Alan Kim Johnson, a professor of health psychology at the University of Iowa. But now, researchers have shown "profound communication between the brain and the body," said Johnson.

As theories on what causes these comorbid conditions develop, so has treatment. "In our culture, we really split people apart," said Dr. Tim Derstine, a consulting psychiatrist at Centre Volunteers in Medicine. Dersteine is involved in the clinic's effort to integrate mental health services and chronic disease care. "We try to look at it from 360-degrees," said Derstine.

On this episode of the podcast, we explore the relationship between mental health and chronic disease and speak with providers who are integrating therapies to more effectively treat their patients.

Chronic Disease and Mental Health are Linked. But How?

With more than 44 million Americans filing for unemployment since mid-March, the financial fallout of the Covid-19 pandemic has made managing chronic disease an afterthought tor some, and an impossibility for others.

Lacking adequate resources, many are struggling to maintain their medical regimens, which often involve produce-rich diets and regular purchases of prescription medication.

"We definitely are seeing a number of patients who are really just barely getting by,” says Dr. Mary Herbert, the clinical director of the Birmingham Free Clinic in Pittsburgh, Pennsylvania.

Herbert treats patients with chronic disease, such as hypertension, diabetes, and heart disease. She says many of her patients are forgoing care to attend to more immediate needs, such as paying the rent or feeding their families. Others have been unable to pick up their prescriptions because they can't afford the cost of transportation.

On this episode of the podcast, we speak with Dr. Herbert and other healthcare providers about how the financial consequences of the Covid-19 pandemic are affecting patients' ability to manage their chronic condition.

"They Don't Have Food, Period. Let Alone Healthy Options." How Covid-19 Has Impacted Chronic Care.

In the Navajo Nation--a sovereign territory spanning 27,000 square miles--responding to Covid-19 comes with unique challenges.

A third of residents don't have access to running water. Grocery stores are few and far between. And many must travel hours to reach the nearest hospital.

While the nation has the highest case rate of any state in the country, it's been successful in containing the spread of the virus through stay at home orders and strict weekend curfews. When the pandemic began, the territory quickly ramped up testing and contact tracing investigations. The Navajo Nation now boasts the highest testing rate in the country with roughly 40% of all residents having been tested for the virus.

On this episode of the podcast, we speak with Dr. Jonathan Iralu, an infectious disease doctor at Gallup Indian Medical Center in Gallup, New Mexico. He discusses how he and his staff adapted to treat an influx of patients during the peak of the outbreak and what they're doing now to ensure continued access to care.

Responding to Covid-19 in the Navajo Nation: A Front Line Perspective.

In the United States, researchers says the coronavirus pandemic is more likely to lead to a baby bust than a baby boom. According to the Brookings Institution, women are likely to delay pregnancy because of economic uncertainty and concerns about the state of public health. The result could be up to half a million fewer births in the next year.

Despite these predictions, some women are experiencing more limited access to family planning services and contraception during the pandemic. One-third of American women have reportedly delayed or canceled visiting their provider for reproductive healthcare services or have had trouble getting their birth control, citing concerns over contracting the virus, and an inability to pay. The percentage of those delaying care increases amongst low-income women and minority populations.

"I'm not getting a lot of demand for family planning services, so that's where I'm worried," says Dr. Karen Lamp, a physician at Venice Family Clinic in Santa Monica, California. "I'm seeing a lot of women presenting late in pregnancy."

On this episode of the podcast, we speak with Dr. Lamp about how the Covid-19 pandemic has impacted her patients' access to reproductive healthcare and what that could mean for women as the pandemic continues.

Fewer Medical Visits, More Unplanned Pregnancies. How Covid-19 is Affecting Reproductive Healthcare.

As California's fire season heats up, preventative power shut offs are likely to follow, potentially leaving millions without electricity. 

Once unprecedented, these public safety power shut offs (PSPS) have become common practice as utility companies seek to prevent wildfires sparked by downed power lines. But the consequences of these shut offs are vast, and have significant implications for health care.

Without power, safety net health facilities must often close down entirely, forcing patients to delay care or rely on their hospital's emergency department. Without insurance, the cost of urgent care can be prohibitive.

On this episode of the podcast, we speak with a Northern California health center impacted by the 2019 power shut offs about the role of power in delivering health care, particularity during Covid, and what they are doing to prepare for this year's PSPS season.

The Health Consequences of California's Public Safety Power Shut Offs

California faces a convergence of public health crises as dozens of wildfires unleash hazardous levels of air pollution across the state.

Smoke-laden air has exacerbated conditions, like asthma, while the menace of Covid-19 looms, mounting a respiratory threat on two fronts. For the more than 650,000 Californians sick with the virus, poor air quality is particularly dangerous. A small increase in air pollution has been shown to significantly increase patients' risk of severe illness and death.

Meanwhile, sweeping evacuations have forced emergency officials to abandon pre-Covid protocols, filling up hotels to avoid crowded shelters. Nearly 50,000 people have been evacuated across the state.

On this episode of the podcast, we speak with Direct Relief's head of research and analytics, Andrew Schroeder, about the heightened health risks of California's wildfires and more on what those affected should know.

CA Wildfires Bring Convergence of Public Health Crises

Rising food insecurity coupled with strained health care systems has created new challenges for those managing diabetes during the Covid-19 pandemic.

When food is scarce and meals are inconsistent, diabetics may experience extreme blood sugar spikes--or dips--that can lead to heart disease, kidney failure, and even death.

In Sudan, where the number of people facing acute food insecurity has increased 65% since last year, pediatric endocrinologist Dr. Omer Babiker says malnutrition has become a serious problem among his diabetic patients. "We see, on a weekly basis, patients that have malnutrition" said Babiker, the deputy director of the Sudanese Childhood Diabetes Association.

As a result, many patients' blood sugar has become uncontrolled and some are facing acute complications due to a lack of food. Others have been unable to access health care services because of Sudan's nationwide lockdown. For Babiker's patients, the consequences have been severe.

On this episode of the podcast, we speak with Dr. Babiker about how the Covid-19 pandemic is impacting his patients and escalating the risks of their condition.

In Sudan, Those with Diabetes Face Increased Risks Amid Pandemic

Hurricane Laura is barreling towards the Texas-Louisiana border after intensifying into a Category 4 storm Wednesday. Unsurvivable storm surge and devastating winds are expected to cause catastrophic damage in some areas. In Beaumont, Texas, where the storm is projected to make landfall early Thursday morning, residents remain under mandatory evacuation orders. 

On this episode of the podcast, we speak with Lauren Rahe, the Executive Director of the Ubi Caritas Health Ministries in Beaumont, TX about how her community is preparing and what health needs she anticipates arising in the storm's aftermath.

"Way Beyond Their Medical Needs." Health Care Providers Prepare for Hurricane Laura

Over 100 wildfires are burning across the western United States, setting the stage for an unprecedented fire season as the Covid-19 pandemic persists. 

In California, six of the state's ten largest wildfires are currently burning, as uncontrolled fires rage across Oregon, Washington, and Arizona, torching millions of acres and killing at least 11 people.

Direct Relief has deployed several kits of emergency medical supplies, including N-95 masks, hygiene items, and essential medicine, to health facilities in fire zones. The current wildfires have only compounded the effects of the Covid-19 pandemic, flaring up respiratory illnesses and straining already limited resources.

On this episode of the podcast, we speak with Direct Relief's head of emergency response, Andrew MacCalla, about how the organization is approaching the concurrent emergencies, ensuring an urgent and robust response to both.

Wildfires and Covid-19. Overlapping Emergencies Demand Strategic Response.

For new and expectant mothers, treating an opioid use disorder comes with added challenges. On top of preparing for motherhood, expectant mothers often face barriers to accessing treatment, which typically involves taking safer opioids to reduce dependency over time. The approach is called medication assisted therapy, or MAT, and is a key component in most opioid treatment programs.

But with pregnant women, providers can be hesitant to administer opiate-based drugs.

According to a study out of Vanderbilt University, pregnant women are 20% more likely to be denied medication assisted therapy than non-pregnant women.

"In the beginning, I was so scared as a new provider to write my first prescription for medication assisted therapy to pregnant women," said Dr. Linda Thomas-Hemak of the Wright Center for Community Health in Scranton, Pennsylvania.

The health center serves low-income individuals who are underinsured or lack insurance altogether, many of whom struggle with opioid misuse.

“Pennsylvania was hit particularly hard by the opiate epidemic that really has plagued, terrified and challenged America,” said Hemak who is a board certified addiction medication specialist.

On this episode of the podcast, we speak with Dr. Hemak about whether medication assisted therapy is safe for new and expectant mothers and how the Wright Center is helping women overcome opioid dependency during pregnancy.

For Pregnant Women, Stigma Complicates Opioid Treatment

As the third wave of the Covid-19 pandemic fills hospitals to capacity, mental health providers are seeing a surge of their own.

"People are under so much stress," said Ryoko Chernomaz, a licensed clinical social worker at the San Francisco Free Clinic. Issues at home--from increasing childcare responsibilities to domestic abuse--are compounding financial anxieties triggered during the early stages of the pandemic, driving an uptick in mental health needs. Sine the pandemic began, Chernomaz has had a 30% increase in appointments.

At CommunityHealth--a free clinic based in Chicago--licensed clinical social worker Ornella Razetto is experiencing a similar trend. "It began with anxiety, depressive symptoms and financial insecurity, said Razetto, but now "reality has sunk in" and patients are battling more severe mental health issues. Razetto has seen a 75% increase in referrals since March.

On this episode of the podcast we speak with both Chernomaz and Razetto about how the pandemic is affecting patients' mental health and what they expect the long-term consequences to be.

Mental Health Providers See "Unprecedented" Surge During Pandemic

Chronic conditions require routine care and strict medication regimens, but for millions, transportation stands in the way of accessing timely health care.

From rural communities to urban cities, patients struggle to make routine appointments. Some can't afford a vehicle, Others lives hours, if not days, from the nearest point of care. The distance--and lack of transportation--leads to delays in medical care, which for some, can be deadly.

On this episode of the podcast, we explore how transportation poses a barrier to care for patients around the world, from rural Nepal to the United States, and what the consequences are for those in need of chronic care.

Sometimes, Just Getting to the Doctor is the Hardest Part

While Covid-19 is typically benign in children, the pandemic could have long lasting impacts for society's youngest members. With childcare programs closed and social distancing measures in place, many children are missing out on critical developmental opportunities.

"Children are not getting the cognitive and social stimulation that they would normally get outside their home," said Dr. Michelle Aguilar, the head of pediatrics at Venice Family Clinic in Los Angeles, California. Providers have noted delays in speech and language as well as issues with sharing.

But for children, the pandemic's effects could go beyond delays in social skills. With many parents undergoing financial stress, children are facing higher rates of housing and food insecurity while others are subject to rising rates of neglect and household dysfunction--all of which can affect a child's trajectory into adulthood.

On this episode of the podcast, we explore the full scope of consequences for children growing up in the midst of the Covid-19 pandemic, from short term effects to long term implications. We speak with experts in the field as well as Venice Family Clinic's Dr. Michelle Aguilar and early head start director, Stacey Scarborough.

Growing Up in the Midst of a Pandemic: How Covid is Affecting Children's Development

Getting treatment for an opioid use disorder can be complicated, often requiring daily visits to receive addiction medication under the supervision of a provider. While guidelines have been relaxed to reduce barriers for those seeking care, it's not clear how effective the changes have been.

"Their barriers are huge here," said Kim Brown, the founder of Quad Cities Harm Reduction (QCHR), "and they've been exacerbated by the pandemic." QCHR distributes supplies, including Naloxone--the medication used to reverse opioid overdoses--to drug users across Illinois and Iowa.

On this episode of the podcast we speak with Brown about how the pandemic is affecting access to opioid treatment as providers navigate a new regulatory landscape.

Treating an Opioid Use Disorder is Difficult. A Pandemic Doesn't Help.

Emergency response and global humanitarian reporting from Direct Relief, an apolitical, nonsectarian non-profit with a humanitarian mission to improve the health and lives of people affected by poverty and emergencies.

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