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Mitch: Have you been feeling a little off lately or maybe sad for a prolonged amount of time without any obvious cause? I know I feel that sometimes. Could it be depression? And if it is, what are we as guys supposed to do about it?

Depression is one of the most common mental disorders in the U.S. impacting as many as six million men a year. And yet, according to research, men may be more likely to suffer from the severe consequences of depression, like substance abuse and suicide.

This is "Who Cares About Men's Health," where we aim to give you some information, inspiration, and a different interpretation of your health. And today we'll see if we can't shed some light on depression.

I'm Producer Mitch, and I bring a little more than the microphones. And as always, we have Scot, manager of The Scope Radio, and he always brings a healthy dose of BS. Hey, Scot.

Scot: That's right. I'm ready with a healthy dose of healthy BS. I don't know what happened there. My mouth stopped working. All right. Why don't you introduce Troy?

Mitch: And the man who brings the MD, Dr. Troy Madsen.

Troy: Mitch, I'm super excited to talk about depression.

Mitch: I know, right? The most exciting topic. And joining us today is Dr. Scott Langenecker, the clinical neuropsychologist and professor of psychiatry at University of Utah Health.

Dr. Langenecker: Hi.

Mitch: Now, before we get to the professional, I think one of the things that we should probably talk about first is kind of the layperson's understanding of depression, because I think we toss that term around a lot. It's like, "Oh, I'm feeling a little depressed." That seems to come up a lot and I'm not always 100% sure if that's true depression. Scot, when you hear depression, what does it mean to you?

Scot: That's a great question because it comes back to this whole notion of what does it even mean to be happy? I tend to think that my people, if you will, tend to be maybe just a little on the depressed side. Maybe we don't relish in life as much as other people. Maybe we're not as effervescent.

But what is it really? I don't know. Is it a feeling of you just can't go on? Is it a feeling of you can't breathe, like you're dragging your feet in concrete just trying to get things done? Is that depression? So yeah, I'll be curious to find out.

Mitch: Yeah. And what about you, Troy? I wonder if in your practice at the ER and stuff like that, you must have at least a little bit of an understanding of it.

Troy: We do see a lot of patients who come in who are depressed. And certainly, I think all of us have fluctuations in mood and outlook. I think depression in my experience, it's more when it's . . . You get to a point where it's just like this haze, this fog that you're in, and it affects your ability to do your work. It certainly affects your outlook, affects your relationships.

So I see it as certainly a step beyond just a lot of, I think, the fluctuations we might feel in our mood over the course of a day or a week or whatever that might be.

Scot: Or just a little sadness or feeling the blues or something like that.

Troy: Yeah. Exactly. And like you said, Mitch, you might be like, "I just feel depressed today." But yeah, I think it's certainly something beyond that kind of mood changes we might experience.

Mitch: Yeah. And personally, I actually got diagnosed with some depression this last year and have been taking a kind of professional approach to it. But I don't want to bury the lede. I don't want to steal anyone's thunder when talking about depression. So why don't we get to Scott?

Dr. Langenecker, what is depression? And I guess as a follow-up, what is causing that?

Dr. Langenecker: So I want to put it in two big categories to start out with. The first big category is that you all alluded to, that sort of feeling sad for more than just a day, maybe a couple of weeks. So that's one big bucket.

The other big bucket is, "Man, I used to really enjoy hiking or skiing or running or playing basketball, and now it's kind of like blah. It doesn't give me that jazz anymore." And it could be one of those things. It could be one of the other things.

There are another seven symptoms that can be part of it, but those are the two big ones that sort of tip people off. But if you're not looking forward to things coming up in the future, or you look at your schedule for the day and you're like, "This is objectively a good day and I still feel sad," that's probably a tip-off.

Scot: Is it really sadness, though? I mean, how do we even define what sadness is?

Dr. Langenecker: Well, that's a great question because I'm not sure men are allowed to feel sad.

Scot: Oh, okay.

Dr. Langenecker: Can I say that?

Mitch: Only anger.

Troy: Scot, you've never felt it, so you wouldn't know.

Scot: Right. The eternal optimist.

Dr. Langenecker: Sadness isn't a man thing.

Scot: I don't know. Yeah, I think about depression and I don't know that I think about sadness necessarily. Maybe something like overwhelmed with some emotion. Maybe it's overwhelmed with sadness.

Dr. Langenecker: Yeah. So let's talk about the male interpretation of sadness, which is, "I've got people counting on me and I can't cut it. I can't do what I'm supposed to do and I'm letting them down. I feel this pressure and I can't do what I'm supposed to do as a man, supporting my family, supporting my job at work." So it comes across as that. That's one way.

The other way is irritability and anger, which is like, "Ugh, that person just drives me crazy all the time." And maybe it's true. Maybe they are. Or maybe it's just that you're feeling a bit depressed and anything is going to set you off. Those are kind of the two big ones for men.

Troy: It's interesting that you frame it that way too, because I agree. I think a lot of times we think of sadness like just being really weepy and down in the dumps. But to think of it that way in terms of just feeling more irritable and angry and just a sense of inadequacy, that makes a whole lot more sense in terms of, I think, probably how that sadness manifests in us as men.

Dr. Langenecker: Yeah. I would add there's sort of this classic trope about the middle-age crisis for men and getting a new wife and getting a sports car and buying new golf equipment. There's a premise for that that's sort of rooted in depression, which is, "Man, the things that used to really interest me just don't anymore. I feel kind of flat. I feel not into it anymore." Every time you go into that sort of stereotypical midlife crisis mode for men, is that depression? No. But it is some clues, right?

Troy: And you also mentioned it's not just a day. It's not just one day, "I feel irritable today." Maybe I didn't sleep well last night. You're talking about something sustained over weeks to really diagnose depression.

Dr. Langenecker: Yeah. And I should add one more thing. I know you've all talked about the interface between the brain and the body. Sometimes depression comes out, not just in men, but in women too, it comes out in the body. So people are like, "Oh, my back is just driving me crazy. I can't get comfortable, I can't sleep," or, "Man, my knee is just bothering me lately." And it turns out that there's actually a reason for that.

So some of the neurochemical systems that interface between the body and the brain are sending some of those signals both directions. And so it comes out sometimes as pain.

Troy: Yeah, and I will absolutely second that. A very large percentage of people I see in the ER with chronic abdominal pain, back pain, even chest pain, they're clearly underlying emotional health issues, and a lot of that is depression.

So that's a good point of being aware of maybe some of the physical symptoms we're seeing. Certainly not to blow those off as just writing those off without getting those checked out, but it makes sense that a lot of that does relate to depression or mental health.

Mitch: Wow.

Dr. Langenecker: And if you take that analogy a bit further, and this goes back to my upbringing, when you had pain in the olden days, you would go see a chiropractor, like if you have back pain or leg pain or whatever. And what happens in a chiropractor's office? You get a kind, caring individual. They do some manual adjustments. They spend some time with you. It's a powerful human interaction, and it resets some of those neurochemical signals in addition to some of the psychological support that comes with it.

Mitch: So if it's causing trouble in your mood, your behavior, and also in your body, do we know what causes depression?

Dr. Langenecker: We have clues.

Mitch: But no answers. Just clues? Okay.

Dr. Langenecker: We have clues, but no answers. Yeah. So the easiest way to think about it is our brain is really, really sensitive to things that are dangerous to us. And we grew up evolutionarily in a place where it was really a bad idea to not be afraid of a tiger or of a rattlesnake. And it was really a bad idea to sort of go wandering out in the dark at night. And so our brain has adapted over time so that, for many reasons, we would sleep, but also so that we would have a healthy fear of things that could kill us.

Well, it turns out in the United States today, it's a pretty safe place. Part of the evolutionary makeup that we had, too, is that we had to form small groups to protect each other. And so social connectedness was a super huge important part of being healthy and staying alive.

And then the final thing is if we got sick, we needed a system to keep us separated from other people so that we wouldn't necessarily get them sick as well.

All of these things are great if you're running around in prehistoric times with sabretooth tigers and whatever, but it's not super helpful in our environment now. So we have these super-sensitive in-tune systems for detecting danger and stress and so on, and sometimes our system gets over reactive to these triggers in the world.

Sometimes, however, we have experiences which I would put in the broad category of not being fair. And if I had a nickel for every time I said to a patient, "Hey, what happened to you was not your fault, and it wasn't fair, and let's see what we can do about it," I would be a very wealthy man and I wouldn't be talking to you right now.

Mitch: So you're saying that everyone is maybe hardwired to have these kinds of responses? It's not like you are some sort of different. You're not some anomaly if you experience depression.

Dr. Langenecker: This is where I'm at today, after 25 years of studying this. I think that apart from maybe 3% or 4% of humans, we all have the capability of becoming depressed. And I think that's actually an inherent part of being human. I think it's a good part of being a human. And if you don't have those signals working when things go wrong, people probably won't like you very much.

Mitch: You're unlikeable if you can't get depressed? Is that what you're saying?

Dr. Langenecker: You're unlikeable if you don't care about things and don't care about other people. And it turns out if you take that capacity to care and you combine it with bad experiences, a lot of times that's going to end up being maybe not depression, but some sadness, a couple of days of sadness.

So you asked me the question, "What is the cause of depression?" And that's the segue. The segue is a couple of days of sad to more than a couple of days of sad. I use this term professionally. It's perseveration of negative mood. What the heck is that? It means that the negative mood doesn't leave, no matter how hard you try and shake it.

So it brings me back to Charlie Brown with the rain cloud over his head following him around. That is a beautiful example. And I know that Charles Schulz experienced depression because nobody else would draw that unless they experienced depression.

Mitch: And that's interesting that you said that because that was kind of my sign that something was up. In the past, I could maybe go for a jog after I learned to enjoy running, or I could watch a movie and I could pull myself out of a funk if I did these particular activities, eating food I enjoyed, etc. Suddenly, nothing seemed to pull me out of it. And it didn't matter how hard I worked or how many self-help programs I tried or how many books I read, I just could not get out of it. And that's when I knew I had to talk to someone. And eventually, I had to get some medication for it.

Dr. Langenecker: Yeah, that feedback system, right? We have a feedback system from our brain to our body. And you sort of think in depression, that system gets jammed up. It isn't working the way it's supposed to.

I don't know about any of you, I joined the conversation about running late, but I don't like to run. I hate running, but I love how running makes me feel. And if all of the sudden I didn't feel that way after running, it wouldn't take long for me to say, "You know what? I don't want to run anymore." And that's what depression does.

So we mentioned it before. Depression is this sneaky [beep] that takes away the joy from things and then convinces you that that's a good idea. Like, "Oh, no. I shouldn't seek out joy anymore. That's a great idea. I should just sit in my bed."

Troy: And how good are we at actually recognizing that in ourselves? How often do you find people like Mitch who recognize it, get help, versus how often is it others who are really pointing that out, saying, "Hey, you used to really enjoy this. You don't do it anymore. What's up?" I'm curious how that really works.

Dr. Langenecker: It's interesting. I don't mean this in a negative way, but we as humans have a lot going on, right? There's a lot of stuff going on in our heads, lots of stuff going on in our lives. And sometimes we just miss it. We miss it in ourselves. We miss it in other people. And that's not bad on anybody else. That's just the complexity of being a human being.

But sometimes it's absolutely the case that you miss it yourself. Absolutely the case that somebody else is like, "Hey, I notice that you're a bit off. What's going on?" And then of course as a man, our first response is, "Whoa. No, no, no. We're not going there."

Scot: "No, no. Everything's fine."

Dr. Langenecker: "I just rubbed some dirt on it. It's fine."

Mitch: Right. Can we say sneaky [beep], Scot, or is that what . . .

Scot: I don't know.

Mitch: All right.

Scot: Why sneaky [beep]? Why is depression a sneaky [beep]?

Mitch: That's what I was going to say.

Scot: What is the fact that has . . . What's the definition of [beep]?

Dr. Langenecker: Yeah. Unpleasant fellow. Let's use "the sneaky unpleasant fellow."

Scot: Oh, yeah.

Mitch: Okay. I love that.

Scot: I thought it meant something else, I guess. Okay.

Dr. Langenecker: So, in technical speak, we talk about cognitive distortions, like how depression changes the way you view the world. You view the world in more black and white terms, like, "Things are all good or they're all bad," or, "People are out to get me," or, "Things are never going to work out for me." And those cognitive distortions don't really work for a podcast or for actually talking to patients, like real humans. And so I've come to think of depression as this sneaky inner voice.

So you might remember back in the day, long ago in cartoons where they had the devil on your shoulder and the angel on your shoulder. This is kind of the devil on your shoulder saying, "Yeah, things are terrible. They're always going to be terrible. And that person is not going to help you, even if you ask them for help."

And so those cognitive thoughts are happening in the same exact system that does all of your problem-solving. And it doesn't take long to figure out, "Oh, so the same exact system that's doing the problem-solving is also distorting my perceptions of the world." That's the trap. That's the sneakiness of depression.

Scot: It's like a little saboteur.

Dr. Langenecker: It is absolutely a saboteur. And then to add insult to injury, in depression, I will feel ashamed that my brain is doing this to me on top of that.

Scot: Actually, it's like that game. What's that game, Mitch, that brought up the term sus? "It seems sus."

Mitch: Oh, "Among Us."

Scot: "Among Us." Yeah. It's like the little evil person in "Among Us" that pretends to be your friend, pretends to be looking out for you, but really behind the scenes, not doing cool things.

Dr. Langenecker: Yeah. So we come back to the question of "What is depression?" Depression is your own brain convincing you that things that are good for you aren't good for you.

Mitch: That resonates so much with me. I was actually talking to my therapist the other day. I've been in a bit of a depressive episode. And when I was chit-chatting, it was just like . . . He's like, "You know what you need to do to get better." And I'm like, "I know. I need to start eating better, I need to get out, I need to do the things that I enjoy more, remind myself I enjoy them. I need to be talking to people."

And he's like, "Even if you don't like doing it right now, that's just your depression telling you, 'No. Don't work out. No, don't go talk to these people because they hate you,' or whatever. Just power through it. Ignore them. It might be unpleasant, but you've got to start doing those types of things if you're going to get out of the depression cycle."

And I think that's kind of what I want to ask next. What do you do? How do you fight back against this saboteur of depression?

Dr. Langenecker: I'm glad you brought that up, Mitch, because there's another piece to this. So you take this maleness of "I don't need help," and then you take this sort of cultural belief that we're doing the Horatio Alger thing and just pulling ourselves up by our bootstraps. And then you take this idea of positive psychology, which is literally rub some dirt on it or rub the dirt off of it. I don't know what it might be. And for somebody who's experiencing depression, that's basically telling them, "You're an idiot. You can't figure it out. You should have figured it out a long time ago. Why are you such a moron?"

And I'm using really strong language here because that's the saboteur. The saboteur can take really well-meaning, "Hey, maybe you could try this," or often, "You should do this," and it comes across as, "I'm incompetent, and I'm making a big deal out of this, and I should just get over it."

So part of the work with a therapist, honestly and truly, is getting folks to realize that they deserve better and to believe that they deserve better and to do things in the world to actually experience the better. That's how we beat the saboteur.

Mitch: That's interesting, because on another episode we kind of talked a little bit about the first couple of mental health workers I worked with. I was suffering from depression and that was the very same thing I felt. When that first person was like, "Oh, yeah, have you tried gratitude journaling?" the first thing I thought was, "I've tried it. It's obviously not working for me, doc. You've got to help me here. I'm not going to open up the journal again. Things are obviously terrible."

And I think looking back on that, he was probably giving decent advice and good advice. I just was not in the mood to hear it.

Dr. Langenecker: And that's why I use the analogy of a journey with some really comfortable shoes because it's not just the what, it's the when. And there's a phenomenon in depression, the waxing and waiting of depression, where as a therapist, I wait for windows of opportunity. I don't force windows of opportunity. And that has taken years to hone that skill, because if I force it at the wrong time, I'm going to be breaching some of that trust that I worked so hard to build with my client.

Mitch: So to kind of wrap up this discussion on depression, Scott, it sounds like depression is when you are feeling out of sorts or sad for more than one day, things that you used to enjoy aren't giving you that spark of joy that they used to. At what point should someone . . . what is a sign, a red flag that they should probably go talk to someone or they should probably seek some sort of treatment in one way or another? And what can they expect on those first steps of their mental health journey?

Dr. Langenecker: So to come back to that point, having the sadness or lack of joy for . . . Technically, we use the term two weeks or more as sort of the breakpoint. That is not a magical number. That is just a number that we've come up with over time. It could be more than five days, it could be more than three weeks, but just sort of this idea that something is off.

And then if it starts to mess with your sense of who you are as a person and what you deserve in the world, that's the point at which you say, "You know what? I don't have to fight alone. There are really talented people who are out there ready to help me."

Mitch: I love it. And what can they kind of expect on their first couple of steps into getting help?

Dr. Langenecker: I think the main thing is don't rush it, like we were talking about before. Don't feel like you have to rush this thing. We get into this mindset of, "Oh, I can take my car in for a tune-up." A brain tune-up is much more complicated than a car tune-up. It might take a couple of months. It might take longer. Be comfortable with the idea that you are investing in you. You are investing in you deserving a better life.

Mitch: Scott, thank you so much for joining us, and thank you for caring about men's health.

Dr. Langenecker: Thank you.

Interviewer: You've noticed a change in your teenager's mood. They're angry, moody, defiant, irritable, and in addition, their school performance or maybe interest in other activity is significantly decreased. You're worried about depression. Is it okay to talk to them about it, or could it cause more harm than good?

Dr. Thomas Conover is a psychologist at University of Utah Health, and what is your advice for parents about how to talk to their teens about these tough topics? Or should they even talk to them about them?

Dr. Conover: Communication is a real key. It certainly is protective and helpful for parents to communicate and inquire with their teen as to what's going on and how they're feeling. And that's something that I think most parents strive for but may struggle with. How do I talk to my teen? What do I talk to my teen about? Is it okay to ask? I would advance to say that it's always okay to ask your child about how they're doing. You seem really sad lately. Is there something bothering you? Is there any way I can help?

Interviewer: No. I mean you probably have to dig a little bit sometimes, huh?

Dr. Conover: You may. I think that there's value in setting an example and leaving the door open by saying those two things. In terms of setting an example, certainly communicating openly oneself is important. Right? So I've talked about various areas of function that a parent might look at for a teen child and use to try to evaluate how serious a problem that they're suspecting maybe. But a parent can show that those things are important themself. Right? A parent can demonstrate that being engage with social activity and self-care and physical activity, you know, which boosts mood, all of those things are important. So a parent may set the stage in their own family by doing those things.

It's always okay to ask your child about how you're they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, I think most of the time people who are struggling even in a small way do want someone to ask. I think it's helpful not to badger. I think if you're met with that initial no on a first inquiry, it's good for a parent to perhaps say, "Well, okay. You know, I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you do . . . if you change your mind about that, if you do want to talk about."

I think that's a tough one. It's a tough balance to strike, because I think if a parent is a concerned at all about their child and they try to make that initial ask, first off that's a hard thing to do. You know, you might be thinking about it all day or all week and then, finally on Friday you say, "Oh, we're sitting at dinner and my kid's actually home with me. I'm going to ask." And then, the first thing that they snap back with this, "No. Everything's fine." And the parent might feel kind of rejected by that and, you know, they might respond by shutting down. Right? Going like, "Oh, well, okay. I guess I shouldn't have asked."

I wouldn't advocate for that black and white of a response, nor would I advocate for a parent then saying, "Well, no, I know something must be wrong. I've been watching you all this time, and you just aren't acting yourself. You need to talk to me right now." You know, in most cases, that's not going to be the best approach either. It's, I think, always appropriate to ask and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond. Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm or threats or acts of a suicidal nature or serious aggression.

Interviewer: Are you concerned that your teen might be suffering from depression? Now, sometimes it can be difficult to tell the difference between moodiness and actual depression, and that moodiness can be common in a lot of teens.

But psychologist Dr. Thomas Conover says you should look at how your children are doing in what he refers to as key life areas. That's school, extracurricular activities, social, and family life.

Dr. Conover, let's just start with school. Why is school performance one of the clues that you use when evaluating children for depression?

Dr. Conover: For teens, school is their primary area of function. It's, in my mind, equivalent to holding down a job or a career for an adult, right? And so if an adult is still functioning in their primary vocation, then that's a good sign. Same way for a teenager. If he or she is still doing well in school and not seeing a decrement there, then whatever is going on with the teen, you've got some reassurance that things haven't gone completely south.

Interviewer: What about extracurricular activities? Some kids just aren't into school, or don't necessarily perform well in school.

Dr. Conover: Well, I look for their performance in school with comparison to earlier performance too. So if you have a kid who was somewhat of an indifferent student and just wasn't that academically inclined throughout their school life, kind of a solid B/C student, then that's what I would be looking for the child to be doing going forward. So I'm not concerned if there's sort of indifferent performance when that's been the norm.

It's really looking at, "Has that gone downhill?" Do you have a child who normally got straight As and is now getting Bs and Cs, or a child who normally gets Bs and Cs who is now failing or having incompletes? That would be more concerning in terms of school performance.

And for those youths . . . let's say you have a child who's an average student and maintaining that performance, but who is an avid athlete, plays a sport year-round, and is withdrawing from that. That could be a concern as well. So looking at function in the academic realm is important, but there are other areas of function too, right?

So other activities are very important to look at. Social function. A normally developing or typically developing teen is a very social creature. It's a time of life where you're learning how to be independent, and you're transitioning in typical development from being reliant on your family as a primary source of your activities and values to your peer group, which in my mind and experience serves as somewhat of a transition to being fully independent. Having your own ideas about things, your own values, your own priorities for your activities.

So, in that vein, your typically developing 15-year-old is going to really want to be out there and socializing with peers. A lot of times, nowadays, that does take place over cellphones, social media, and the like. And so it's important to take that into account, that just because a teen isn't going out all the time doesn't mean that they're not socially engaged.

But a parent can reasonably expect that their teen is going to be interested in what's going on out there with their peers. And if they're more withdrawn or less interested in that than they used to be, that's a concern.

Then there's also family function, and it is normal and expectable to have a teen be less interested or less enthusiastic about certain family activities than he or she used to be. That is normal and expectable.

Then I would go back to the idea of, "Well, just how pervasive and intense is it?" Do you have a teen who says, "I don't want to go to family dinner at grandma's this Sunday. My friends are going out. I want to meet up with them," but who ultimately you can cajole and negotiate and get the teen to do it? Or do you have a teen who has a big blowup over that and ends up leaving the house and you don't know where they went? I'm giving fairly stark examples, but the gray area in between can be evaluated.

I haven't mentioned the threat of self-harm, or aggression, or worse, suicide. That would be an obvious red flag. If inquiry into a teen's mood or a parent making a request or demand of the teen leads to any sort of threats or acts of self-harm or aggression, then that's something that a parent would want to seek help for urgently.

Interviewer: Moody teenager or depression? When is the time to seek help? That's what we're going to find out today.

Dr. Thomas Conover is a board-certified child and adolescent psychiatrist. He is also board-certified in general pediatrics, and he has taken care of teens with and without depression for over 20 years.

Dr. Conover, when a parent comes to you or walks up to you or sees you at a party or something like that, and they say, "Dr. Conover, I've got a question for you. I've got a teenager. I'm a little bit concerned," what kinds of words do they start to use to describe their concern with their teenager?

Dr. Conover: You'll often hear about moodiness or irritability, being more isolative than usual, simply not wanting to do things with the family the way that they used to. Those are some of the most frequent keywords that parents who are concerned about their child's behavior or mood as a teenager will say to me.

Interviewer: And when you hear those words . . . certainly, when I hear those words, I think, "Well, that's a teenager." Right? So is it a little difficult to determine when to be concerned and when not to be concerned?

Dr. Conover: It sure is. Even as a practicing psychiatrist all these years, if I hear a parent say that their teen is moody or irritable, I don't immediately jump to the assumption that he or she is depressed.

Interviewer: So then you would, I would imagine, start asking some questions, trying to get a little bit more information. What are some of those questions that you would start to ask to start to make the decision whether or not there was something to be concerned about?

Dr. Conover: One question is, "How long has it been going on?" That's a common question in medical inquiry in general. Another is severity. Just how bad of moodiness or irritability are we talking about here? I always think too about how is the youth functioning. That's a really important thing.

So particularly, in a casual setting, if a parent just asks me a question about their teenager, a lot of times I'll ask, "How are they doing in terms of their other life pursuits?" So if a youth seems to be more moody and irritable but he or she is still doing all the things that they would normally do, still functioning in school, still recreating with friends, still engaged in other activities, but just kind of crabby, I'm a lot less concerned.

Not unconcerned, because there are some youth or adults too who are suffering but still managing to eke out their function because it's that important to them to do well in school, or with their sports, or whatever else they do. But I am often reassured if a teen is still doing the things that he or she normally would do despite the apparent problem with mood.

Interviewer: At what point does a parent say, "You know what? We should go talk to somebody"? When does it become something that a parent can help? Because it would occur to me that any of these little symptoms would be something you might want to talk about anyway. If the grades are starting to fall, you might want to approach that topic. If they're defiant a lot more, you might want to say, "I've noticed a change in . . ." Or maybe you don't want to say it like that. Help me out.

Dr. Conover: It's always okay to ask your child about how they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, most of the time people who are struggling, even in a small way, do want someone to ask.

I think it's helpful not to badger. I think if you're met with that initial "no" on a first inquiry, it's good for a parent to say, "Well, okay. I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you change your mind about that, if you do want to talk about it."

It's, I think, always appropriate to ask, and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond.

Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm, or threats or acts of a suicidal nature, or serious aggression.

Interviewer: So we have a pretty good idea of some of the different behaviors we might see that might indicate that a teen is depressed or heading towards depression. We've learned that the first step really is to try to talk about it and be genuinely concerned and not force, not corner. If you get met with some rejection, give the teen some space. At what point then does a parent seek professional help if they're just so frustrated, they are convinced something is up, and they just don't know what to do?

Dr. Conover: The primary care provider is equipped with enough training and understanding about childhood and teen depression to help to evaluate that and may then refer on to other resources.

Interviewer: I feel my approach would be I'd want to find out even more information. Maybe I might want to go to a professional on my own before I take the step of involving the teen in the process, because I'd be afraid that maybe doing that would somehow damage our relationship or cause problems. What's your take on that?

Dr. Conover: My take on that is twofold. On one hand, I think it's perfectly reasonable for a parent to seek education or support from other resources themselves. An initial inquiry in that fashion might mean that the parent would do some reading. They might get online and go to a reputable source such as the websites for the American Academy of Pediatrics or the American Academy of Child and Adolescent Psychiatry, both of which have really good information about child and teen development and kind of the presentation of various problems and resources for how to respond.

It might take the form of talking to a family member, a friend, a clergyperson, or the parent's own physician. All of those could be things that a parent could do.

On the other hand, I do think people may make the mistake of not asking, not saying something, not doing something for fear that it might damage the relationship. And it has very rarely been the case in my experience, even if asking or stating that observation leads to a fight or argument in the short term.

Interviewer: As that parent that asked you initially if they should be concerned about their teenager walks away, what would be the last thing that you would say to them?

Dr. Conover: "Let me know if there's more help that I could give." You can go off in one direction, make a decision to act, and maybe that initial effort comes up not as fruitful as you had hoped. So I would hope that people would feel open to asking for help again or talking more about it.

But it can be an uncomfortable topic. My experience both as a clinician and as a parent myself is that parents want their kids to be happy. They want them to feel okay. And it can be very, very troubling, very sad to contemplate that their child may not feel okay, that they might not be all right. And so it's really hard to ask and really hard to bring up, because you don't want it to be so.

Interviewer: So the thought is a few drinks during a time of stress can help a person relax and sleep. However, according to Dr. Andrew Smith, psychologist at University of Utah Health, drinking too much can actually have the opposite effect, and it comes with a lot of other mental health repercussions as well.

Dr. Smith: Moderation is the key here. I'll tell you what alcohol does when it's consumed at too high of levels. Alcohol has an effect on sleep. So it's a famous disruptor of deep sleep, the kind of sleep that we need to process those stress hormones, for example. It's a famous disruptor of social connection when used in too large of quantities. It can be a social lubricant to be connected, but it can also be a disruptor if we go too far. I think we think that alcohol helps us to be more relaxed, and again, at certain levels, at moderate levels, it might do that. But when we go too far, what it helps us actually do is ignore the signs in our bodies that we're angry or that we're irritated, and it increases the likelihood that some kind of social disruption is going to happen.

It can also have an effect on our mood when it's consumed at too high of levels. So when our mood gets affected, our likelihood of exercising or going to bed on time or starting a new structure and a new routine in this kind of disrupted structure and routine, those would all be affected by going over the line with alcohol.

Interviewer: And if you notice alcohol is beginning to impact one of those many things, to get back on track, Dr. Smith suggests starting by fixing your sleep first with the thought that the other things might follow.

Dr. Smith: Focus on sleep routine and rhythms and reducing, not abstinence from alcohol, but "harm reduction" is a term in the literature that we think about, which is reducing to a moderate amount, and I would say not drinking, you know, based on some of the science, not drinking within three hours before you go to sleep to disrupt that. So if you pay attention to those two features, you might have an increase in energy and motivation that might get you exercising.

Interviewer: And if a person is consuming more alcohol than they want, Dr. Smith has some advice to help scale that usage back.

Dr. Smith: There are very few things in the mental health literature that we know that are better for you than moving your body. If you're not exercising and your alcohol use is up, it's a hard shift to make, but it's intellectually a simple idea. And that is, I should modulate my alcohol use by getting my body moving, doing something else.

There are simple little tweaks to this that can be made. We keep carbonated water around the house as a bubbly substitute. And then cravings typically don't last forever, and if we don't lean into a craving and if we are able to notice in ourselves that, "Oh, I like having a beer at 5:00, but then what happens when I have 3 beers at 8:00," I can reduce that by choosing to ride out a craving with a substitute of some kind and watch that craving go away. Typically, in 15 to 20 minutes, it'll go.

Interviewer: And since we know excess alcohol consumption has negative impacts on all aspects of our health, both mental and physical, if you're having difficulty scaling back, don't ever hesitate to contact your primary care provider for help.

Interviewer: Are you feeling overwhelmed, distressed, depressed, or just simply need to talk, but not sure how to proceed? Dr. Benjamin Chan is a psychiatrist at University of Utah Health. And what do you recommend for someone who feels a need to seek mental health care in today's world? Has that changed, or is it pretty much the same path?

Dr. Chan: It's still pretty much the same path. I mean, we have our outpatient providers, counselors. So we have therapists, psychologists, psychiatrists, not only here at the U, but throughout Utah, throughout the nation.

There has been a large uptick of activity. People are calling in, scheduling appointments, talking through their feelings. There's so much negative emotion, so much uncertainty that it feels good just to connect with someone and share those feelings.

Now, my mental hat that I put on says, "Oh, this has to be with a mental health professional. They're trained. They can do cognitive behavioral therapy. There could be a medication management aspect to this." But when I take off my mental health hat and just put on my human hat, that connection can be with someone in your family or a long lost friend from college or high school. And it's incredibly powerful and beautiful to connect with someone and share those emotions.

So yes, the University of Utah Health, everyone who are mental health providers are here and ready, and we are very, very busy and that pathway is still open. But I also feel that connecting with someone is also a part of that ability to take care of yourself during these times.

Interviewer: Uncertainty, fear, sadness, maybe even a feeling things are not going to be okay, those are all very natural reactions to the uncertain times we're currently living in. And if you are experiencing those or other negative emotions, what should you do about those? Dr. Benjamin Chan is a psychiatrist at University of Utah Health. What advice do you have?

Dr. Chan: So right now, my advice, my counsel is to embrace the negative emotions. We really struggle, as humans, evading, avoiding negative emotions. They don't feel good. It's uncomfortable. But right now we're going through an unprecedented crisis, where people are going to feel anxious, overwhelmed, the ambiguity of the future. And instead of running away from the negative emotions, embrace it. It's okay to feel angry. It's okay to feel scared, overwhelmed at times. So don't suppress those emotions. Embrace them temporarily and then what we talk about in mental health is to embrace positive coping skills.

Interviewer: All right. And what are we talking about when a psychiatrist says "positive coping skills?"

Dr. Chan: So positive coping skills, I would say, are things, activities, experiences that take us away from our current situation temporarily and bring us that feeling of joy, bring us that feeling of control.

Interviewer: When you talk about finding something that can bring you some joy, for some people it's exercise, right? That's a coping skill for them. If somebody isn't necessarily an exerciser, what are some other options for some coping skills? Are you talking about hobbies? What are we talking about?

Dr. Chan: For most people, getting some fresh air, going for a walk, tending to the pets, children going for a walk, that is supreme. So yes, I would recognize that's probably the most positive coping skill people have adopted during this time. But it can be hobbies. It can be reading books. It can be connecting with people that you haven't connected with. And actually, pick up the phone and call someone and just talk about what they're feeling, experiencing. That's been really beautiful. And then projects around the house. You can say hobbies. For a lot of people, like we have these things that we should be doing in our house, and we have put it off, put it off. So I have furniture I need to deconstruct and reconstruct. I have spring cleaning to do. There's all these projects that can be done. And again, it feels really satisfying to do something that I have put off for two, three years and to start doing that at home.

Interviewer: So it sounds like doing things where you can get a feel of satisfaction or success is really key, even though you might not feel like starting that project. Kind of like running is for me. Once I get going, I'm always glad that I did.

Dr. Chan: Yeah. Exactly, right. That's an excellent point. So I like the running analogy. When we look back to where we came from after a run, like think how long you went, like the journey to get there. And you went up that hill, down that hill, and then how you feel afterwards. You have that endorphin high of finishing a run, and you sleep better, you feel better. The same could be applied to those projects, those hobbies around the house. Because how many times have we walked through the garage, seen the pile of junk that we need to go through, what needs to be recycled, what needs to be thrown away, actually taking the time to do it, and then looking at that? Just like that run, like look at what you have accomplished. And you set aside an hour or two to do that, and now your garage is cleaner.

Interviewer: All right. So don't be afraid to embrace the negative emotions and then do a project, whether it's . . .

Dr. Chan: So you look at the body of work, the evidence, the literature, as you will, these type of activities have really helped people's outlook, mental health, well-being. And so these are incredibly important for us to adopt.

Interviewer: We are currently in a state of hyper awareness. It seems like any moment of the day we could get an update about how our life will significantly change.

Dr. Benjamin Chan is a psychiatrist at University of Utah Health. And Dr. Chan, I'm hoping that you can give us say three tools to cope with the stress and the uncertainty and the feeling of anxiousness that a lot of us are feeling right now.

Dr. Chan: So the first one I would say is live in the moment. Too much of our existence we focus on the past, which arguably causes depression, or we're worried about the future, which can cause anxiety. We use this word in mental health called mindfulness, being in the moment, breathe in, breathe out. Whatever is going on right now is all you can really control and all you can really feel. So number one, live in the moment. Don't worry about what happened yesterday. Don't worry about what might happen tomorrow. So be very mindful.

Number two, adopt a new routine, embrace it. How you do things, how you go about your day, how you structure your life is going to be different, and it's okay, because everyone is in the same boat. That's the beautiful, maddening part of all this is we're all in this together and it's impacted so many of us. So my routine today is different, so is all my staff, all the people that work at the hospital, all the people at these different jobs. They all have different routines.

And then the last one is self-care. Take care of yourself. Develop a skill, a hobby, a project. Get your mind off things. Get something accomplished. Read a book. Do that garage project that you've put off. Connect with a long lost roommate, classmate, family member. So take care of yourself in a new, more meaningful way. So those are the three things I would say.

Interviewer: To somebody who's lost their job, doesn't know how they're going to necessarily support their family anymore, doesn't know when things are going to return back to normal, you know, might not even be able to get a job right now, I mean things are really bad. They might hear some of the advice that's out there, be mindful, breathe and think there's no way that's going to help me. What do you say to that person?

Dr. Chan: I would say you have to walk before you run. So if you lose your job, if things are super stressful today, it's not going to get better tomorrow. There is a path there that you need to take to prepare yourself emotionally, mentally, physically, that in a week from now, a month or now when you have that job interview, when you have that critical moment as a husband, father, wife, mother, you will be prepared to run.

So breathing, being mindful, enjoying the moment, going for a walk, reading a book, accomplishing a project around the house that you've ignored or put off for the past two to three years that helps you be a stronger, better person, and it'll prepare you for that next jump, for that next leg in your journey.

Interviewer: It's certainly a stressful time for many of us. But what about kids? Dr. Benjamin Chan specializes in child and adolescence psychiatry at University of Utah Health. What can parents do to help their kids during the COVID crisis? And, I mean, I guess, first of all, do children feel the stress as well?

Dr. Chan: Incredibly so, especially when most children have been sent home from school. Children, like us, crave structure. They crave routines. And those routines have been upended during the past few weeks. And no child or teenager will tell you, "Hey, I want more routine." They will tell you they want more iPad time, more screen time. But all children and teenagers crave routine. They seek it out. They flourish. They do really well with it.

So I like to use the example, when I was a child, of a chore chart. For me to get my allowance of, like, $10 a week, I had to do X, Y, and Z on my chore chart. Now, I remember, there were physical little tokens I had to do, take out the trash, wash the dishes, take the dog for a walk, clean my bedroom. And I got my allowance. So my advice to parents is to create structure within their home. Kids, teenagers will respond to that structure. So even if it has to be, like, a physical manifestation of a chore chart: when people should get up, what time should they have screen time, what time should they work on homework, what time should they call a friend on a phone, what time should they go outside for a walk. People, kids, teenagers will respond to that.

Interviewer: Dr. Chan, are there some warning signs that parents should look for to help indicate that, maybe, something isn't right and they do need to do something?

Dr. Chan: They should look for teenagers who seem very sensitive or frustrated. Anger is very common. And, again, that is very normal, but where I get very concerned is if that leads to a deterioration of their functioning. If they seem to be in their bedroom for an extraordinarily long time, if they are not communicating their feelings as much, if they are not finishing their workbooks at home or they are refusing to call their best friend on the phone, that's something I would recommend that parents should really keep an eye on is a deterioration in their functioning.

Interviewer: All right. And that would be a good time to check your child's routine. And don't forget to include a little bit of work, a little bit of play, some socialization, of course, appropriately physically distanced. And if you continue to have trouble and your child is struggling, don't be afraid to talk to them about what is going on and involve a professional to help you get your kids back on track, if necessary.

Interviewer: Why should autism be diagnosed early in life? We'll talk about that next on The Scope.

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Interviewer: I'm talking with Dr. Debbie Bilder. She's Principal Investigator of the Utah Registry Of Autism and Developmental Disabilities. We'll be talking about the need to diagnose children with autism spectrum disorder early in life.

So, Dr. Bilder, if I were sitting next to a three or four-year-old who has autism spectrum disorder, what might I notice about this child that may be a little different from a typically developing child?

Dr. Bilder: Well, that child may not be making eye contact or may be preoccupied with something that is really hard to separate them from, in particular something which is not a typical toy that a child that age might be interested in.

Maybe when you do talk with that child, that child would have a particular interest that that child would go on and on about regardless of whether you may share that interest or not. A child may also have self-stimulatory behaviors, like hand flapping or even looking at things through the corner of their eye.

Children with autism have a really difficult time connecting effectively with their peers. So that child may be sitting on the bench next to other friends or the other children are out playing on the playground.

Interviewer: And is it usually obvious? I mean, if I were a parent, would I just know that, you know, maybe there's something a little different about my child?

Dr. Bilder: For parents, particularly, you know, thinking about a parent in which that's the first child, so they don't have a child to compare their first child to, they might notice that there are significant delays. Some children with autism also have other delays as well. So there would be a delay in language that their pediatrician or family practice doctor would mention to them. They may have difficulty in interacting with other children or choose not to play with other children.

But the majority of children with autism who have normal [intellectual 00:02:06] ability, which is the majority of children with autism, it may not be apparent to a parent who does not have another child to compare that child to.

Interviewer: I think you would argue that it's important to make that diagnosis, to make that identification early on.

Dr. Bilder: Well, we know that children who are identified by two or three years of age and receive treatment right away, intensive treatment can really optimize their ability to function, optimize their ability to be in a school classroom with other neurotypical children.

And some children who receive this intensive intervention may even no longer meet criteria for autism when they get older, and even though that's a very small percentage, we want to give children whatever shot they can get to be able to develop these skills when their brain is most capable of learning them.

Interviewer: So it's more difficult to make this intervention effective later in life?

Dr. Bilder: Yes. There's a developmental window as we develop language, as we develop our interactive skills. Clearly, there's a time in which our brains are intended to develop these skills. And if we could take advantage of that in these children, even though they may not develop those skills inherently, they can be taught these skills and that is the time at which their brains are going to be most receptive to that education.

Interviewer: So you've been involved in some large-scale research recently, looking at the ages at which children are getting that diagnosis from autism spectrum disorder. What did you find?

Dr. Bilder: Well, as far as the diagnosis itself, as far as receiving a diagnosis, we did not see a reduction in the age at which that child first received a diagnosis. The median age, when we looked at this for children who were four years of age back in 2010, was about 35 months here in Utah, and similarly it was 35 months two years later.

And then this particular study actually extended over six years. We participated in two of those years that I just mentioned. But even looking across the six years, there was no significant difference in the median age at which these children across seven different sites were identified with autism spectrum disorder.

The focus of this study perhaps goes even a little bit before then. The real aim is to have these children recognized as having a developmental concern so that they then are able to access a comprehensive evaluation.

So for those children when they can access and they do access a comprehensive evaluation even before the diagnosis is made, the developmental delays will be identified and you can initiate treatment even before you have a clear diagnosis of autism.

Interviewer: And so you said that there was no change in these two years that you looked at the numbers of diagnoses. I mean, what does that mean to you? Why does that concern you?

Dr. Bilder: Well, there was no change in the age at which these children were identified with autism. And what concerns me is that we as medical providers, as medical professionals despite our best efforts and there is a lot of work going into early screening so we can subsequently have early identification of autism to give these children that opportunity.

Despite these efforts, that age at which they're first presenting for a comprehensive developmental evaluation is not going downward. So it makes me really wonder, well, what about the process we have in place, because we're working really hard to initiate this process, what about this is not ultimately leading to the goal in which it was established, which is to reduce the age at which these children can access treatment?

Interviewer: And do you have any insights into what barriers are in place there?

Dr. Bilder: Well, this particular study was an epidemiologic study. So its purpose was to look at this in a very systematic way across multiple sites so that we can say this is a problem, and with an epidemiologic study, it creates the validity that this really is a problem.

What's up to future research and we even have fabulous researchers here in our Department of Pediatrics, what's up for these researchers is not just to accept that there's a problem, but then to look to see, well, where is this process breaking down, and they're doing that. And I'm looking forward to seeing the results they come up with, because that's the type of research, even though not done at an epidemiologic level, but done on a more fine-tuned, kind of make more granular level to figure out what exactly needs to change so that we can be successful.

Interviewer: I'm wondering if you think part of the problem might be that there might be a reluctance of parents to admit that there's something different with their child.

Dr. Bilder: Part of this process is beyond the typical office setting in regards to the pediatrician or the family doctor. Part of this process in addition to identifying which children are screening positive and then making the referral for those children to obtain a comprehensive evaluation is the part about it which requires the parent to be able to do so.

And if that parent were having a difficult time accepting that there might be something wrong with their child, that can unintentionally affect their willingness and speed at which they access a comprehensive evaluation for their child.

So as we look at this bigger picture, recognizing and measuring the gaps between that positive screen and the time at which the child presented for a comprehensive evaluation could really help us get a sense for if there is a delay, what could be causing it?

Interviewer: Do you have a recommendation for parents in maybe looking at their child or thinking about their child or their future or being screened for autism spectrum disorder?

Dr. Bilder: Well, every child, regardless of whether there is a concern or not, should be screened by their pediatrician or family practice doctor at 18 months of age and again at 24 months of age.

My recommendation is that when that medical provider expresses concern and makes the recommendation of referral to allow themselves to ask that provider, you know what specifically are they concerned about to be able to have an opportunity to be convinced that this is important.

As far as red flags for parents, like things to look out for, you want to look for a baby at six months of age, they should be smiling, having a reciprocal smile. So the mother smiles or the dad smiles and they smile right back and expressing joy even their facial expression of joy by six months of age. You should be expecting back and forth sounds and other facial expressions certainly by nine months of age.

They should be babbling or at least pointing to objects by 12 months of age and indicating that desire to engage and initiate that interaction with the caregiver. Using single words by 16 months of age. And then if by 24 months of age they're not using two words together in a meaningful way, that also is a red flag that they need to be evaluated.

I think the big red flag that's important for parents to be aware of because primary care providers go through these developmental milestones routinely during their well-child visits, the particularly important red flag for parents to be aware of is that if their child loses any social skills or language skills, then they really need an immediate visit with their primary care doctor even before the next well-child check. That is not normal. That itself should initiate a visit to their primary care provider for further screening.

Interviewer: And what's next for your research?

Dr. Bilder: We are excited to have received a four-year grant from the Centers for Disease Control and Prevention through the Autism and Developmental Disabilities Monitoring Network. We are thrilled to be part of this. What this funding does it allows us, the University of Utah, along with the Utah Department of Health and the Utah State Board of Education, to really enhance our case finding for children who are affected by autism as well as allowing Utah to be part of these national prevalence numbers that are established for the U.S.

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Dr. Jones: We know as women that the effect of trauma that happened to us when we were younger echoes throughout our biology and our psychology for many years if not, all of our life. What do we know about this? How can we look at it more carefully? How does it affect our health? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health and this is "The Seven Domains of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Trauma, sexual trauma, psychological trauma, and even trauma to children, and trauma in utero, we become more and more aware of how trauma echoes through our health in many ways throughout our life. Today in "The Scope" studio, we have Dr. Leslie Halpern. Now, she is a doctor and a dentist and is here to talk about her interest in neuroscience and the long-term effects of trauma on women's health. Thank you for joining us in the studio.

Dr. Halpern: It's my pleasure to be here.

Dr. Jones: Tell us a little bit about your interest in women, health, and trauma.

Dr. Halpern: Well, within my own life, I have had suffered trauma indirectly, but it left an impression on me as both a female and as a healthcare provider. When I say that, I really talk about violence and abuse. My only sister at age 23 was brutally raped and murdered right before her wedding day. And it was very hard. It was very life changing, which makes sense when you're a family member.

Through my education, and with that experience and my passion for health, I became an oral maxillofacial surgeon. And I trained in an inner city, in New York. And there was another incident that sort of really kept my passion to look at victims.

There was a woman who came into our emergency room on a summer afternoon. Her husband had boxed bladed her face, and it took me several hours to suture her wounds. And I said to her, you know, "You don't have to go home. We have social services here and you can be safe with your family." And she said, "No, no. My husband didn't mean it. My children are home, and I know he loves me."

Well, when you're an intern in the emergency room you just say, well, you know, you spoke to the patient, you did your due diligence, and now, you're on to the next patient. Three days later I was on call and the head of the emergency room came in and said, "Dr. Halpern, do you remember Mrs. so and so?" I said, "Yes." He goes, "I want to show you something." Of course, I as an intern thought that there was something wrong with the wound.

He brought me into our trauma room and the patient was on the table with a sheet over her. Her husband basically finished what he started. And this really sealed my passion to make a difference. I was fortunate to be involved with a grant, a large grant from the Oral and Maxillofacial Surgery Foundation with my mentor, Dr. Thomas Dawson, who asked me to develop a diagnostic protocol.

Now, dentists are in the most pivotal position to diagnose patients, because 75% of the injuries are to the head, neck, and face. So it's intuitive to be able to apply our knowledge and identify more patients. We developed a protocol, which I'm very happy to say increased our prevalence rate of identification.

But you identify and everybody says, "Well, so what?" And this is in relation to your original comment about how does trauma impact the future. Well, violence and abuse is associated with chronic illnesses that can decrease a victim's lifespan. And my background as both a researcher and clinician has afforded my colleagues and I to develop grants in order to look at exposure to intimate partner violence and its effect on health.

We know that women and men react very differently to stress. And specifically the inflammatory cascades in women are more irreparable with damage than they are in men. And I see that in the maxillofacial injuries that I treat in men and women. And it gets again into sex and gender in medical treatment that women will respond differently. They present with different symptomatology than their male counterparts do. So the female model for a post-traumatic stress disorder is a more complex type of model, and you have to be more vigilant as a physician.

Dr. Jones: So when you have a new patient or someone or you as a woman are coming to see your physician, you don't always say this, "You have to understand this one thing about me. I was sexually abused or I witnessed trauma, and I've never been the same." They won't do that. They're hoping, like my conversations about sex, they are hoping that maybe you'll bring it up. But in fact, we don't always. We're interested in someone's heart disease or cholesterol. But it turns out that you found that the long-term consequences of these horrible events have effect on the heart and have effect on inflammation for the rest of a woman's life.

Dr. Halpern: And it's all about how to approach the patient, number one. And many practitioners are very hesitant to approach patients and ask them, because they're too busy, they are worried about litigation, or they themselves have been victims of abuse and do not want to go back there again.

Dr. Jones: Oh, that's an interesting one.

Dr. Halpern: Yes. And it has been shown when many health practitioners are questioned around the country. So we try to do it indirectly. As I said previously, there are certain common chronic illnesses from cardiovascular disease to GI to GU to reproduction. And what we have tried to do with our group is to use some type of a diagnostic indicator that can help us follow progression of disease.

In the field of oral health, the advantage that we have is that we can apply a non-invasive method. We utilize saliva. Okay? And people aren't afraid to "spit in a cup." Some of the projects that I've done have looked at victims who have been exposed to intimate partner violence versus those that have not. And I've utilized cardiovascular disease markers just to get a trend. Okay? And what I found are significant differences not only between victims that show a positivity towards intimate partner violence, but differences between different ethnicities of women.

What I have seen in treating many women is that the cultural competency, if I can use that term, of violence and abuse within their community is a norm. My grandfather beat up my grandmother, my father beat up my mother, so it's okay that my husband does the same to me because this is part of their life.

Dr. Jones: So women talk about their hair differently than men, and they treat their hair differently than men. And it's often been the phrase crowning glory has been used to describe women's hair. But it turns out that we push out this hair for years if you have really long hair and you mentioned you've been using . . . some research using hair as a way of looking at these markers.

Dr. Halpern: Yes. I think hair is the hidden secret in a way because we also have looked at the amount of cortisol which happens to be found in the hair. Hair is a wonderful depot for cortisol isolation. Cortisol . . .

Dr. Jones: Cortisol is a stress hormone.

Dr. Halpern: Yes.

Dr. Jones: We make it normally. We make it differently throughout the day. But if we have three or four years of hair, one could maybe slice it up in little bits and say, "Oh, what happened to you in 19 whatever or 2005?"

Dr. Halpern: I've never thought of it as a timeline.

Dr. Jones: Oh, but I think it could be.

Dr. Halpern: But it gives me another idea for a grant.

Dr. Jones: Well, heavy metals, we know that people put heavy metals, which are toxic to our body, we put them in our hair. And then of course, what about women who color their hair? Maybe all those coloring, even women with natural hair or even women who color their hair, God forbid, anyone would look at my hair and figure out anything.

Dr. Halpern: That makes two of us. But yes, you know, that is definitely a truism. But, you know, we are looking for biomarkers.

Dr. Jones: Biomarkers.

Dr. Halpern: And the reason why we're looking for them because we want to try to determine an interventional strategy. And when you're an adult and you've been exposed to violence and abuse, the damage is done in a way. And you just try to intervene secondarily. But what we are now looking at is we're going back and looking at children. It is well known that children who are exposed to violence and abuse are susceptible to adverse health events sooner in their life than their counterparts who have not been exposed.

Dr. Jones: Right. They are more likely to have obesity, hypertension, diabetes, depression, suicide, substance abuse, difficulty in school. The list could go on and on. So, if you could figure that out in kids, because maybe the parents won't say or the kids won't tell, then we'd be able to help kids give words, help them, mindfulness maybe to calm. Who knows.

Dr. Halpern: Yes. And taking a sample such as a saliva and being able to map a temporal timeline of exposure to the marker that would allow for intervention would be a wonderful finding. And some of my colleagues are indeed doing that.

Dr. Jones: That's been very helpful, and I'm encouraging everyone to keep tuned because this is going to be an ongoing effort for all of us who take care of women and children and men. And I think what we try to do is identify people so we can build resiliency so that their health and they can rise above the issues that happen to them when they were younger. And their health can continue to be as strong as it can be given some very unfortunate situations that happened before. And I want to thank you for being here in the studio and thanks for joining us on The Scope.

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Interviewer: Helping asylum seeking refugees deal with trauma so they can better integrate into their new communities, we'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Often when refugees make it to the United States, they've been through a lot before that, and I think a lot of us here at that point think, "They've made it." To some extent, they are safer in their new environment, but they still have a lot to process, especially the trauma that followed them to their new country.

Dr. Omar Reda is a board certified psychiatrist and a refugee trauma expert, and he's also a refugee himself with quite an incredible story. He was a doctor in Libya. His friends became a little bit more politically active. As a result, they and later he found out that he was on Muammar Gaddafi's hit list. His father had found that information out through sort of his own sources and came to his son one day with a handful of cash and said, "You need to leave." He had about five minutes to say goodbye. And eventually, he ended up in the United States of America.

Always wanted to be a psychiatrist, but in your own country, there were no jobs to do that. You were an emergency room physician instead. But when you came here, you got your psychiatry degree. You went to Harvard. You learned more about refugee trauma treatment, and that's what you do now. Welcome, it's a pleasure and a privilege to talk to you.

Dr. Reda: Thank you, the pleasure is mine.

Interviewer: So today, I'd like our audience to better understand what's been described as the "tangled web of trauma" that refugees come from. I'd also like to find out how we would help them deal with that trauma and then, ultimately, better understand how they would integrate into our communities better. So first, if you could briefly paint a picture of what it's like to be a refugee forced to leave your country and come here. What kind of trauma are those individuals dealing with?

Dr. Reda: So many people think coming to a new country is the end of the story. It's usually the beginning because you lose your psychosocial support network that you left behind, and you might face lots of struggles in the new culture, trying to learn a new language and pursue a dream. Many people, they try their best. They work very hard to master the language and maybe navigate the job industry. Many of them, unfortunately, they pursue the American dream and they lose the American dream chasing it, because they will provide materialistically for their families but they will not be available emotionally.

Wounds, the invisible scars of a trauma and war, they go from one generation to another if we don't early intervene and try to come up with preventions. So our youth can be very vulnerable. So I have this little boy and he was extremely anxious, and we found out the reason was because his father was leaving 6:00 in the morning, coming home at 12:00 midnight, seven days a week. And the boy does not have any quality time to spend with his dad.

When we sat down with him and we try to educate the importance of taking care of your family's emotional needs, he said, "What you trying to advocate here is wonderful, but I don't have that luxury. I'm trying to work two jobs. I'm trying to master the language and obtain a Green Card and provide for my family." So this is a very sad dynamic that we see in lots of refugee families that come here.

Also, leaving behind your loved ones and worrying about them, especially the trauma and the war zone, for example, I come from Benghazi, Libya, but I worry about my family every day. There are lots of drama and traumatic experiences that they go through. So there is a lot of stress when it comes to people worrying about the safety of their loved ones. Yes, we are safe here but, in a way, a piece of your heart is left behind.

Interviewer: And that's fascinating because you didn't even really touch on the trauma that may have been occurred in their country as a result of being in a war zone or constantly in danger which adds to what you just explained.

Dr. Reda: Some people come because of choice, some come by chance, and others come by a forced choice. People think, just coming to safety here means that everything that you went through is going to be okay, and maybe now you have the trauma behind you. If you are dealing with PTSD, the post-traumatic stress disorder, and that disorder, many people argue, can actually cause lots of dysfunction in your inter and intrapersonal relationships.

So you might be struggling with your own symptoms but also you can relive the trauma, either in your dreams, or in the flashbacks during the day, and maybe even become more irritable and take your anger on your loved ones. So yes, I mean, I'm not dismissing the trauma that people went through in their own homes, but if we make the system very difficult . . . I come across some of the refugees who, they say, "Maybe staying in Syria was a better decision. Maybe if I am in the Jordanian camp, I still have brothers and sisters and friends and still we will have my language and my culture."

So I mean, many American citizens are wonderfully accepting to the newcomers, our new neighbors, but if we treat them with suspicion and we think that everybody is a potential terrorist, then there is another re-trauma that happens on a daily basis.

Interviewer: Explain to me the model that you use in Oregon to help refugees start to untangle this. It's actually called "untangled."

Dr. Reda: Yes.

Interviewer: It's a program. So explain to me what that is and what you ultimately hope to accomplish with it.

Dr. Reda: Yes, I mean it's a dream of mine to have it as a model of care that's recognized. So I'm working on trying to fund it and also test it so we have an evidence-based support for this model of care. But mainly, we work on psychoeducation a lot. So we try to educate the newcomers that there is nothing wrong about expressing your emotions, talking about your basic needs, and especially the emotional needs.

Many of them, they come from culture that dismisses that. There's lots of stigma. And the mental health clinic that we offer for free one Saturday a month, and we see people when they are quite advanced in their either psychosis or suicidal thoughts or the dysfunction that they go through, and that's very unfortunate. They will traditional healers, they will talk to their local Imams, and eventually, somebody will tell them, "Just go, you aren't really struggling." They come to us at a very advanced stage, and that's a shame.

So I have been doing seminars and workshops on parenting, on marriage and Islam, on how to take care of your youth and empower them, and then just trying to use tools that they bring from their culture, from their religion and try to build on that. So it's quite strength based and solution focused in the here and now, touching on the trauma story. Many of the interventions they shy away from the trauma story because it's painful for me, the listener, or the therapist and that's not fair for the survival of my client because they deserve, when they are ready to tell their trauma story, to have somebody who's ready to listen to it. So psychoeducation is a big one.

Then, we try to build team capacities, so we do lots of training the trainers. We try to establish relationship with the local organizations that are interfaith and also the suicide hotline, for example. And we try to do support groups for newcomers, so we bring our new neighbors and we try to mix them with other neighbors and people who have been in the country for like five years or ten years and people who are born and raised here, and we do panel discussions.

And we see what's the experience of a new refugee, what's the experience for somebody who had been here for a decade or so, and the experience of somebody who's born and raised in America. So just an eye opener how much diversity and strength we try to build, and people come with lots of resilience. Yes, refugees are usually vulnerable but their trauma story makes them or breaks them. And many of them are quite resilient.

Interviewer: Help me as just an individual. If I come in contact with a refugee family, whether they move in my neighborhood or go to my church or start a job at my workplace, how could I be empathetic and help or shouldn't I. I mean, shouldn't I reach out. I mean, I don't know what I should do. What would be considered proper?

Dr. Reda: I mean, humanity has no barriers, so we don't have a language barrier or religious or cultural barriers. If you are genuine and if you are compassionate, people will appreciate that regardless even if they don't understand a word of what you are saying. So if you don't treat everybody as a potential criminal and in some cases, especially with a Syrian refugee had been, "You are potential terrorist." Or, "You have links to ISIS and stuff like that."

So if we just try to say, "These people went through an exhaustive and extensive venting process because at least, 20 steps before you enter the country." Then, we try to just bring, "Let me try to learn something about you."; I think, it doesn't matter who starts the first "hi" as long as we open that bridge of communication and try to start the process of reconciliation and maybe not paint all religion with a single brush or every culture. We try to generalize.

Of course, it's not fair for people to run away from trauma to be stuck in another trauma. It is wonderful to reach out to people and understand that all of us are refugees. Everybody came from somewhere else. And eventually, all of us are brothers and sisters. We have Adam and Eve as our father and mother. So I hope people will just put the differences behind their back and treat each other with dignity and integrity and know that we are in this together. We either stand united as brothers or fall as fools.

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Interviewer: Coping with anxiety, we'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: You know there are a lot of things that can happen in this world that can cause fear and anxiety and most of the time they're not really under our control but what do you do about them? How do you cope with them? Maria Reyes is a psychiatrist with University of Utah Health Care and she's going to give us some tips right now on how to deal with anxiety-causing events in your life that you don't have control over.

Maria: To your point about anxiety, as a psychiatrist, and I think this about it, every emotion in general I think the first step in being an emotionally healthy person is acknowledging your feelings and not judging them. So feelings and thoughts are just those - feelings and thoughts - but the first thing you need to do is acknowledge those and put a name on them. Don't ignore them is the bottom line because they will ultimately come to fruition in ways that may not be so pleasant sooner or later.

Interviewer: So it's better to just face up with it and just go, "I'm feeling a little stressed or sad or whatever about this situation."

Maria: Absolutely.

Interviewer: And go, "Okay. I'm feeling it."

Maria: Right. That means you're alive, that means you're a human being.

Interviewer: That's a good thing.

Maria: Yeah. And join the club.

Interviewer: So acknowledging is kind of the first step. Within that what else would you want to do as part of acknowledging it?

Maria: I think what distinguishes humans from primates is the ability in general to articulate our thoughts and feelings and I feel that people that tend to talk about their feelings tend to be more emotionally healthy and so I would encourage people when they do experience anxiety to talk to someone you know and trust. It doesn't have to be myself or a health care professional necessarily, but just being with friends, family and just using them as a sounding board for kind of what you're thinking and feeling.

Interviewer: Find that person that listens to you or that you have a good rapport, some trust with I'd imagine.

Maria: Absolutely.

Interviewer: Would be a big part of that. So acknowledge it, experience that emotion, talk about it. That's kind of the big first step when you're faced with some source of anxiety. What would you do after that?

Maria: After that, I encourage people to step back from their problems. Now I want to make the distinction between stepping back and avoidance. I'm not encouraging avoidance. That actually makes anxiety worse in the long run. However, creating some healthy distance when you feel overwhelmed emotionally is a good thing and it can be helpful in the long run. By that I mean things like engaging in hobbies, exercise, sometimes disengaging from social media if that's something that is anxiety provoking.

Interviewer: Especially if it's a world event.

Maria: Exactly.

Interviewer: You keep diving into more news stories about it or go to social media or go to the comments section.

Maria: Exactly.

Interviewer: So it's healthy to get away from that.

Maria: Right, or going on a news social media cleanse of sorts or just kind of being cognizant of the time you spend in those realms. So part of stepping back, the outcome of that is hopefully just a reframing of the situation. So stepping back could kind of give you the emotional distance to kind of look at a problem from a different perspective, seeing that silver lining around the cloud.

Interviewer: That's a good thing to look for?

Maria: Yes.

Interviewer: It's a healthy thing to do.

Maria: Yes. Our ancestors had it right when they came up with that adage.

Interviewer: So try to find something in the situation that maybe makes it not seem quite so bad or what good could come out of this or . . .

Maria: Absolutely. So just finding what lessons are there to be learned or how could I have done things differently are good ways to think about problems.

Interviewer: So step back and then is there something else you could do to help maybe make it not seem so big and scary?

Maria: Absolutely. Again, I don't want us to get the message that I'm advocating for burying your head in the stand or avoiding your problems. Of course, the step after stepping back would be to re-approach the problem or the precipitator of that anxiety but hopefully now it would be with a clear head. Then the outcome of that, I would hope, is some sort of sense of control over a situation that you may have limited control in. However I think there's always some part of that problem that seems beyond your control that you have a little bit of control over and I encourage people to know the difference between what you can control and what you can't.

Interviewer: And try to find that little piece maybe that you can do to make yourself feel better about it all.

Maria: Exactly.

Interviewer: So how do you know when it's time for an in-person session with a professional?

Maria: I think anytime you have feelings and emotions that interfere with your ability to fulfill your role as a mother, a spouse, a friend or if it's interfering with your ability to work or go to school or function in general. Also I have to throw in there any time you feel that life is not worth living anymore, these should certainly prompt your attention to seeking immediate help.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 31, 2019
originally published: November 10, 2016

Interviewer: Going to learn more about a brand new book called Autism Spectrum Disorder in Mid and Later Life. That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Scott Wright is a researcher at University of Utah and also the editor of the book Autism Spectrum Disorder in Mid and Later Life. Tell me about this book. Why did you decide the world needed this book?

Scott: I do think the world needs this book. My interest into autism issues with the aging intersect, the gerontological connection, came about when I was involved in a research project where I saw grandparents, grandparents as being very involved in the care of children, young adults on the autism spectrum, and realized that okay, here you go. Here's the grandparents yet again showing the kind of support and that safety net to help out their grandchildren. But think about this, their grandchild that has special needs and the grandparents were there providing that care. Well, from there, I realized that grandparent issues are also aging parent issues. Are there aging parents that are still supporting their adult child with disabilities, in this case perhaps with autism spectrum disorder, autism conditions? And yes, there are. In my discovery of the literature and the research, aging parents very much have this very, in a way, very concerned futuristic look about what is going to happen to their son or daughter who's an adult in their 30s, 40s, and 50s. What's going to happen to them when the aging parents, when they die? And then from there I came to appreciate that the amount of research, literature looking at this topic, it simply wasn't there. There was just this huge gap in looking at autism issues and aging, which literally stopped at adolescence and then picked up again a little bit in the geriatric years but nothing in between.

Interviewer: So kind of like a dumbbell. There's a lot young, a lot old, but mid to later life, nothing.

Scott: That's a great image to think about, very much like this barbell effect where you have a lot of interest, activity, services, programs, just general thinking that autism is a childhood issue and then it just goes away. Or that we're not paying attention to it once individuals transition, the transition years to adulthood. What happens then? Because autism is a life-long condition. What happens after adolescence? This is what this book does.

Interviewer: Is this book accessible for the lay public? I'm noticing a lot of references and I don't even know what these are called, oh, they're called references. At the end of the chapter it looks like an academic kind of book.

Scott: The original intent of this book was to create a publication of the latest evidence-based research. And indeed it has, I would say a good part of the book is academic and written for other professionals. But really this book is for a variety of different audiences - grandparents, aging parents, adults on the autism spectrum that are aging themselves. So this book has this great feel of being accessible to so many different groups and I think it's been accomplished. That goal has been accomplished with the final outcome.

Interviewer: It sounds like, so when you first brought up what interested you in it, I guess I just automatically assumed that parents with, somebody with a child that has autism are probably just going to be essentially parents their whole life. And that's what you're seeing is actually going on, but maybe that's not the best way.

Scott: That is a great question because for many parents, their son or daughter will reach adulthood and the programs and services that were there in the K-12 years, which are federally mandated, suddenly it appears that once their son or daughter reaches adulthood there is such a lack and a huge gap in services and programs. Parents become, in effect, the support system. When we look at individuals with autism, role models like Temple Grandin, she has some very interesting advice. And what she would say is a key issue during the transition years to adulthood, work. Work. Employment is such a big factor for a hallmark indicator of adulthood. But it would be my guess that the listening audience may not even know this statistic: 90% of individuals on the autism spectrum, they have the highest unemployment rate of any disability group. We're talking about 85-95% of this population with autism are unemployed. This is unacceptable in our society. Why is this happening? Work is a hallmark for adulthood and yet unemployment is a huge challenge. We need to address this.

Interviewer: So what were some of the things that you found out in the process of editing this book? And I will say that you did tell me that there were a lot of contributors to it. International contributors, not only people with MDs and PhDs but people on the spectrum as well. So what did you learn? What are some of the things that can be done in mid and later life that isn't being done?

Scott: What to glean from this book, with you're right, international authors, individuals, adults on the spectrum who are contributing the chapters, I think the two big themes that emerge out of the book that are important issues actually relate to the general population, to you or me and to everybody. That is when you think about to love and to work are two key factors to well-being and quality of life. For individuals on the autism spectrum, to work, which we would think of as almost like an automatic factor of being involved in our society, is a huge challenge for all sorts of different reasons. And then to love would be the issue of establishing relationships. More importantly, social networks and I think of this term social capital in terms of to love and having connections and social support. And then work to have a productive contribution to society and in return the rewards of that, this is what needs to be worked on, addressed for autism issues into adulthood and then into later life.

Interviewer: And what are they answers? Are they within the covers of this?

Scott: I think that the authors, yes. The authors that have been collected here, brought together in this book, they've done a great job with indicating what the answers are. I'm proud to say that, again, the researchers that are involved in this are talking about the data that they have collected but more importantly are the contributors who are adults on the autism spectrum, they have shared their story. And their story says we have learned a lot, we'd like to share it with everybody else, the right steps to live a fulfilling life.

Interviewer: And it sounds like it might offer some new perspective and new thoughts, too. Just even the perspective of, boy, a job is really important. Inclusion is really important but yet also is autonomy. That's important as well.

Scott: It is, so think about . . .

Interviewer: And these are all relatively new concepts to the thinking of the condition, is that correct?

Scott: It would be because, again, think about how we view autism, it used to be primarily a childhood/adolescent context. Now the context is when you're an adult on the autism spectrum the issue of community inclusion is huge. How can I sustain an independent living circumstance? Which to maybe many other people that's going to be an automatic transition, for individuals on the spectrum it's fraught with a variety of different challenges. So community inclusion is big. And then the employment issue, again, I can't think of one issue that would help so much in the lives of individuals on the autism spectrum and their families and our communities and our society would be meaningful work, and the opportunity to engage in and interact with meaningful work is one of the key issues in the landscape of autism today.

Interviewer: So it sounds like it's really kind of perhaps a guide into some uncharted waters.

Scott: I think that's really the best way to describe that. This book is pioneering, I think, in opening up new understanding of autism and aging issues.

Interviewer: What would you hope if a parent or a grandparent that had somebody with autism in their life purchased it? What would hope that they would be able to do after they have read it?

Scott: I think the key here is to realize that services, programs are becoming available in our society and in our communities are rapidly increasing. That's the good news. And that for the individuals who would read this book is that they should not, please, feel like that they're all alone, isolated in this particular context. That there is an increasing amount of services and programs in our communities. The key is to build the bridge between the individuals who need it and the individuals who can provide it. That's going to be the key factor.

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Interviewer: A new study just came out indicating shorter life expectancy for those with ASD. We're going to find out what you should take away from that next on The Scope.

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Interviewer: Scott Wright is a researcher at the University of Utah and the editor of the book, "Autism Spectrum Disorder in Mid and Later Life." A recent study just came out that indicates that life expectancy for those with autism spectrum disorder is actually shorter than what we previously expected. Tell me a little bit about that study first of all, and then eventually I want to get to what's our takeaways from this.

Scott: This is a relatively new study in the British Journal of Psychiatry, and that the perception was that autism would affect the lifespan, average life expectancy, as equivalent to like Down syndrome that most individuals would not reach mid-life or perhaps even the 20s or 30s. But the perspective changed in the last two decades that autism is indeed a lifelong condition, and we have examples of individuals like Temple Grandin, Donald Triplett. These are individual that are pioneers. They're into their 60s, 70s, and 80s with autism.

Then comes this study. This study has indicated that premature mortality is a very, very important characteristic of the overall health, well-being, quality of life for individuals. In effect, the researchers in Sweden discovered that there is a loss, on average, for some groups in the autism landscape, up to the course of 30 years less than the general population. This says a lot about two factors.

Is it a biological vulnerability of individuals? Or is it the fact that the context, especially in the healthcare settings, has a lot that needs to be worked on so that individuals on the spectrum can interact with the healthcare system to deal with their healthcare challenges?

Interviewer: What I understand that you're saying is that it could be a genetic cause that individuals with autism just are going to live 20 to 30 years, on average, less. Or it could be they're not getting the adequate healthcare that they need in order to have a full life like the rest of us?

Scott: The article and the analysis of this data is indicating that many individuals are simply left to the side of the advantages that we find in healthcare settings for the general populations.

Interviewer: And I should also say a lot of the times individuals with autism could be a little medically complex as well.

Scott: Yes.

Interviewer: And they're not completely always understood by physicians or the hospital system, not able to necessarily communicate what their conditions or concerns are. Do you feel like that's where it's kind of happening?

Scott: I think that's exactly . . . it's an interaction effect. If we think about the challenges of an individual in the autism spectrum, a premiere characteristic is social communication. And let's just use the term, there can be a degree of awkwardness of interacting with other individuals. And an individual that is very reluctant or hesitant, or has stress or anxiety about interacting with the healthcare system, is going to be very reluctant to even go.

So that's another added factor that I think physicians, healthcare professionals should be aware of, that the individual in the spectrum, might be having difficulty in expressing the challenges that they're going through.

Interviewer: What's the takeaway for somebody that might have an individual with autism in their life or an individual with autism? Is it, "Boy, go to the doctor, find a physician that understands where you're at, that you feel comfortable communicating with"?

Scott: I think that would be a very important issue is to find a primary care physician, specialist, who can show that they are aware, they have empathy for the challenges that are associated with autism. The other takeaway message would be, I think that we also need a greater level of training, training for healthcare professionals to be aware of the characteristics of autism so that it is realized, recognized in a clinical setting. I really think that the training has just started. We have a long way to go.

So that'd be the other aspect, the other side of the coin, is training of healthcare professionals, to be more aware of autism issues because we just said that it's not just a pediatric issue. It's an internal medicine, it's a primary care, clinical setting, it's a geriatric. It's a life course issue that we should all be aware of.

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Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015