Healthcare, COVID, Neurogenesis, Oh My

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Healthcare. The word is loaded never mind in the year 2020 making it sound like a time bomb. As a person in healthcare, I’ve seen firsthand the emotional and mental detriments this pandemic has placed not only on the entire population, but especially caregivers. Other than this virus magically disappearing, what can we do to address the wellbeing of the caregivers so that ultimately the quality of care they provide is top-notch? Neurogenesis.

What in the world is neurogenesis? Neurons are the building blocks of our brain and nervous system that allow communication between different parts of the body and receive senses from the outside world. Neurogenesis is the process of forming new neurons in the brain (The University of Queensland, 2017).

Neurogenesis occurs in the subgranular zone of the hippocampus, the subventricular zone in the brain’s lateral ventricles, and in the amygdala. These specific areas of the brain focus on memory, mood, and spatial learning according to The University of Queensland (2018). Proper neurogenesis in the hippocampus positively affects emotions. The amygdala processes emotional memories and can be linked to depression and anxiety when there are disruptions to the area (2018).

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While we do not know if neurogenesis will increase quality of care provided in a healthcare facility, we know that neurogenesis can decrease depressive symptoms (Hanson, Owens & Nemeroff, 2011). If depressive symptoms in healthcare workers are decreased, then the rates of low job performance and suicide should theoretically decrease. Therefore, if Healthcare Administrators focus on neurogenesis improvement and decreased depression among their staff, the quality of care of the healthcare services will increase while healthcare employee suicide will decrease.

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Let’s take a dive into what it’s like to have neurogenesis depletion. What scientists have studied throughout some time, is there is “neuronal atrophy, neurotoxicity, and neuro-endangerment” in the brain when there is prolonged stress (Hanson, Owens & Nemeroff, 2011). When we reduce the number of cells and their ability to regenerate (neural plasticity) the risk of depression, suicidal behavior and the decreased ability to make appropriate responses increases (Hanson, Owens & Nemeroff, 2011). When neural plasticity is not at it it’s top performance, neither is neurogenesis.

As studies are pretty clear about how neurogenesis can be depleted and can affect memory, physical and emotional behaviors, the studies showing how to increase neurogenesis is still being explored. We will address the ways in which we can encourage neurogenesis later in this blog.

So how does this all connect to healthcare workers and this pandemic?

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In the perspective article, “Preventing a Parallel Pandemic-A National Strategy to Protect Clinicians’ Well-Being”, the authors there is a burnout crisis among healthcare professionals which is a associated with “anxiety, depression, substance abuse, and suicide” even prior to the pandemic which has now increased(Dzau, Kirch, & Nasca, 2020). Dr. Moutier labels frontline health and essential workers at the top of high risk populations for suicide risks during COVID-19 (Moutier, 2020). An additional article “More Than Ever, Healthcare Professionals Face Increased Suicide Risk” states that not only do healthcare workers face a paralleled crisis, but they are less likely to seek treatment and help with their mental struggles (2020). As the article suggests, they will resort more to self medicating with prescription medications or substance use.

In addition to the deteriorating mental health of the healthcare provider themselves, the quality of work provided tends to decrease as well. The qualitative study by Kieft and colleagues state that nurses who felt pressured to increase productivity did not feel that there was quality in the nursing care provided (Kieft, de Brouwer, Francke, & Delnoij, 2014). Nurses who had positive work environments felt as though they were able to provide quality care for their patients. From a personal perspective, I have become aware of my difficulty in providing the same care I once had. Although I still greatly care for my residents in our nursing home, the stress and burden of their situation has made it even more difficult to provide the same enthusiastic care that I once had.

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WHAT NOW???

We encourage neurogenesis. Here is the boring and repetitive list of ways to increase neurogenesis (Shohayeb, Diab, Ahmed, 2018). The same ways we increase heart, lung, and brain health. The same way we decrease risk of cancer, encourage healthy weight, blah, blah, blah. It’s the stuff everyone knows they need, but the things we even as healthcare professionals fail to do at times. It’s the elephant in the room. Everything we preach to our patients but sometimes have difficulty committing to ourselves on a consistent basis.

• Consistent exercise
• Low saturated fats and simple sugars
• Increased fresh fruits, vegetables, herbs, and spices
• Stress reduction (meditation, music, reading, etc.)

Consistent exercise, especially cardiovascular training promotes neurogenesis in the hippocampus by positively effecting the brain derived neurotrophic factor (BDNF), enhancing the memory and learning (Sung, 2015).

A diet rich in flavonoids and antioxidants increase neurogenesis through also increasing levels of BDNF in the hippocampus (Mhedlin, 2016).

Music can activate the amygdala though triggering emotions while the hippocampus is activated by triggering memories and allowing new neurons to generate (UCF, n.d.).

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When our minds are in a constant fight or flight mode, it is easy to forget about these basic and simple needs our body is craving. We know that we need this. We know how much our body desires the ability to take care of itself…but we are too busy! We must take care of everyone else before ourselves right?! That’s our calling. Well, how can we take care of others when our neurogenesis tank is running low?

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Now, while healthcare facilities do not have control over the health of their employees and there isn’t a guarantee that increasing neurogenesis will decrease depression and suicide, there are strategies in which healthcare leaders can encourage neurogenesis among their staff.

Well if we think about implementing some of the above ideas of consistent exercise, eating well, and stress reduction, I propose that health care facilities not only provide the required 30 minute lunch breaks, but also a paid 30 minute active break. What if there was a paid 30 minute meditation break? Well of course the feasibility of both in a day for most facilities is non existent to have any productivity.

To satisfy the need for self wellness as well as continuing to provide care and complete the job at hand, alternate days in which staff participate in a paid “30 minute Active Break” or a “30 minute Meditation/Rest Break”. The following picture depicts and example of Employee Self Wellness.

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Let’s be honest, even though healthcare facilities are in the business of helping others and providing health care, there is still the grand ol’ dollar that we all have to think about. Sometimes we have to think about what the long term financial impact of a decision is. Healthcare Administrators not only have to think about the functionality of their facility, but also carry the financial burden on their back. It is important to know that in 2013, the cost of a suicide was around $1,329,553 according to The Cost of Suicide by the Suicide Prevention Resource Center (Figure 10) and the costs include medical care, income loss, and productivity loss for the employers. We don’t want to think about the sad what if’s, but wouldn’t it be cheaper to provide one 30 minute paid break a day? This break can increase the neurogenesis of the caregiver and ultimately help prevent the loss of a life…maybe multiple.

Figure 10: “Mean Medical and Work-Loss Costs per Injury Death by Intent — United States, 2013" and the “Mean Medical and Work-Loss Costs per Emergency Department-Treated Nonfatal Injury, by Intent — United States, 2013”

Whether or not the exercise and meditation encourage neurogenesis and increase quality of care by the medical staff, self care will ultimately increase. The hope becomes that this will decrease depression and suicide attempts. It is time that we as healthcare professionals start focusing on our neurogenesis!

References:

1. Adult neurogenesis. (2018, March 14). Retrieved November 21, 2020, from https://qbi.uq.edu.au/brain-basics/brain-physiology/adult-neurogenesis
2. Costs of Suicide. (n.d.). Retrieved November 21, 2020, from https://www.sprc.org/about-suicide/costs
3. Dzau, V. J., Kirch, D., & Nasca, T. (2020, November 12). Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being: NEJM. Retrieved November 21, 2020, from https://www.nejm.org/doi/full/10.1056/NEJMp2011027
4. Hanson, N., Owens, M., & Nemeroff, C. (2011, December). Depression, antidepressants, and neurogenesis: A critical reappraisal. Retrieved November 21, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230505/
5. Kieft, R. A., De Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014, June 13). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. Retrieved November 21, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064111/
6. Kneisel, K. (2020, July 16). More Than Ever, Healthcare Professionals Face Increased Suicide Risk. Retrieved November 21, 2020, from https://www.medpagetoday.org/publichealthpolicy/generalprofessionalissues/87595?vpass=1
7. Mhedlin. (2016, April 14). Diet and Neurogenesis. Retrieved November 21, 2020, from https://hopes.stanford.edu/diet-and-neurogenesis/
8. Moutier, C. (2020, October 16). Suicide Prevention in the COVID-19 Era. Retrieved November 21, 2020, from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772135?resultClick=1
9. UCF. Music and the Brain: What Happens When You’re Listening to Music. (n.d.). Retrieved November 21, 2020, from https://www.ucf.edu/pegasus/your-brain-on-music/
10. Shohayeb, B., Diab, M., Ahmed, M., & Ng, D. (2018). Factors that influence adult neurogenesis as potential therapy. Translational neurodegeneration, 7, 4. https://doi.org/10.1186/s40035-018-0109-9
11. Sung, Y. (2015, October 30). Effects of treadmill exercise on hippocampal neurogenesis in an MPTP /probenecid-induced Parkinson’s disease mouse model. Retrieved November 21, 2020, from http://doi.org/10.1589/jpts.27.3203
12. What is neurogenesis? (2017, May 18). Retrieved November 21, 2020, from https://qbi.uq.edu.au/brain-basics/brain-physiology/what-neurogenesis
13. Figure 1: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fnurseslabs.com%2Fwp-content%2Fuploads%2F2020%2F06%2Fnurse-meme-silently-wtf.jpg&f=1&nofb=1
14. Figure 2: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fwww.researchgate.net%2Fprofile%2FSh_Cedar2%2Fpublication%2F314386272%2Ffigure%2Fdownload%2Ffig1%2FAS%3A624312646111232%401525859142366%2FTwo-main-endogenous-neurogenic-regions-contain-multipotent-adult-neural-stem-cells-the.png&f=1&nofb=1
15. Figure 3: https://scitechdaily.com/images/Brain-Energy.gif
16. Figure 4: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fi.pinimg.com%2Foriginals%2F0d%2F0f%2F7f%2F0d0f7f491191f2f685ec6b9c71289c2f.jpg&f=1&nofb=1
17. Figure 5: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fnews.usask.ca%2Fimages%2F2020%2Fhealthcare-worker.v2.jpg&f=1&nofb=1
18. Figure 6: https://duckduckgo.com/?q=music+effects+to+neurogenesis&iax=images&ia=images&iai=https%3A%2F%2Flh5.googleusercontent.com%2Fproxy%2FjbwFQthDOfgtejIvST7cu_JQwar-StNJb8qdvMuAiRMwatf0W_r0XiqHvHbeP1aR4-4AxUkhwjFS5CWRwBPehXRC2nFNbhUws0ZLuz9_iLN1z_qGwVsgjt_H_x9x2Aw3%3Dw1200-h630-p-k-no-nu
19. Figure 7: http://bestanimations.com/Science/fuel-gauge-animation.gif
20. Figure 8: https://duckduckgo.com/?q=wellness&iax=images&ia=images&iai=http%3A%2F%2Fwww.wcs.k12.mi.us%2Fdepartments%2Fnutrition-services%2Fwellness%2FStaff%2Fimages%2FEMPLOYEE-WELLNESS.png
21. Figure 9: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fbigpinekey.com%2Fwp-content%2Fuploads%2Fdollar-sign-carry.gif&f=1&nofb=1
22. Figure 10: https://www.sprc.org/about-suicide/costs