Child Mental Health for Pediatric Clinicians

48. The Emotional Flu: A New Epidemic Impacting Teens

• Elise Fallucco, Chase Fallucco • Season 3 • Episode 48

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In this episode of Psyched for Peds, Dr. Elise Fallucco and her teenage son, Chase Fallucco, discuss the seasonal surge of mental health symptoms, termed the 'emotional flu,' impacting teenagers during October and November.  They discuss:

** What are the symptoms and signs of the emotional flu?

** Why are October and November high-risk periods for the Emotional Flu?

** What can we do to "vaccinate" teens against the Emotional Flu?

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Dr. Elise Fallucco:

Welcome back to psyched for feeds the child mental health podcasts for pediatric clinicians. Helping you help kids. I'm your host, Dr. Elise Fallucco Child psychiatrist and mom, and I'm really excited to bring this special episode today. We're going to be talking about the epidemic of mental health symptoms that are affecting teenagers and now even tweens. At this time of year in the beginning of winter season. And these symptoms are what I'm going to call the emotional flu. So here to help me understand things about the emotional flu is my 14 year old son Chase Fallucco.

Chase Fallucco:

Thank you mom. Thank you for having me on today. I'm glad to be here.

Dr. Elise Fallucco:

I'm so glad to have you. So first we're going to start out and talk about the outbreak. What are these cases of these mental health symptoms that are plaguing teenagers this time of year? Just in the past week, multiple parents have approached me talking about things that are affecting their teenage sons and daughters. One mom told me she was called out in the middle of her job unexpectedly because her daughter texted her in the middle of an anxiety attack and was just saying, I can't, I'm so overwhelmed right now. My heart is racing. I'm having trouble breathing. Mom, I need your help. I think I may need to leave school. And then another mom was telling me that her daughter is having these meltdowns at home. She's crying and she just seems to be so irritable and just isn't like herself. And the mom was telling me, she's worried about her daughter. And also this is a lot. Because when a kid's not doing well, they often take out their anger on their parents and this poor mom. Was just of course, feeling bad for her daughter, but also feeling a little helpless and overwhelmed. I could go on forever with all of these cases, honestly, just from the past couple of days. I wanted to ask you chase have you noticed anything like this in school or with any of your friends lately?

Chase Fallucco:

Oh, yeah, last week I was turning in paper and I was just talking to one of my other friends about it and he was like oh yeah, I gotta turn that same paper into, and I got a essay to write in history. He was feeling nervous about. So I've definitely seen it.

Dr. Elise Fallucco:

So

Chase Fallucco:

your friend was talking about how nervous he was with all the papers that were going on. I think I was, I felt a little stressed too last week. I had to turn in a huge English paper and I also had four tests that week. Oh my gosh. Especially like on top of the normal homework and everything. Yeah.

Dr. Elise Fallucco:

So it was like a particularly stressful week school-wise and it just like with anything, like when we're experiencing a lot of stress, it can become really overwhelming and it can affect your mood or just how you feel. Did you notice anything personally about how it made you feel.

Chase Fallucco:

Yeah. I was definitely a little stressed. It's always like hard in the moment because you feel like you got so much stuff to do and you don't have a lot of time, especially like with exams coming up. So definitely a little bit of anxiety.

Dr. Elise Fallucco:

Yeah, for sure. And that's totally a normal experience. So to summarize, like all of these cases with this outbreak, we have different presentations, but it's a lot of emotional symptoms like sadness or irritability or temper outbursts, anger, meltdowns, anxiety, attacks, distress. All of these things are peaking This is the worst time of year for these type of emotional outbreaks. We actually have national data that I'm going to nerd out on for just a little bit. That tell us that October. And November in the Northern hemisphere tend to be peak seasons in teenagers for both depression and suicidality. But they did this really cool study that was published in JAMA last year in 2023, where they looked at over 73,000 teenagers who had visited the emergency department or who had been hospitalized for suicidality. And they were trying to look at trends over a five to six year period and what they found. Is really similar to what we see in our clinical practices. October was the peak month for suicidality out of all 12 months, over a five to six month period, which is really interesting. The month that came in, number two behind October was actually April which we'll get to and talk about later. But right now we're talking about October, November. And this national data makes a lot of sense. If you ask any child psychiatrists or pediatricians about what are the worst months. In terms of how many patients are coming to us with stress. And in crisis, what they will say is also October and November. But why is that? What I've realized in talking and working with teachers and in a school system is that this is a peak time of stress academically. So the first couple months of school, and certainly the first couple of weeks of school are really academically, relatively easy. Like it's a tough transition to start school from the summer. But things haven't ramped up. There's actually a lot of time for review and most teachers are spending the first couple of months just reviewing material from the previous year but once we hit October and definitely November. That's when things start to ramp up. And so you're being exposed to a lot of new material and more challenging material You're getting to the point in the year where you're starting to actually have big deal papers that are due and assessments. I

Chase Fallucco:

I completely agree with that because in my math class, at the beginning of the year, it was like a lot of review from last year. Then we started to slowly build into new topics. And then I would say right now we're doing more difficult stuff.

Dr. Elise Fallucco:

That's a great example with math too, because every single year builds upon the previous year for the most part, except for geometry. What was geometry?

Chase Fallucco:

Uh, I think geometry. I don't know. I had a nice teacher in geometry. So that was good.

Dr. Elise Fallucco:

Oh, that's very nice. That was not my favorite year in math. I was like where are we going with this? What is a co-sign and a tangent? But back to our topic so chase is helping us understand seasonal trends in the emotional flu from a student perspective. So when we see these kids in our offices who are presenting with irritability, with outbursts, with sadness, with just worsening mood symptoms, first of all, be unsurprised, this happens every single year around this time, so we know what to expect it. And then when we're thinking about what could be causing this, always be thinking about is this is the stress of. The academic year causing a new onset of some sort of mental health problems. So what I always like to say is we know that stress makes every single, underlying health problem worse, and that includes, aDHD anxiety, depression, as well as asthma diabetes, all sorts of chronic illnesses. And the other thing we know with our stress diathesis model, which basically says that severe stress can cause the onset of new types of illnesses, any types of physical and mental health illness. So in this context of heightened stress of October, November, we would expect to potentially see a new onset of something like major depression, which presents in the teens. Or potentially a worsening of underlying anxiety. So we want to be thinking about those things in the office, screening kids for anxiety, using the scared or for depression using the PHQ or similar screening tools. And then of course always assessing for safety and suicidality, knowing that this is the peak time of year for suicidality. And I want it to go back for a minute. Because I have to give a shout out and tons of credit to. The woman who in my mind coined the idea of the emotional flu. Her name is Jan Gallagher, and she is a brilliant therapist and colleague. We were talking about the difference between physical health symptoms and mental health symptoms and how people can understand if you have a really bad cold or some sort of gastroenteritis and they want you to cope and get better, but that sometimes it's harder for people on the outside to recognize when you're struggling with emotional health problems, because you don't necessarily have a high fever and. Other physical symptoms that are very obvious to people. And so Jan told me, she said, I like to think of it as the emotional flu. Like sometimes people need to take a little break or need to take care of themselves and recover when they're experiencing a worsening of underlying emotional and mental health problems, just like a regular flu. So shout out to Jan, thank you for this idea. So anyway what do we do when kids present to our office with the emotional flu? What do we say to teenagers? Really important to validate to cause they may not even be aware that part of the reason why they're feeling awful is that they're under a lot of stress. So validate that they're under a lot of stress. And, provide encouragement regardless that we know that they've got this. And we're going to talk about ways to help them feel better. So chase at home we are constantly trying to get all of our family members to do a better job of being healthy and trying to prevent regular types of infectious illness. I'm always screaming at the kids to wash their hands And we should have stock in the airborne company because we have a lot of vitamins. I was just about to say that. Go ahead. You got to take it

so much airborne,

Dr. Elise Fallucco:

so much airborne in our house and we try to eat fruits and vegetables, and we're always telling the kids to bundle up and try to maintain a healthy sleep schedule that all of these things are really good for overall health and certainly for the emotional flu. But let's talk about what can we do specifically to try to prevent. Stress from impacting our bodies and to build up resilience.

Chase Fallucco:

Yeah, I would say, uh, for me, I think. Way to that helps me like deal with the stress and everything is, I love to exercise. Just go for a run. Lyft or something. I'm just like, just be outside, honestly. I feel like being outside is one of the best best ways to deal with the stress and everything. Cause you can take a break from the homework and everything for a little bit and just like reset.

Dr. Elise Fallucco:

And that's excellent in two ways, you're incorporating movement into your life. And we know that movement gets our endorphins going and, it's like our body's way of combating stress. And you're outside. So you're with nature and in Florida, we've got lots of sunshine, even this time of year. And so you're getting exposure to the sun, which is helping promote our vitamin D levels. Which is also healthy for our mood. And I think stress relief looks different for every individual. And a good exercise for teenagers or for their parents, or for physicians is to try to work with the teenager or the individual to figure out. What do you do that helps you relieve stress? Some people are really in to baths but for other people it looks really different, like connecting with friends or spending time journaling, or like you said, having movement and going outside and. So I think part of our job as clinicians is to work with families and individuals to try to figure out what does stress relief look like for you?

Chase Fallucco:

Yeah. And I think I totally agree with that. I think it it definitely depends on who you are as a person. What what best helped you.

Dr. Elise Fallucco:

I have to say that you and I have the exercise thing in common.

Chase Fallucco:

Yeah, I would say exercise is the most helpful for me.

Dr. Elise Fallucco:

But is there anything, More broadly, is there anything we can do to vaccinate our kids against the emotional flu? If do we have some sort of analogous thing that can lower their risk of even developing the emotional flu? And I think here is where we start thinking about things like resilience, The more often kids are exposed to stressful situations and that we can provide them some sort of support to help them process that. And to get through them, the more they develop confidence that like I've got that, and I think this is a big part, this is a huge reason to be investing in therapy for your kids because that the role of the therapist is to help the child and also help the parents. Process stressors.

Chase Fallucco:

Yeah. And I think just as you were saying earlier, like just validating their concerns and realizing that Hey, this is like a real thing. That this happens just like a normal flu, like you were saying. This is like this emotional flu. Is definitely something somewhere to deal with.

Dr. Elise Fallucco:

It's predictable. We know that this time of year the teens and students are gonna develop more intense emotional symptoms and just be prepared and know that's what to expect. The first step is awareness and being recognizing like this as possible, and you're at risk. And, just like with the regular flu, there are certain people who are at higher risk, right?

Chase Fallucco:

I think a lot of people, some people could be more susceptible of it. Like just like in a normal cold. Some people have a lower immune system, so they're more susceptible to those illnesses. Some people are more susceptible and then others are pretty much immune. Like they're very cool with everything. Not much bothersome.

Dr. Elise Fallucco:

So that's a great way to put it, like I think people who have more practice in managing stressful situations or for whatever reason, their temperament, they're not as bothered by stress. Like we're not going to expect to see them be effected. And since we're talking specifically about academic stress and stress related to grades, I think, that analogy holds true as well. So there are some people. Who are much more concerned about their academic performance, about getting certain grades? And so those people may be more likely. To be affected by that this stress

Chase Fallucco:

because I would say, like to answer what you're saying is a lot of the grades get finalized, like from a student perspective. All of the grades are really getting finalized. There's only a certain amount of your grade can change. So everyone's they're some of them like they're scrambling just to get to that like instead of an a minus or like an a minus instead of a B plus, just to get that like little extra bump. They can put in so that they definitely put a lot more pressure on themselves to do it rather than the start of the year where they know, there's going to be a ton more grades being put in.

Dr. Elise Fallucco:

So much of their grade has already been determined at that point. And then to your point, like at the beginning of the semester, you have, you still have a whole semester to raise your grade or have opportunities to do really well. And so it feels lower stakes, but right in the middle or two thirds through the semester is when you start to see the crunch. And this brings us back to April. So that study that we talked about earlier in this episode said that the two peak months for suicidality were October, which was number one and then April, which was number two. And while there could be a myriad of reasons why this is possibly true, certainly from a student perspective and an academic perspective, April and October, both represent the halfway to two thirds of the way. Point through the semester when you're feeling that academic crunch.

Chase Fallucco:

And I think April, especially it's right before the end of the year. It's the very final determination. There's no more semester left where you can. improve your grade again. It's it's really the end.

Dr. Elise Fallucco:

So wrapping up, everybody bundle up, take lots of airborne, spend lots of time outside doing whatever type of movement makes you happy. Figure out what it is. That's your stress release. And try to carve out some time to do that, to protect yourself from emotional flu. So to recap. What we know is that. Halfway through an academic semester, particularly October, November, and then also again in April is when we begin to see signs of the emotional flu and the symptoms of the emotional flu vary depending upon the student, but they can be sadness, irritability, meltdowns, or anxiety attacks, and suicidality. So we need to be on the lookout for this. And also we need to be thinking about how we can promote resilience and protect our kids from the effects of. Some of this stress whether it's through therapy. Or through individual stress relief plans or whether, this is bringing out some sort of underlying mental health problem or exacerbating an underlying mental health problem. Like depression or anxiety. That we can identify and treat in our offices. And so we want to make sure that everybody's protecting themselves and their kids and teenagers that they're caring for. From the emotional flu so that they can stay healthy and resilient throughout the entire year. Finally, I want to thank my sweet kind son for being vulnerable and taking time to be a guest on the podcast and sharing the perspective of a student.

Chase Fallucco:

I'm glad to help mom.

Dr. Elise Fallucco:

Thank you, sweetheart. All right. Thank you for listening and we hope you guys will tune in next time. As we continue talking about mental and emotional health for teenagers, kids and families.