Temperatures are rising, summer is almost here, and stress levels are increasing. We spoke with psychiatrist Dr. Suhaila Ghuloum, Senior Consultant at Hamad Medical Corporation’s Mental Health Service, to discuss how stress can affect your life.
Can you give us a definition of stress, and talk to us about the symptoms?
Well, I don’t think you need to define stress as such. There are many definitions but ultimately it’s a subjective feeling and therefore difficult to define. You could say it’s a state of mental tension alongside physical manifestations which result from the increasing social, occupational, and other demands placed on individuals.
As mentioned, it causes mental, or cognitive, and physical symptoms. These include irritability, anger, feelings of being overwhelmed or losing control, low mood or depression, difficulty concentrating, lack of energy, restlessness, racing thoughts, poor planning and judgment, difficulty making decisions, insomnia (sleep disturbance), and palpitations, among other symptoms.
What are the most common causes of stress?
Most people get stressed by family, or occupational and financial demands. Even some pleasant life events are known to cause stress—for example, marriage, building a house or moving home, changing jobs. Among familial or personal factors, having marital difficulties, divorce, experiencing the loss of a loved one, taking care of a sick relative are also major causes of stress. Financial demands can play a part, for example when an individual’s earnings do not match their financial needs, having debts or loans. Occupational causes of stress include long hours, lack of support, lack of reward, and dissatisfaction with work.
When should patients seek medical (psychiatric) care?
When symptoms of stress start affecting their relationships with others, their ability to work, and their family life. While stress can be temporary and a normal reaction to certain situations, prolonged symptoms affecting personal and social life can result in clinical depression or anxiety disorders for which treatment should be sought. For example, when the stressed person is no longer able to be an actively engaged member of the family, perform their duties as a parent/student/employee, when their lack of motivation affects their socializing and they start isolating themselves and not enjoying the things they normally enjoy, when they become irritable and angry to the point where it affects their relationships with those around them, when they are no longer able to sleep, with difficulty falling asleep, interrupted pattern, or waking up very early in the mornings. Basically, help should be sought when the symptoms are persistent and severe. It’s usual for those around the person under stress to advise them to seek help, as the symptoms gradually creep in and the sufferer may not even notice until it’s brought to their attention
In Qatar, the youth actually know and have already read about the symptoms that they have and what can possible be wrong, and the medication available. They then come to the doctor prepared with that knowledge and knowing the risks and side effects that might come from the medication. This then eases the stage of psycho-education that completes the therapy. Some even know that they are just worried or anxious and only want to talk about the problem rather than taking medication.
However, the stigma attached to seeking help for mental health issues and speaking to a psychiatrist is still widespread, as is the idea that those who seek professional help are crazy. The concept of seeking therapy in some areas has become a trend, however the stigma attached to people seeking that same therapy is still surfacing in many parts of the world.
What are the long-term complications of stress?
Prolonged stress affects all the body’s organs. It is not just a mental health condition, as it is known to influence physical health, either causing illness or worsening existing conditions. Stress is the biggest risk factor for stroke and heart disease.
It causes irritable bowel syndrome and other gastrointestinal conditions. It can affect menstruation and cause sexual dysfunction. It can induce or worsen diabetes, hypertension and result in, or complicate the management of, cancer.
Among the most common physical manifestations of stress are chronic headaches, neck and back pain or general muscle aches and spasms. Prolonged stress can result in mental illnesses such as depression or anxiety.
Can you speak about the role of psychiatrists in treating stress?
Psychiatrists evaluate the symptoms and causes, and investigate for underlying physical complications. They then agree on a management plan with the patient that may or may not involve medication. If symptoms are severe, medication may be required and the type should be discussed with the patient, taking into consideration effects and side effects. In most cases, psychotherapy is needed and the psychiatrist will then refer the case to a psychologist for shared care. Patients usually need relaxation training and guidance on coping skills. The most common type of therapy is cognitive behavioral therapy, which allows the individual to see how their feelings, thoughts, and behaviors are linked in causing their symptoms, and how they can change their thoughts about situations to subsequently improve their mood and behavioral or physical symptoms.
The psychiatrists here are trained in a very biological way; they give the medication and have a session just to ask how the medication is working. This is part of the training that those doctors received. Second, there is a shortage of professional psychologists and qualified therapists who can provide patients with the necessary time needed to discuss and help solve issues requiring attention. Therefore, medication becomes the easy route.
Some qualified psychologists don’t understand the comprehensive concept of biopsycholosocial, which looks at the problem from a physical, mental, and social aspect. This helps the doctor determine the severity of the situation at hand. The need for professionals has become so dire that we have taken over the primary care of mental health, when we should be in a tertiary care position at the hospital and continue being specialized. We should focus on complicated cases and chronic illnesses rather than on simple anxiety.
Right now, we’re witnessing a change in the clinics and we are organizing it so that each patient gets a 45-minutes session with the doctor and a 20-minute follow-up session. The waiting list will be longer. However, the service and care will be better.
What are some of the other challenges you face when it comes to providing the right service?
The language barrier is one of our biggest challenges. Because the therapy session is strictly confidential, most of the time we struggle to find the translators to open up communication with the patient. We work with certain embassies and they provide us with translators. Sometimes, if the patient agrees, an immediate family member can work as a translator. However, there are some things that even family members can’t hear, so we usually seek help from professionals.
Another challenge is matching the population changes to the number of professionals who are qualified to provide therapy. In the department we have about 20 specialists. According to the International Standards of Therapy, 1 doctor should be able to treat 100 patients. We need to encourage more young people to study psychology and specialize in it because it is very important, and career development is a sure thing in the future.
Are there any links between diet and stress?
There is no direct link between diet and stress. However, there are direct links between a poor diet and poor stress management. Healthy eating generally is one component of having a healthy lifestyle which also includes things like exercise, having a work-life balance, etc.
Work is a proven cause of stress, what can employers do to solve this problem?
This is a very big topic and deserves to be discussed on its own to give it the importance it deserves. I will answer here very broadly. With work-related stress, there are employee and employer factors. Employers need to listen to their employees, recognize stress among them, and address the causes. There may be issues such as lack of training or poor personal development opportunities within the workplace. The work environment might be stressful for many different factors, such as the office space or relationships with colleagues. Employees might have to perform certain tasks without adequate training or preparation. The expectations placed on them might be unrealistic. Generally, employers need to ensure they support their employees to improve job satisfaction, minimize stress, and subsequently increase productivity.
What would you advise people do to avoid stress?
As above, having a healthy balance between work, home, and social lives. Healthy eating and exercise are excellent anti-depressant and anti-stress interventions. Talking to others always helps. It allows one to see that they are not on their own. For example, when related to work, they will realize that others are also facing the same stresses, and they can support each other through it. Having time out from the source of stress, short breaks of even a few minutes, and regular holidays can help take the edge off things.
People need to realize that stress is a normal part of our daily lives and cannot be avoided. What matters most is being aware of it, of how it impacts us, and finding what helps each one of us deal with it. Different things work for different people.