Jolie is joined by Dr. Mary-Jon Ludy, chair of the department of public and allied health and an associate professor of food and nutrition at BGSU, and Dr. Jyothi Thrivikraman, an assistant professor of Global Public Health at Leiden University College in the Netherlands. They discuss their interdisciplinary, international research study of how COVID-19 has impacted the sleep and mental health of college students and offer advice on resiliency in the midst of stress.

 

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From Bowling Green State University and the Institute for the Study of Culture & Society, this is BG Ideas.

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Jolie :

Welcome back to the Big Ideas podcast, a collaboration between the Institute for the Study of Culture & Society and the School of Media and Communication at Bowling Green State University. I'm Jolie Sheffer, Associate -Professor of English and American Culture Studies and the Director of ICS. Due to the ongoing COVID-19 pandemic, we're not recording in the studio, but from home via phone and computer, as always, the opinions expressed on this podcast are those of the individuals involved and do not necessarily represent those of BGSU or its employees. Bowling Green State University is located in the Great Black Swamp, long a meeting place for the Wyandot, Huron, Kickapoo, Erie, Miami, and Peoria tribes. We honor the rich history of this land and its indigenous inhabitants, past and present.

Jolie:

Today, I'm very pleased to be joined by two guests, Dr. Mary-Jon Ludy and Jyothi Thrivikraman. Mary-Jon is department chair of public and allied health and an associate professor of food and nutrition at BGSU. Her research interests include energy balance, body composition, and innovative teaching. Jyothi is an assistant professor of global public health at Leiden University College in the Netherlands. Her research interests include food insecurity, food waste, and healthcare financing. She has worked and taught in countries around the world, including in Asia and Africa. MJ and Jyothi were part of an interdisciplinary, international research team studying how COVID-19 impacted the sleep and mental health of 2000 college students spanning seven countries and three continents. The study's findings and recommendations were first published in an August 2020 special issue of Clocks & Sleep. Thank you both for being with me today. I'm really happy to get to talk to you about your research. To start, could you explain the questions motivating this research and what you learned from your surveys?

Mary-Jon:

We are looking at the intersections between lifestyle, behaviors, resilience to stress and rumination in college students during the COVID-19 pandemic. So to unpackage that a bit by lifestyle behaviors, we're talking about food intake, alcohol consumption, sleep, physical activity. When we speak about resilience to stress, we're thinking about bounce back or recovery from a stressful situation. And when we think of rumination, we're considering excessive negative thoughts. So with that context, there's been a great deal of research to show that positive lifestyle behaviors, help to bolster mental health and likewise with resilience to stress, if an individual has more resilience to stress that helps to support their mental health. So more resilience, less anxiety, more resilience, more positive mood. The flip is true for rumination. If an individual has more excessive negative thinking, they're likely to have more markers of depression or more perceived stress. There have not been many studies that have looked at that intersection.

Mary-Jon:

So between lifestyle behaviors, resilience, and rumination, and certainly not in college students during a global pandemic. So that is the focus of our study. And it's a survey, and we have been working, as you said, in the introduction with researchers and a variety of disciplines and a variety of places across the globe. Something that you didn't mention in the introduction. We did our initial research in April and May, but we have done a follow up in October and November. And one of the exciting things I think that we added, we have a new partnership. So we have some partners who are in Ghana. So we have a fourth continent and an eighth country that we're excited to be collaborating with. And I think initially what we have found is that college students are struggling during this pandemic and it doesn't matter where those college students are.

Mary-Jon:

So the mental health struggles are very real. We're seeing in terms of those lifestyle behaviors that students' dietary quality has decreased, their physical activity has decreased. Their sleep quality has decreased. They're experiencing more stress, less resilience. We have seen perhaps what you would characterize as positive changes in alcohol consumption. So students are drinking less and they're actually spending more time in bed, so more sleep hours, but that hasn't led to better sleep quality. So even though you're staying in bed longer, not sleeping as well, and if we're thinking about the alcohol consumption, a lot of times alcohol consumption comes with group gatherings and folks are doing less of that right now.

Jolie:

Jyothi, mental health has been on the minds of lots of American parents, faculty members, staff for a long time. How does that compare to where you are at Leiden? Are these patterns similar where the pandemic is exacerbating existing problems, or is the context there a little bit different for sort of what the base point comparison was?

 Jyothi:

So my college, Leiden University College, is part of Leiden University and we're in the international honors' college of Leiden University. And we draw our population 50% from the Netherlands, but the remaining population comes from countries around the globe. And so for many of our students in the initial lockdown, it was this uncertainty about if their country's locked down. Will they be able to get home? And so there was a fear about, will they be able to go home? And if they go home, will they be able to come back and return to study? But the situation now is slightly different. Most of the students have come back to study, and we are doing a mixture of online and face-to-face classes. And the Netherlands as a whole, for most schooling has opted for face-to-face. So primary and high school students are all face-to-face and college students, we have the option of meeting face-to-face if we want to with reduced numbers, smaller classes, ventilation, and mask wearing, which has just been legalized in the Netherlands.

 Jyothi:

So our situation is slightly different in terms of that face-to-face interaction, which I do think has helped a lot with the students. In the initial stages, when we had that very, very strict lockdown in March, April and May, it was a challenge. We're not as an institution used to having online education. So we went from a very small, interactive dynamic program to being on Teams and Zoom, which none of us had ever done before. So there was a great deal of transition, uncertainty, uncertain Wi-Fi connection for many families, right? And many students. And I think some of those issues have resolved as time has progressed.

 Jyothi:

That being said, the students, what they're struggling with now, I would argue is the social aspects. So they're getting the education that they need, but there's the social component of learning that is being missed out on. So we do have a residence building and we do have students living in their dorms, but surprisingly, I was really apprehensive about 400 students moving in from many different countries. I was absolutely confident that we would be ground zero for a COVID outbreak and we've had five or six cases since they've come back. And so that's been amazing, but that has meant that they've been following really strict social distancing guidelines, isolation. So they haven't had the social interaction. And I think now, as the weather gets colder and darker, you can see some of those challenges appearing. We've had beautiful unseasonably warm weather, and now it's cold and dark and it gets dark around four here. So people are fraying at the ends.

Jolie:

You talked about the way your teaching had to adjust in very short order to online, but I'd like you to talk a little bit about how your research and your data collection methods changed in this time period. And for this project in particular, did you have to do the project differently than you normally would have, or was this kind of similar to the kinds of research each of you had done previously?

Mary-Jon:

It's really interesting that you ask this. And for a number of years, I've been working with research that involves health patterns in first-year college students. And one of my collaborators, Robin Tucker, is at Michigan State University. And another collaborator, Laura Keaver, is at Institute of Technology Sligo in Ireland. Laura had obtained some grant funding that would have enabled her in April to travel to Michigan State and to BGSU, to help build on our research collaboration. Obviously that didn't happen because of COVID, but one of Robin's graduate students,Chen Du, had recently had a study approved for face-to-face data collection that looked at the intersections of lifestyle, behaviors, resilience, and rumination and college students. So we needed to regroup.

Mary-Jon:

And Robin and Chen worked together really quickly to reformat this investigation into an online survey. Robin reached out to Laura from Ireland and me at BGSU and said, "Would you like to collaborate on this?" So Laura and I said, "Sure." And we worked quickly to gain approval from our institutional review boards. I posted about the survey to our faculty listserv to get help in recruiting students. And when I did that, almost immediately, I had responses from some colleagues who were interested in getting involved. So Wan Shen is a Chinese faculty member, she is in nutrition. She said, "Could I help you to recruit a Chinese sample of students?" And I said, "Oh, that would be fabulous."

Mary-Jon:

And HeeSoon Lee, who is a South Korean faculty member in social work, said, "I would love to help you recruit a South Korean population." So both of them jumped on board and then another colleague. His name is Brent Archer, he's a South African colleague, he's in communication sciences and disorders. And he said, "Oh, maybe I can help you recruit a South African population." Well, that didn't work out. However, Brent connected us with Jyothi and her team in the Netherlands, and this just kept growing and growing. And we formed this international team of health focused investigators, but health in a broad sense, multidisciplinary health. And it's been just super exciting to work with and learn from this whole team.

Jolie:

And Jyothi, what about for you? Was this process in doing sort of everything online and surveys and the sort of international approach, was that in line with previous research you had done, or was this a sort of new mode of work for you as well?

 Jyothi:

It's a very new mode of data collection for me and tend to be very much more of a participatory action research type of researcher. So I've done a photo voice project where participants in the Hague had to take photos of their food waste. So I do believe in local engagement, right? So this was very new for me in survey data. My strong suit is not quantitative data, so this was a leap for me as well too. But you know, what was nice was to join a project with researchers from different countries and to learn from each other, to understand people's different viewpoints on these topics, to even get feedback on the paper. So we've had one paper submitted and accepted. And so it was nice just to see how other people thought about the different issues and the suggestions they gave. So I think it's an opportunity to learn and MJ, Robin and myself, we've applied for another grant. We weren't successful, but this possibility has opened up other possibilities, which has been lovely. So I welcome future collaborations with this team.

Jolie:

I'm curious, another question I have is sort of how do you when you're working internationally across multiple disciplines, right? So a general common language of health, but thinking about those questions with different methodologies, different theoretical orientations, all of that, how did you create a common research language for talking across those disciplinary, theoretical, geographical and cultural differences?

 Jyothi:

Sure. I can actually give an example. We had multiple email exchanges about this. So in the first round of a survey. We didn't collect any race and ethnicity data. And we were talking about that, during the second round, there is race and ethnic data collected, but solely in the U.S. and we were trying to think about how would we collect that here in the Netherlands? And we don't collect data like that. And so we emailed back and forth with Laura at Sligo. And she said that they just dropped that question. The same with the Malaysian partners and Taiwan and we don't categorize individuals according to Black, white, Hispanic, African-American, those categories don't exist. It's whether you're Dutch or not. And whether you come from a migrant background or not. And so the categories that are used in the U.S. even though they make sense to me, because I'm American, they're not practical here.

 Jyothi:

And for our students, if they had to fill that out, they would know what to make sense of that. We do have students that are Black, but they're African black. We have Zimbabweans; we have Ethiopians; we have a different category. So their experience about being Black is very different. And so I think we spent a few emails, so we actually don't have those questions. So it was also looking at the survey to contextualize it for the various regions, what made sense. And that was fascinating for us to think about as a team. How do we think about this, and what are the assumptions that we're making when we include these questions?

Jolie:

So, MJ, you were the founding director of the Health, Wellness, & You academic learning community at BGSU where first-year students guided by upperclassmen, grad students and faculty mentors became researchers about their own health patterns. Can you talk a little bit about why you think it's important for first-year students in particular, just to really think reflectively about their patterns and to find opportunities for improving their own self-care practices?

Mary-Jon:

Jyothi and I actually talked about this yesterday. And one of the concepts that she talked to me about was critical junctures in life. And Jyothi was talking about that in the context of the COVID pandemic being one of these time points, where it can cause you to take either path A or path B, and it's a life course shift. And I think that parallels the work that we do with first-year college students. So it's one of these critical junctures in life where students are adopting patterns that may follow them throughout life. So it's a time where if you're able to establish healthy lifestyle behaviors. So if you're able to learn techniques that will help you to improve your resilience or be more physically active, or eat a high-quality diet or sleep better, that those are patterns that you can use to support you throughout life.

Jolie:

Given your experience at both the U.S. systems, and now in the Netherlands, I wonder what changes you'd like to see implemented. And you can answer this at whatever scale you want, whether it's sort of on the small scale, like a college campus, right? Are there recommendations you think that could improve health care access and the issues of resilience and things like that for students, or they're kind of bigger scale changes? Clearly, you're mentioning sort of the different kind of economic and social support models that's a much larger scale, but what are some of the smaller scale changes that you think could help improve student outcomes in times of real challenge?

 Jyothi:

So, one of the things that my institution did, because we were shifting online, we decided that the student's well being was central to that. And we weren't going to operate as a business as usual standard. So our Dean actually said, "it's okay if you want to cut back on content a little bit to ensure that whatever you teach you meet the learning outcomes, but you kind of focus on a few things and ensure that they learn those well." So that relieves a little pressure from us, but it also helps the students that they're not just moving from one task to another, to another, one topic to another. So I think it's recognizing at the moment what you need and for the students, it wasn't drilling content and more content into them. And so I think it was even in the initial stages of the pandemic we had from the institution and understanding that 80% is good enough. That we need to transition ourselves. Many of us have families, kids that were home, and it wasn't this expectation of you must work a hundred percent.

 Jyothi:

You need to be on calls. 80% is okay. 70% is okay. And part of that is, it's a different sort of job guarantee. In the U.S. you have tenure in institutions, but many of us here have permanent contracts. So after two years, you're generally up for a permanent contract, which means that it's really hard to fire you. But most people work really hard, so there's a level of trust. So with my husband's company, for example, he was locked down and worked from home, but it was also, they told him universally for the first two weeks, just make that transition to being at home, ensure that your kids are okay. And I think it's not just us as a university or college, it has to be multiple pieces of the puzzle to recognize that we're all in this together and working together. And it made a huge difference that my husband could take two weeks and we could kind of focus on the kids and we didn't have to worry about this and that, that we could kind of transition as a family into this new reality.

Jolie:

You've both studied, taught and worked at universities and cities around the world. I'm curious as to some observations you might make about similarities or differences with how different regions or nations provide mental health resources and support to students in particular.

Mary-Jon:

Something that we have both talked about is the stigma that is associated with mental health care and concerns. At BGSU, right before the pandemic, we participated in something that was called, The Healthy Minds survey to look at mental health factors on our campus. And some really interesting findings came out of that. So most of our students were experiencing mental health challenges. So about 60% of them were experiencing mental health challenges, but only about half over the time course of a year actually got treatment for their mental health challenges. So that's half of students going untreated, and the students by and large are reporting that those mental health challenges affect their academic performance. So about four and five of them are saying "these mental health challenges have affected my academics."

Mary-Jon:

And I think maybe the most interesting thing that came out of that survey for me was that almost no students said that they would judge another person for receiving mental health services. It was very small. It was about 4% of them, but 47% of people thought that other students, other people in their lives, would judge them for receiving mental health services. And when I'm thinking about that, that is the single biggest challenge is to mitigate that stigma so that we're getting students and we're getting members of the population at large connected with the services that they need.

Jolie:

How does that compare to your experiences, Jyothi?

 Jyothi:

So while we do have good overall medical care, I think mental health is one area that we don't do so well here. So there are waiting times, and it is a challenge to go and seek mental health care. And at my college, we do have student life counselors, but there's a limited number of sessions that you can have and schedule with the student life counselor. So once those are done, you do need to seek care outside of the college and getting and accessing that care, while it might be free, is a challenge. And even that, there are limits to how much the insurance will cover.

 Jyothi:

So in the Netherlands, they ask you to define whether you have a low problem, a medium problem, or a high problem. And then they decide how many sessions they think that you might need. So someone who has a low mental health issue, they might decide to give you 10 sessions, and then it just scales up from there. So while we do have a system that there are not barriers financially, there are other barriers. And so it has been a challenge this semester for some students accessing those services and part because in the country where we struggle with that in general.

Jolie:

We're going to take a quick break. Thanks for listening to the Big Ideas podcast.

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Jolie:

Welcome back to the Big Ideas podcast. Today, I'm talking to Dr. Mary-Jon Ludy and Dr.Jyothi Thrivikraman about sleep, mental health, and resilience in the face of the COVID-19 pandemic. Nancy Krieger, a professor of social epidemiology at Harvard's Chan School of Public Health said that COVID is pulling a thread that is showing the very different conditions in which we live because of social structures that are inequitable both within the United States and between countries. By pulling the thread, it's revealing patterns that have long been known in public health. I think this really speaks to what we've been talking about. As we've seen, the pandemic has exposed and deepened racial, socioeconomic, and health inequalities. In the U.S. this is definitely true in the case of Black Indigenous, Latinx, and other communities of color, having higher rates of infection, serious illness and death. And we're certainly seeing that here with the disparate economic impacts of the virus. Do you also see differences in access to and the efficacy of self-care, sleep and resilience among members of at-risk groups?

Mary-Jon:

I would see some specific challenges to these BIPOC communities and challenges that I have experienced when working with my students are that oftentimes these communities are essential workers. So they haven't been given the same breaks or the same flexibility that lots of us have had for working from home and social distancing. So these communities are put at greater risk. And some of the students that I've worked with, they have had to continue working at their jobs because they are the only family member who's currently working right now. So even though they're trying to navigate the higher education system, they're also responsible for supporting their families. And I think that there's a good body of research to say that the BIPOC communities are also living with higher levels of day-to-day stress. And those experiences with chronic stress can have an effect both on mental health and on physical health. So it's a more vulnerable population.

Jolie:

Anything you want to add to that, Jyothi?

 Jyothi:

Yes. So we don't have the same categories. So for us, it's migrant, non migrant. And within the migrant category, we do distinguish between Western and non-Western migrants. So for non-Western migrants, so in the Netherlands, that would be Moroccans, Turkish. We do have a large Indonesia Surinamese population from the former Dutch colonies in Indonesia and Suriname. And in the first wave, they were not disproportionately impacted, but in the second wave they have been disproportionately impacted. In terms of whether they're essential workers or not, we don't necessarily have that. So it is much more of a mix between Dutch and non-Dutch doing some of those grocery store clerks, the other essential roles.

 Jyothi:

So it is a different mix here, but I would argue, yes, these communities have been impacted in other ways. So whether it's primarily suffering illness and death from that, but they might have impacts around food. They might be under employed, so the other secondary impacts. A lot of them may not speak Dutch. So accessing medical care, the shift to online education, if your kids go to a local school, everything was in Dutch. And so some of the parents have challenges understanding what is going on if you don't speak Dutch. And then there aren't very many support mechanisms to help non-Western migrants who don't speak Dutch right now.

Jolie:

We are recording this conversation in December 2020. So we're now a year out from the first confirmed cases of COVID-19. I want to ask a last question. What do you think are the most important lessons that you hope we are learning? What do you see as the best-case scenario for how this current crisis might transform our conversations around mental health and wellbeing? Mary-Jon, you want to go first?

Mary-Jon:

Sure. For me in the pandemic, I have seen the value of educational institutions. Bowling Green State University, often calls itself a public university for the public good. And I believe that the pandemic has made that mission even more clear. So I'm reflective. And I think about the pandemic as an opportunity to be part of the solution. Something that I think about with higher education is that it has a reputation for being a bit of a dinosaur. So we don't adapt very rapidly to change. And the pandemic was something that forced us to rapidly adapt to change. So we were able to transform our courses quickly online. We have been able to learn that we can work in hybrid course environments in hybrid work environments. And if we have students or we have faculty, or have staff who are experiencing challenges, that it gives us an opportunity to work with them in a flexible sense.

Jolie:

And for you, Jyothi, what do you hope we take away from this time?

 Jyothi:

I think to follow up on what MJ just said; I do think that it has opened up new possibilities from an educational standpoint, new ways of collaborating across institutions, amongst faculty. We've had guest speakers from around the world that we didn't even think were possible. And so, for exposure to students, that's been brilliant. We've also gotten much more creative about trying to design assignments, where students go outside of the building. So we don't just give them essays anymore. We say go safely or in groups of two with masks and go take photos and develop an essay. So we've started to think creatively about how education works and what's the best way for students to interact with the material. But because I like larger pictures, I do wonder because there is this talk about getting back to normal and some of the conversations we've had about structural inequalities, both in the U.S. and here in the Netherlands.

 Jyothi:

I do hope that we don't go back. I hope that one of the lessons that we learn is how to creatively engage with solutions and problems. To realize what we've been talking about, which is that we're people and that we need each other much more than we've realized. I think both the U.S. and the Netherlands tend to be very individualistic on some level. And one of the lessons that I hope and that public health is formed from is how important we are and how connected we are. And we sometimes forget that. And I hope the pandemic has made us realize our connections.

Jolie:

Yeah, I think that's so true. I think this time, and the challenge is so many of us have with social distancing, that feeling of isolation really does reveal that when we talk about public health, we're not just talking about viruses or bacterial infections or things like that. We're also talking about collective mental health, and the social fabric of communities and the need to really prioritize that. If we can get a man to the moon, if we can do this moonshot warp speed for a vaccine, why can't we have those same kinds of ambitions and success at really rethinking the social fabric of our communities to be more equitable? So thank you both so much. You wanted to add something?

Mary-Jon:

So can I add something? And I don't know where to throw this in later, I think many of the pieces of education and pieces of programming already exist, it's just getting people connected with those and something that's been really neat on our campus is we've had these dining robots. So these little robots that you can order and they deliver your meals to you. So that's something that happened on our campus right before the pandemic began and something I serve on this mental health awareness and education committee, and something that we were able to do was to get messages to students about support services, like the counseling center to be included in the dining robot. So when you get your meal, you also get a message reminding you of support services.

Mary-Jon:

I don't know that will work and actually help to connect people to the services. But I think we need to look at those unique communication methods. And another thing that campus is doing is Designing Your Life. So that's a book that came out of Stanford, but it's an approach. And it's been mostly used with mid-career professionals who might be unhappy in their lives. So to think about how to design more successful and more meaningful lives, but it's an approach that's really being considered for college students to think about designing their lives in a manner that will promote better balance and better self-care.

Mary-Jon:

So I'm thinking about some of these things that we discussed, and I'm thinking that if we have this designing your life approach, that part of that is thinking about how to bolster your resilience and thinking about how to set up healthy lifestyle behaviors. So I think about these pieces just being infused in all of the courses, and as faculty members, we're always putting together a syllabus design for course. So what can you put in there that can help to connect students with services and let them know that it's actually okay to access the services?

Jolie:

Listeners can keep up with ICS by following us on social media, whether that's Twitter, Instagram, or Facebook @icsbgsu. You could also listen to Big Ideas wherever you find your favorite podcasts. Please subscribe and rate us on your preferred platform. Our producers are Chris Cavera and Marco Mendoza with sound editing by Marco Mendoza. Research assistance was provided by ICS intern, Morgan Taylor, with editing by Kari Hanlin.

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