At Risk for Stress

It has been more than a decade since the May 2001 issue of the American Pediatrics Association’s journal Pediatrics was published. That particular volume was especially noteworthy for an article, entitled “Reduced Spinal Bone Mineral Density in Adolescents of an Ultra-Orthodox Jewish Community in Brooklyn” which was written by five physicians from Maimonides Medical Center, and one from the Byrd Regional Hospital in Louisiana. This relatively small study that examined bone mineral density (BMD) in 30 Haredi boys and 20 Haredi girls ages 15 to 19 found that BMD was “significantly decreased in ultra-Orthodox Jewish adolescents,” and that the males had “profoundly lower spinal BMD” than the girls. Despite the limited size of the study sample, the results sparked a great deal of concern because low BMD in adolescence can lead to severe osteoporosis much later in life. In fact, the study suggested that some of the subjects studied already had an indication of osteoporosis, a disease found almost exclusively in the elderly. The additional concern of the study authors related to the fact that low BMD in younger ages is caused primarily by insufficient physical activity and second by low calcium intake, or not having enough milk in one’s diet. The study also sent ripples of concern throughout Israeli society, which commissioned its own similar study, and in turn, the same results were found. Hareidi adolescents, especially boys, had significantly lower levels of BMD than their less religious and non-religious peers did. Recommendations were made to increase exercise time and encourage students to take better care of their health. After all there is a positive commandment to care for one’s self –Ushmartem es nofshosaichem.

In a small study of 67 teenage boys who learned in yeshivas it was found that all had self-reported levels of stress, including mood issues such as depression and anxiety, higher than their peers who attended public high schools. Fully 75% of the respondents were at middle to high risk for developing mental health disorders, peer relationship difficulties, educational and delinquency problems. Levels and type of stress were also correlated with the type of yeshiva attended. Those who attended yeshivas considered more Hareidi had higher levels of emotional stress. Recommendations were again made to increase exercise time and for students to spend more time with emotionally supportive adults.

A recent survey of young adults who were single and wanted to be married also found extremely high levels of stress in some of the respondents. The author of the study concluded “one sub-group, strict women, (i.e. women who identify themselves as being Hareidi) consistently demonstrated associations between more frequent social control and poorer mental health.”

As if these findings were not enough, several large epidemiological studies found high correlations between low rates of exercise or physical activity and substance abuse among adolescents. If teens exercised regularly they were less likely to become involved with illicit substances.

According to the most recent study of stress in the United States, the American Psychological Association found that younger Americans are more stressed than older individuals are and men are less likely to deal with their stress than women are. Stress is known to be both a precursor to and a factor in exacerbating chronic illness. Moreover, from what we have seen, it is likely that Orthodox adolescent young adult men have even higher rates.

Virtually all studies of stress in children and young adults report a strong inverse correlation between stress and exercise. The more an individual exercises the lower their levels of stress, the less the amount of exercise the higher the amount of reported stress. The correlation is so robust and reliable that all treatment modalities for anxiety and mood disorders now include in the protocol for care a recommendation for a physical exercise regimen. Exercise of 30 to 40 minutes four to five days a week helps to overcome the effects of stress and may even short circuit the development of severe stress reactions.

We are very aware of what we need to do to help our children and teenagers to stay healthy but when it comes to self-care that includes physical activity we still seem to be lacking. While it is true that many yeshivas have access to open gyms after school hours there is some question as to the effect of exercising very late in the day. Most studies of exercise suggest that mornings, afternoons, or early evening are the optimal time. We must do more to teach our children to care for their minds and bodies. Health is an imperative.

Dr. Michael Salamon, a fellow of the American Psychological Association, is the founder and director of ADC Psychological Services in New York. He is the author of numerous articles, several psychological tests and books including “The Shidduch Crisis: Causes and Cures” (Urim Publications) and “Every Pot Has a Cover” (University Press of America). His newest book is called “Abuse in the Jewish Community: Religious and Communal Factors that Undermine the Apprehension of Offenders and the Treatment of Victims.”