Nick Mertens – Young Patients' AREA

The Invisible Weight: Mental Health and Chronic Illness

Ranging from National Suicide Prevention Month in September, to National Stress Month in April, to BIPOC Mental Health Month in July, mental health is a recurring topic throughout the year. Similar to myself, mental health is a year round battle, with these months holding special places in my psyche. Awareness is key, especially as someone with an autoimmune disease. As someone with an autoimmune disease and actively in therapy, mental health is an ongoing journey as I move away from my youth. Focusing on connecting with old friends, picking up hobbies, and finding satisfaction in my work has been hard. Plus, having Crohn’s disease, I am at an increased risk for exhibiting suicidal tendencies—like depression and anxiety.

Let’s delve into some research, along with some introductory tips from my own experiences, to help support everyone’s mental health.

Individuals living with an autoimmune condition such as Crohn’s disease or rheumatoid arthritis can be more susceptible to mental health issues. Globally, at least 1 in 10 people have a mental health condition, with anxiety and depression being the most common. For people with autoimmune conditions, several studies have shown that symptoms of anxiety and depression are over 50% higher, especially in young adults. While the reasons are diverse, the most common include autoimmune conditions masking mental health symptoms and a disconnect between a patient and their doctor. Specifically, increased inflammation in the body can disrupt delicate mood-regulating reactions in the brain and nervous system.

In one study focusing on rheumatic conditions and mental health, many patients attributed their current mental state to their chronic condition—many did not consider that both a chronic disease and mental health could be linked. Simultaneously, for patients with mental health symptoms, exploring options with a doctor can be daunting, and at times, downright frustrating. Several patients across studies noted how their doctor may be over-reliant on a rubric or chart when diagnosing a mental health condition; an over-reliance on a rubric can invalidate a person’s lived experiences. Coupled with existing systemic barriers to healthcare, such as high healthcare costs or location, people with autoimmune conditions are significantly affected by mental health issues.

For myself, my mental health journey has been a constantly evolving landscape. For many years, I tended to catastrophize situations and social interactions—sometimes to the point of hyperventilation and paralysis. During my sophomore year of undergrad, I faced several experiences that pushed me emotionally and mentally. A tough breakup, coupled with the death of a loved one and dissatisfaction with my professional life, culminated in a perfect storm of isolation. Outside of academics, work, or social obligations, I realized I had no personal coping mechanisms to process my feelings. I would spend evenings either journaling or lamenting internally, wondering how to escape the catastrophizing spiral—especially around my professional life.

Simultaneously, I would (and still do) suffer panic attacks when a situation seems dire and uncontrollable. Later, while studying abroad in Australia, I finally took action to address my emotions and homesickness. By living 12000+ miles from home, coupled with not knowing anyone in my cohort, I was both geographically and socially isolated—initially anyway. I realized I needed to focus on the root of my anxiety, not just cover it with social distractions. During that time and into my senior year, I attended more than a dozen counseling sessions at my university. A key lesson I learned is that counseling can provide short-term support, but therapy is where long-term progress happens.

Since graduating, and with my parents’ support, I found a therapist who works with young adults. We reviewed different providers through my primary doctor’s clinic, as well as other providers recommended by our insurance, and reached a mutual decision on a provider. Together, we are addressing my anxiety, tendency to catastrophize, and other personal challenges. Therapy has been one of the most effective strategies I can recommend—it has helped me in the moment while also fostering long-term healing. It can be difficult, even draining at times, but the growth that follows is invaluable. Therapy is not going to solve problems overnight, but it will provide tools and insights into helping your mental state.

Below, I’ve included a few parting tips from my own journey, along with mental health resources you may find helpful.

If you’re a student, reach out to your guidance counselor or your university’s health office—counseling can be truly helpful.
It’s okay to feel your emotions, acknowledge them, and take time to process bigger moments—whether good or bad. The key is what you do afterward.
It is also okay to ask for help—especially if you feel trapped or siloed. For myself, I struggled with reaching out until my emotions exploded like soda pop.
Therapy isn’t just for people with serious concerns. Think of it like visiting your doctor for regular check-ups—mental health directly affects physical health.
When looking for a therapist, ask your primary doctor about their connections—your insurance may cover more than you expect. Your insurance provider may also have a tool that can help find covered therapy providers as well!
For me, journaling and escapism (like geeking out over Marvel or playing trombone) have been excellent outlets to manage emotions. Try picking up a new hobby or returning to a past passion.

988 Suicide & Crisis Lifeline: Call or text 988 to connect with a trained counselor 24/7. This free and confidential service is for anyone in suicidal crisis or emotional distress. You don’t have to be suicidal to call.

Crisis Text Line: Text HOME to 741741 from anywhere in the U.S. to connect with a crisis counselor. It is free, confidential, and available 24/7.

The Trevor Project: Call 1-866-488-7386 or text START to 678-678for 24/7 crisis intervention and suicide prevention services for LGBTQ young people under 25.

Veterans Crisis Line: Dial 988 and press 1, text 838255, or chat online at veteranscrisisline.net for veterans and active-duty military.

National Domestic Violence Hotline: Call 1-800-799-7233 or text START to 88788 if you or someone you know is experiencing domestic violence.

Disaster Distress Helpline: Call or text 1-800-985-5990 for immediate crisis counseling related to disaster

References

Brundin, L., S. Erhardt, E. Y. Bryleva, E. D. Achtyes, and T. T. Postolache. 2019. “The Role of Inflammation in Suicidal Behaviour.” Acta Psychiatrica Scandinavica 132 (3): 192–203. https://doi.org/10.1111/acps.12458.

Conrad, Nathalie, Shivani Misra, Jan Y Verbakel, Geert Verbeke, Geert Molenberghs, Peter N Taylor, Justin Mason, et al. 2023. “Incidence, Prevalence, and Co-Occurrence of Autoimmune Disorders over Time and by Age, Sex, and Socioeconomic Status: A Population-Based Cohort Study of 22 Million Individuals in the UK.” The Lancet 401 (10391). https://doi.org/10.1016/s0140-6736(23)00457-9.

Gordon, Sherri. 2024. “People with Autoimmune Diseases Experience ‘Significantly’ More Mental Health Symptoms, Study Shows.” Health. 2024. https://www.health.com/autoimmune-disease-mental-illness-7569310#citation-3.

Mudra Rakshasa-Loots, Arish, Duncan Swiffen, Christina Steyn, Katie F M Marwick, and Daniel J Smith. 2025. “Affective Disorders and Chronic Inflammatory Conditions: Analysis of 1.5 Million Participants in Our Future Health.” BMJ Mental Health 28 (1): e301706. https://doi.org/10.1136/bmjment-2025-301706.

Ravan, Jayaprakash Russell, Sucheta Chatterjee, Pratima Singh, Debashis Maikap, and Prasanta Padhan. 2021. “Autoimmune Rheumatic Diseases Masquerading as Psychiatric Disorders: A Case Series.” Mediterranean Journal of Rheumatology 32 (2): 164. https://doi.org/10.31138/mjr.32.2.164.

Sloan, Melanie, Chris Wincup, Rupert Harwood, Thomas A Pollak, Efhalia Massou, Michael Bosley, Mikko R. A. Pitkänen, et al. 2023. “Prevalence and Identification of Neuropsychiatric Symptoms in Systemic Autoimmune Rheumatic Diseases: An International Mixed Methods Study.” Rheumatology, July. https://doi.org/10.1093/rheumatology/kead369.

Climate Change Hits Hard—Even on Your Cycle

At first glance, climate change and equitable access to menstrual products may seem unrelated. Climate change is a global crisis driven by greenhouse gas emissions from daily activities such as driving cars, using plastic-based products, and raising livestock. Since pre-industrial times, the Earth’s average temperature has risen by about 1.2°C, and scientists warn it could surpass 1.5°C in the 2030s. The consequences are already visible: hotter summers, shifting rainfall patterns, and more frequent and destructive natural disasters. Simultaneously, menstrual equity remains a pressing concern. According to the American Academy of Pediatrics, 1 in 3 U.S. teens experiences “period poverty,” or the lack of reliable access to safe menstrual products. For many young people, schools, doctors’ offices, and local grocery stores are their primary sources of these products.

Climate change threatens these access points. Natural disasters can interrupt supply chains, floods or storms can close schools and clinics, and heat-related stress can influence reproductive health outcomes. Research also suggests that climate-related stress and extreme heat can physically disrupt menstrual cycles, adding another layer of vulnerability. While many factors influence what menstrual products are bought, the most common, and often cheapest menstrual products, often carry the highest carbon footprint. While many factors influence what products someone may choose, What may appear to be two separate issues — climate change and menstrual equity — are deeply connected. Without intervention, a warming planet will make it even harder for young people to access safe, affordable, and sustainable menstrual products.

Looking closer, climate change’s impacts on menstrual products are complex and far-reaching. Physically, climate change can exacerbate existing stressors on the body, leading to disruptions in normal menstrual cycles. For example, extended periods of extreme heat have been shown to change hormonal balances, specifically amplifying endocrine disorders and UTIs. Focusing on indigenous peoples’ testimony, insufficient water access during unpredictable rain cycles can affect menstrual hygiene practices. In tandem, intensive disasters like hurricanes, frequent flooding, or forest fires impact supply chains and people’s access to distribution areas. When seeking shelter, menstrual products are often a limited and overlooked resource – food and medication take prominent attention. Just as important, improper menstrual products can cause infections and may worsen a person’s mental health from social stigma. From a health and logistical perspective, climate change worsens menstrual product access by disrupting a person’s health and hindering community access during a crisis event.

Tangentially, single-use, plastic-based menstrual products like tampons and pads remain the most popular choice worldwide. Decades of branding, education, and refinement have made products like tampons and pads safe – and often desirable – compared to unsanitary methods. Nevertheless, the greenhouse gas emissions, coupled with plastic waste, make menstrual products an environmental concern as well. Over the course of a year, single-use menstrual products emit 20 pounds of greenhouse gases during production and transportation – equivalent to charging a phone over 1000 times! In addition, once disposed of, a product like a tampon or a pad is nonbiodegradable; it can take 500-800 years for a single product to fully decompose. As a necessary health product, menstrual products are intensive on the environment during manufacturing, transportation, and in a landfill. While not the largest contributor, continuing to use unsustainable menstrual products slowly contributes to worldwide climate change.

While separate issues, climate change directly impacts local communities and people’s access to sanitary menstrual products. From ongoing health impacts, intensive natural disasters, supply chain disruptions, and single-use products environmental toll, menstrual products are in a catch-22. Nevertheless, sustainable options are more readily available than ever before! Products like menstrual cups are reusable items that are inserted into the canal and can be rewashed for multiple uses. Further, biodegradable pads and tampons are becoming market staples – even if it has a price premium. Resources like the Good Shopping Guide (here) or getting involved in initiatives like the Pad Project (here) can help make a difference too! Regardless, it is important when picking menstrual products, you pick the ones that are best for you – both healthfully and personally. Whether it is a reusable cup or single-use item, ensuring everyone has access to menstrual products is vital. We can change the system, whether by voting with our dollar, pressing companies vocally to change, or working to ensure everyone has access to menstrual products.

Click here to read Laila’s personal story about choosing a birth control method.

References

American Academy of Pediatrics. 2020. “Period Poverty Research Finds 1 in 3 Teens Lack Access to Menstruation Products.” Aap.org. 2020. https://www.aap.org/en/news-room/news-releases-from-aap-conferences/period-poverty-research-finds-1-in-3-teens-lack-access-to-menstruation-products/?srsltid=AfmBOoo8Go8K_pjStrWigCEN4C9xOVJQIMhSb5lyZxKHBMJJIYdyiU0V.

Muralidharan, Arundati, Marije Broekhuijsen, Lady Lisondra, Aeka Guru, Jacquelyn Haver, and Sidra Irfan. 2025. “The Ripple Effect: Impacts of Climate Change on Menstrual Health and Paths to Resilience.” Frontiers in Global Women S Health 6 (April). https://doi.org/10.3389/fgwh.2025.1569046.

Parnian Khorsand, Sara Dada, Laura Jung, Siufung Law, Poorvaprabha Patil, Marie-Claire Wangari, Omnia El Omrani, and Kim van Daalen. 2023. “A Planetary Health Perspective on Menstruation: Menstrual Equity and Climate Action.” Planetary Health 7 (5): e347–49. https://doi.org/10.1016/s2542-5196(23)00081-5.

Yasemin Hamlaci Baskaya, Nazlı Unlu Bidik, and Busra Yolcu. 2024. “The Effect of Level of Anxiety about Climate Change on the Use of Feminine Hygiene Products.” International Journal of Gynecology & Obstetrics 165 (3): 1158–66. https://doi.org/10.1002/ijgo.15324.

The Sky’s (Almost) the Limit: Traveling with Crohn’s Disease

If you know me, you know I love to travel. At the same time, you probably also know I’ve been living with Crohn’s Disease for the last five years. When I was first diagnosed, I was told my life wouldn’t change much—if my medication worked well with my condition. Initially, I was receiving IV infusions every few weeks, but I experienced an anaphylactic reaction during my early treatments. This led to a quick transition to Humira, a biweekly injectable biologic. That was five years ago, and now I’m fortunate to be in long-term remission.

Enter my love of travel! Over the past year, I’ve traveled to eight countries: the U.S.A., Turkey, the U.A.E., the Bahamas, Australia, Azerbaijan, Spain, and back to the U.A.E. Most of these trips were relatively short—just a couple of weeks at a time. For those trips, I worked with my doctor to adjust my medication schedule, avoided trigger foods, and bought travel insurance. Pro tip: Don’t leave your travel prep until the last minute, like I did once. Another Pro Tip: If you cannot justify travel health insurance, you’re leaving yourself in a vulnerable position. Procrastination should be reserved for homework, not medical logistics! With a little foresight, even short trips can be smooth sailing.

My favorite destination so far? Australia. This past spring, I spent five months in Perth as a university student—shoutout to Notre Dame Australia and Fremantle! Living abroad required a “long-term” plan, which included purchasing foreign health insurance and securing an adequate supply of Humira. Navigating foreign health insurance can be tricky, especially since coverage doesn’t always transfer seamlessly from the U.S. Medications might go by different names or require additional steps for prescriptions. If you need to see a specialist, be prepared for referrals that could take time—and sometimes, a lot of money.

If you’re traveling with medication, here are some key tips:

1. Bring a doctor’s note and the original packaging of your medication.
2. Check if your medication is safe for x-ray machines. Some medications, like biologics, may have restrictions. Request manual inspections from TSA if needed.
3. Declare your medication at customs checkpoints. Transparency and documentation will make the process smoother.
4. Know your foreign insurance plan inside out. If anything were ever to happen, knowing your coverage and rights will make your life easier.
5. Mental health is just as important as physical health. When I traveled, I sought counseling for international students. My anxiety and overthinking was horrible; it directly influenced my Crohn’s. Even if your stint is short, it’s okay to talk about mental health with a professional, trusted peer, or friend in your life.

For my trip to Australia, I avoided x-ray screening for my Humira pens by requesting manual inspections. I also traveled with a cooler bag that kept my medication at the proper temperature for over 40 hours. Don’t hesitate to ask flight attendants or airport staff for ice or other assistance—they’re there to help! Upon arrival in Australia, I promptly declared my biologic medication. Thanks to my preparation, the process went smoothly. Even after, I safely managed my Crohn’s by avoiding trigger foods and staying in contact with my doctor.

Traveling with Crohn’s Disease (or any chronic disease) can feel daunting, but it’s absolutely doable with the right preparation. Whether you’re planning a quick getaway or a long-term stay, a bit of foresight can open up the world. The world is YOUR oyster… make the most of it!

Eco-Friendly Sneezes and Green Wheezes: Navigating Health in a Changing Climate

Hello, beautiful faces and people!

First off, happy Earth Day! I am Nicholas J. Mertens, an undergraduate student in environmental studies and political science from Minneapolis, Minnesota. I also go by “Nick” or “Ringo” if you ever meet me in person! Nevertheless, I am currently visiting “the land down under”, writing from my fifth country this year, in Australia! I have also conducted qualitative research in Dubai, UAE; Istanbul, Turkey; Nassau, The Bahamas; and soon Baku, Azerbaijan; and next summer, I will be working in Washington D.C.! I have traveled worldwide for the last two years, studying climate change, private investment, and its intersectional relation with many industries — like healthcare. While lesser known, healthcare and climate change have become so inextricably linked with equitable healthcare. Many communities in the U.S. and worldwide are at greater risk from changing climate: whether it’s increased respiratory diseases from construction, increased exposure to toxic chemicals from overconsumption, or increased risks of heat-related diseases for people who are immunocompromised. Further, as a person with Crohn’s Disease, I take it as my duty to shine light on intersectional environmental and healthcare policy.

Before delving into healthcare and environmental jargon, understanding the beginnings of Earth Day is essential. The motivation to start Earth Day was derived from several environmental developments during the 1960s: Rachel Carson’s environmentalist book Silent Spring, The Ohio Cuyahoga River Fire in 1969, and a disastrous 1969 oil spill in Santa Barbara, California. In each example, people’s health were consistently jeopardized, and further exacerbated if they were suffering from an autoimmune condition. Silent Spring was first denied by big companies, and highlighted the constant use of pesticides that killed numerous animals and gave fatal health conditions to humans — including liver disease and seizures. Further, The Cuyahoga River Fire and Santa Barbara oil spill caused petroleum and other industrious chemicals to runoff into aquifers, impacting lower-income areas prone to health impacts from worse water treatment. While the “Big 3” events emphasized a need for change, numerous smaller environmental disasters inspired activists to advocate for a designated holiday. Action was finally reached when Senator Gaylord Nelson (WI) saw the Santa Barbara oil spill, stretching over 500 miles along the California coast. Teaming up with activists and educators, Senator Nelson authored the bill to start Earth Day on April 22, 1970.

Following its inception, Earth Day has ballooned into a worldwide phenomenon. When it was first celebrated in 1970, over twenty million people, from university students to senior citizens, organized events, rallies, and lectures to spread sustainability awareness. Further, several Canadian and American community leaders championed the day for local awareness and impact. Today, April 22, is recognized as Earth Day by every country in the United Nations. Further, over 4 billion people annually participate in earth-related events of some nature. Earth Day is no longer “just about pollution”, but encompasses all parts of intersectionality: the physical environment, climate change, our own identities, and potential barriers to equitable success. Earth Day has permeated borders and become a rallying cry for intersectional, equitable change in the ongoing climate crisis.

In my own experiences, the relationship between healthcare and climate is not discussed enough. In the U.S., we have already seen climate change impact health nationwide. For the last five summers, our forest fire season has been prolonged and exacerbated by ongoing drought, heightened temperatures, and shifting wind patterns. Many states have experienced at least two weeks of Air Quality Index (AQI) levels above 150 — a value that designates unhealthful conditions for the general population. Some areas, most famously Buffalo, New York, and my home of Minneapolis, Minnesota, faced smoke so severe some days that sunlight couldn’t reach the ground. Because of these conditions, people with respiratory conditions, like asthma, are encouraged to wear an N-95 mask to dilute particulate matter. The smoke matter is dangerous, as it can cause scarring in lung tissue or diffuse into the bloodstream. While some people can travel to areas less affected by fire smoke, most are forced to remain in their housing or continue work outside.

In addition to respiratory conditions, more significant temperature fluctuations can place greater stressors on local healthcare systems — especially hotter temperatures. Last summer, many areas in the Southern U.S. experienced record-breaking temperatures. In Phoenix, Arizona, the city experienced a running streak of over 20 days with temperatures above 100 degrees Fahrenheit. Further, several communities in New Mexico, Nevada, and Texas faced scorching heat without access to air conditioning or cool liquids. The consecutive heat-waves contributed to a significant rise in hospitalizations. In addition, for people who are not used to extended periods of high heat, this can cause stress on immune responses. Conversely, cold snaps (polar vortexes) are less common than they were two decades ago. Still, their extremely low temperatures are colder than similar examples from the 1990’s.

Specifically in the northern U.S., inaccessible heating can cause hypothermia and frostbite. Amongst the immunocompromised and elderly, the impacts from cold-related injury are heightened compared to healthy, young individuals.

From my experiences, traveling in the U.S. and abroad, a changing climate has impacted my health. Last summer, I had to work outside during the horrific wildfires in Northern Canada. Somedays, I was stationed outside for ten hours with an AQI above 200 — where the CDC recommends ALL persons wear an N-95 mask. As someone with Crohn’s, I found my mental health to be more demanding that day, along with my gastrointestinal system to operate more dynamically. Further, it wouldn’t be uncommon for me to cough vigorously for hours after my shift — even after wearing an N-95 mask. The extreme heat placed strain on my mental health and work output as well. While reaching 90 degrees in Minnesota is expected, we are now having multiple weeks in July where the temperatures exceed 100 degrees. I’ve experienced these problems even while abroad, specifically in Dubai and Perth, Australia. Each city is situated in an environment that receives little rain with high average temperatures. In Dubai, when I met with country delegations, many people were forced to flee their homes. While reasons spanned from poorer farm yields to rising sea levels, people worldwide felt the impact equally. From the Congo to the Asian Steppe, many people have changed their habits and political policies to accommodate climate change’s health policies. There was even an entire day last year at the United Nations dedicated to negotiating healthcare and climate change treaties! In Australia, communities lack air conditioning comparable to the U.S. Sea rise in coastal cities — Sydney, Melbourne, Perth, and Tasmania — harms coral reefs, real estate, and access to proper healthcare. Pushing people inwards from the coasts not only disrupts natural ecosystems, but forces many to uproot their communities and present lifestyle. The mental health implications from climate-induced migration are not well understood. My Crohn’s has been kind thus far in my travels, but climate change has made me consider what impacts I might face compared to home.

Earth Day is a holiday ripe for celebration and active education. Formed from environmental disasters of the 1960s, today it is a holiday that transcends borders and language boundaries. It forces people to consider their own impacts on the environment, but also share in the beauty and wonder of our planet. Climate change will impact us all — the least affluent communities will bear the worst of the impact. Further, climate change is here to stay: it will take all of us to address the habits needed to stop its progression. Still, I challenge you to consider something different this Earth Day. While most editorials will explore how you can better protect the world via recycling or less use, I see another opportunity. How does your health and well-being fit into the environment around you? How would your environment be changed, be it by climate change or another factor, influence your health? When considering, explore not only how it would impact you physically, but mentally, spiritually, and emotionally as well. For myself, I see that my Crohn’s makes me more susceptible to temperature and lifestyle changes. Still, by being aware of my limits, I know that I am capable of so much more — like traveling all around the world! The world is going to change and we will make a difference, but how will you take care of yourself during this time? Before taking on the world, you have to be comfortable taking on yourself.

Author: Nick Mertens

The Invisible Weight: Mental Health and Chronic Illness

Climate Change Hits Hard—Even on Your Cycle

The Sky’s (Almost) the Limit: Traveling with Crohn’s Disease

Hilary Cronon