Anxiety screen added to US checkups for gals
March 2, 2021 1:15 AM Subscribe
From Soo Youn in The Lily: On Jan. 1, women and girls in the United States became eligible for an additional check on their health. Now, starting at 13, they can be screened for anxiety as part of a routine checkup or physical with a primary care doctor or OB/GYN as a preventive service under the Affordable Care Act. “This is a real breakthrough because we’re now saying that the mental health conditions that women suffer from are extremely important and they need to be screened for,” said Maureen Sayres Van Niel, a psychiatrist and the president of the women’s caucus of the American Psychiatric Association. “Some mental health issues are as important as the physical health things we screen for, like cancer.”
And then there's the whole gendered component to it , discussing mental health in such a binary way.
posted by AlexiaSky at 2:02 AM on March 2, 2021 [19 favorites]
posted by AlexiaSky at 2:02 AM on March 2, 2021 [19 favorites]
Hey US govt, I have anxiety blowing my mind rn, plz scrn.
posted by kfholy at 2:24 AM on March 2, 2021 [8 favorites]
posted by kfholy at 2:24 AM on March 2, 2021 [8 favorites]
What do you know? The brain's an organ. Huh.
posted by villard at 2:37 AM on March 2, 2021 [1 favorite]
posted by villard at 2:37 AM on March 2, 2021 [1 favorite]
That's good. Both of my daughters (one is in adulthood and the other is on the cusp of it) have struggled with anxiety. As do I, although I didn't even know what it was until a decade ago. I just deemed it "nervous stomach." To say it has been occasionally debilitating for them is an understatement. Thankfully it was recognized and they've had on-going counseling and treatment. What I didn't know until one of their counselors told me was that it is an extremely common problem in young women but is often left undiagnosed/untreated.
posted by drstrangelove at 4:26 AM on March 2, 2021 [3 favorites]
posted by drstrangelove at 4:26 AM on March 2, 2021 [3 favorites]
Hey. I agree that the screening should be offered to everyone. I am shocked that it is automatically being offered to anyone. And I want to help spread the news so that people who don’t know about it but potentially could use it, find out.
Given how badly medicine treats many categories of people, including women and girls, I do not plan to hate on this specific small amount of progress but rather cheer it while also pushing my particular nationally elected officials to demand the screening be extended to all. I encourage everyone who gets to vote in the US to do the same.
posted by Bella Donna at 4:46 AM on March 2, 2021 [30 favorites]
Given how badly medicine treats many categories of people, including women and girls, I do not plan to hate on this specific small amount of progress but rather cheer it while also pushing my particular nationally elected officials to demand the screening be extended to all. I encourage everyone who gets to vote in the US to do the same.
posted by Bella Donna at 4:46 AM on March 2, 2021 [30 favorites]
I have such mixed feelings about this as an idea (not that I have skin in this game as a person living outside the US who won't be having kids and already knows they have anxiety).
As the child of a mother with intense high-functioning anxiety who's only been aware of it & medicated for the past few years, having a doctor at any time during my childhood point out to her that the level of anxiety she was living with wasn't normal, wasn't the same that everyone else was experiencing and could be improved with a fairly simple intervention could have been life-changing. My own adult life is still hemmed in all around the edges by her anxiety, particularly my concepts of what is and isn't safe to do.
I'm glad for her that she's got better tools for dealing with it now, and medicines that turn down the anxious noise in her brain, but that could have happened twenty years earlier and would have been revolutionary not just for her but for me and our entire family system. She's not particularly mental health literate (not in the way that I was basically forced to be by the severity & extremely early onset of my own issues in that domain), so having a trusted authority figure broach the subject might have short-circuited the process by literal decades.
On the other hand, as a non-binary person, the gendered aspect of it seems like a weird constraint. If I had an appointment and they assumed my gender was the same as my birth sex but then I was like "no, lol, actually no gender", would they then not screen me?
To stretch the cancer analogy from the quote in the body of the post, it makes sense to me, for example, to restrict some kinds of cancer screening to the populations that are the most likely to develop that kind of cancer (e.g. screening people who have cervixes for cervical cancer). What I can't make as much sense of is why you'd only choose to screen one gender for something like anxiety. While women & AFAB people might be more prone to anxiety as a demographic, it's not like they have an "anxietal lobe" or comparable brain structure that men & AMAB people don't have.
I guess in conclusion, "yes good, but why not more good for more people?" A shame that society has so thoroughly bought into the capitalist idea that it's too expensive to do things that benefit people and we should ration the amount of benefiting we do to the point where it twists the good stuff into weird boxes that aren't maximally accessible.
posted by terretu at 5:49 AM on March 2, 2021 [26 favorites]
As the child of a mother with intense high-functioning anxiety who's only been aware of it & medicated for the past few years, having a doctor at any time during my childhood point out to her that the level of anxiety she was living with wasn't normal, wasn't the same that everyone else was experiencing and could be improved with a fairly simple intervention could have been life-changing. My own adult life is still hemmed in all around the edges by her anxiety, particularly my concepts of what is and isn't safe to do.
I'm glad for her that she's got better tools for dealing with it now, and medicines that turn down the anxious noise in her brain, but that could have happened twenty years earlier and would have been revolutionary not just for her but for me and our entire family system. She's not particularly mental health literate (not in the way that I was basically forced to be by the severity & extremely early onset of my own issues in that domain), so having a trusted authority figure broach the subject might have short-circuited the process by literal decades.
On the other hand, as a non-binary person, the gendered aspect of it seems like a weird constraint. If I had an appointment and they assumed my gender was the same as my birth sex but then I was like "no, lol, actually no gender", would they then not screen me?
To stretch the cancer analogy from the quote in the body of the post, it makes sense to me, for example, to restrict some kinds of cancer screening to the populations that are the most likely to develop that kind of cancer (e.g. screening people who have cervixes for cervical cancer). What I can't make as much sense of is why you'd only choose to screen one gender for something like anxiety. While women & AFAB people might be more prone to anxiety as a demographic, it's not like they have an "anxietal lobe" or comparable brain structure that men & AMAB people don't have.
I guess in conclusion, "yes good, but why not more good for more people?" A shame that society has so thoroughly bought into the capitalist idea that it's too expensive to do things that benefit people and we should ration the amount of benefiting we do to the point where it twists the good stuff into weird boxes that aren't maximally accessible.
posted by terretu at 5:49 AM on March 2, 2021 [26 favorites]
I am all for more easily accessible screening, but I do hope there is additional training on how to talk to patients about anxiety. Maybe my experience is an outlier, but I approached my OB-GYN about some anxiety I was dealing with a couple of years ago, and it wasn't great...it felt pretty harmful actually. He suggested I make sure to eat more vegetables (??? I am overweight, but my diet had never come up before and if it had, he would have known that I eat quite a few vegetables), and that he didn't want to prescribe anything unless I insisted because it would be on my record and make getting health insurance hard. This was not a doctor who was just a jerk, he had always spent lots of time with me, explaining tests and results in detail and treating me as a whole patient, which is why I chose to bring this to him in the first place.
Looking back on it, I think it was a combination of ignorance about the topic and some personal baggage he was dealing with at the time. But for a long time after that, I felt like my anxiety wasn't real, and was something I should be able to deal with on my own. I don't want that to happen to other people.
posted by TheFantasticNumberFour at 6:05 AM on March 2, 2021 [11 favorites]
Looking back on it, I think it was a combination of ignorance about the topic and some personal baggage he was dealing with at the time. But for a long time after that, I felt like my anxiety wasn't real, and was something I should be able to deal with on my own. I don't want that to happen to other people.
posted by TheFantasticNumberFour at 6:05 AM on March 2, 2021 [11 favorites]
This is a great initiative, and hopefully it can be expanded to all genders. Maybe some doctors will start doing it for everyone after it becomes a routine thing to look for.
I'm not convinced that anxiety is even more common in women in the first place, despite being diagnosed more - of course it's hard to know any numbers about the undiagnosed population, but I've known a hell of a lot of anxious dudes who would never ask a doctor about it.
posted by randomnity at 6:19 AM on March 2, 2021 [1 favorite]
I'm not convinced that anxiety is even more common in women in the first place, despite being diagnosed more - of course it's hard to know any numbers about the undiagnosed population, but I've known a hell of a lot of anxious dudes who would never ask a doctor about it.
posted by randomnity at 6:19 AM on March 2, 2021 [1 favorite]
FTA:
“It legitimizes the fact that anxiety is a very serious condition that needs treatment and has huge consequences for people, and for women’s lives particularly. It’s not that it’s only in women. It’s just that it’s twice as prevalent in women,” she said.
That "twice as prevalent in women" is a link to - Anxiety and Depression Association of America:
Over the course of their lives, about 40 percent of women report suffering from anxiety — twice as many as men, according to the WPSI. Yet only about 20 percent of those affected seek treatment.
According to the WPSI report, in adolescent girls, “anxiety disorders can begin in childhood at a median age of 11 years, can develop in mid-adulthood, and often decline beginning at approximately age 60 years. During pregnancy and the postpartum period, anxiety disorders increase in both frequency and effects, including effects on the infant and family.”
So, y'know, an awful lot of the "Y Not Everyone !!??" questions are addressed in the article . . .
posted by soundguy99 at 6:39 AM on March 2, 2021 [17 favorites]
“It legitimizes the fact that anxiety is a very serious condition that needs treatment and has huge consequences for people, and for women’s lives particularly. It’s not that it’s only in women. It’s just that it’s twice as prevalent in women,” she said.
That "twice as prevalent in women" is a link to - Anxiety and Depression Association of America:
From the time a girl reaches puberty until about the age of 50, she is twice as likely to have an anxiety disorder as a man. Anxiety disorders also occur earlier in women than in men.Also FTA:
Women are also more likely to have multiple psychiatric disorders during their lifetime than men. The most common to co-occur with anxiety is depression.
Differences in brain chemistry may account for at least part of these differences. The brain system involved in the fight-or-flight response is activated more readily in women and stays activated longer than men, partly as a result of the action of estrogen and progesterone.
The neurotransmitter serotonin may also play a role in responsiveness to stress and anxiety. Some evidence suggests that the female brain does not process serotonin as quickly as the male brain. Recent research has found that women are more sensitive to low levels of corticotropin-releasing factor (CRF), a hormone that organizes stress responses in mammals, making them twice as vulnerable as men to stress-related disorders.
Over the course of their lives, about 40 percent of women report suffering from anxiety — twice as many as men, according to the WPSI. Yet only about 20 percent of those affected seek treatment.
According to the WPSI report, in adolescent girls, “anxiety disorders can begin in childhood at a median age of 11 years, can develop in mid-adulthood, and often decline beginning at approximately age 60 years. During pregnancy and the postpartum period, anxiety disorders increase in both frequency and effects, including effects on the infant and family.”
So, y'know, an awful lot of the "Y Not Everyone !!??" questions are addressed in the article . . .
posted by soundguy99 at 6:39 AM on March 2, 2021 [17 favorites]
As a veeery anxious male, I also wish this was all-inclusive.
On the other hand, I've spent a lot of time with psychologists and psychiatrists and they're all pretty ambivalent about the ease with which PCPs are encouraged to prescribe mental health drugs. This is how you end up with patients on 10s of medications.
posted by es_de_bah at 6:52 AM on March 2, 2021 [3 favorites]
On the other hand, I've spent a lot of time with psychologists and psychiatrists and they're all pretty ambivalent about the ease with which PCPs are encouraged to prescribe mental health drugs. This is how you end up with patients on 10s of medications.
posted by es_de_bah at 6:52 AM on March 2, 2021 [3 favorites]
More attention on mental health is good; the gender disparity is bad. But unless I'm understanding it incorrectly, this new development isn't actually requiring anxiety screenings; it's just saying that female patients don't need to be charged for said screenings any more. Which is bringing home how ridiculous health care billing can be.
Most private insurance plans — including those provided through the Affordable Care Act — will cover the screenings, which may involve answering a questionnaire or having a conversation with a doctor. A screening is not a diagnosis, which would be the next step
So basically insurance plans are agreeing to "cover" the extra minutes that it takes to look at a questionnaire. Or have a conversation. There's no special equipment that needs to be paid for, or blood tests to run, or anything like that. This is about paying for a little extra time, right? And I get it - time is income - but at the same time I don't: if a doctor asks a male patient about anxiety, does the patient truly have to get billed for those minutes? If a patient brings up anxiety of their own accord, are they getting billed for that? If a doctor decides to "have a conversation" with patients about how they're dealing with the pandemic, or some other factor of the day that is likely to affect the patient, is that a "screening" that needs to be on a line item? How is appointment time itemized anyway? I've had a doctor or two spend over 20 minutes monologuing to me about how they don't think my chronic illness is worth spending even a few minutes looking into; that extra time was not billed. I've had doctors spend entire minutes talking about their personal lives, their personal beliefs, the weather, and what have you. I've had doctors take personal calls during appointments. When is appointment time expensive and when is it not?
Mental health should absolutely be required as a standard aspect of checkups, and doctors should also have far more training on the subject than they do now. But if the idea here is that this new development is a breakthrough because doctors are basically only technically allowed to ask about a narrow range of things without specifically billing their patients for the words exchanged and the (few) extra minutes spent -- that's absolutely awful, and a recipe for incomplete care.
I'd be grateful for corrections if I'm misunderstanding this, and for any insights from practicing doctors.
posted by trig at 7:06 AM on March 2, 2021 [19 favorites]
Most private insurance plans — including those provided through the Affordable Care Act — will cover the screenings, which may involve answering a questionnaire or having a conversation with a doctor. A screening is not a diagnosis, which would be the next step
So basically insurance plans are agreeing to "cover" the extra minutes that it takes to look at a questionnaire. Or have a conversation. There's no special equipment that needs to be paid for, or blood tests to run, or anything like that. This is about paying for a little extra time, right? And I get it - time is income - but at the same time I don't: if a doctor asks a male patient about anxiety, does the patient truly have to get billed for those minutes? If a patient brings up anxiety of their own accord, are they getting billed for that? If a doctor decides to "have a conversation" with patients about how they're dealing with the pandemic, or some other factor of the day that is likely to affect the patient, is that a "screening" that needs to be on a line item? How is appointment time itemized anyway? I've had a doctor or two spend over 20 minutes monologuing to me about how they don't think my chronic illness is worth spending even a few minutes looking into; that extra time was not billed. I've had doctors spend entire minutes talking about their personal lives, their personal beliefs, the weather, and what have you. I've had doctors take personal calls during appointments. When is appointment time expensive and when is it not?
Mental health should absolutely be required as a standard aspect of checkups, and doctors should also have far more training on the subject than they do now. But if the idea here is that this new development is a breakthrough because doctors are basically only technically allowed to ask about a narrow range of things without specifically billing their patients for the words exchanged and the (few) extra minutes spent -- that's absolutely awful, and a recipe for incomplete care.
I'd be grateful for corrections if I'm misunderstanding this, and for any insights from practicing doctors.
posted by trig at 7:06 AM on March 2, 2021 [19 favorites]
On the other hand, as a non-binary person, the gendered aspect of it seems like a weird constraint.
terretu, I think you have a very good point.
The brain system involved in the fight-or-flight response is activated more readily in women and stays activated longer than men, partly as a result of the action of estrogen and progesterone...Some evidence suggests that the female brain does not process serotonin as quickly as the male brain
soundguy99, this probably gets at the actual medical science of it (and thank you for actually referencing the article!) - at least the hormone part (estrogen and progesterone). I am very leery of the term "female brain." From what I understand, that has not been well defined in medical science.
There's definitely a 'how to do we handle gender now' aspect to this. In these situations, I tend to be a hormone essentialist, I must admit. While the root cause appears to be linked to estrogen and progesterone, I don't think we can have medical forms that ask what levels of estrogen and progesterone patients have.
We CAN have forms (and doctors questions) that provide a non-binary option. Not all non-binary people are "on" estrogen and progesterone (whether via ovaries or via medication), but many are (many others are "on" testosterone).
I would posit that a solution to terretu's concern would be to have non-binary individuals be included in the ACA coverage for anxiety screening. It would get to the root medical science raised by the article, by including a lot of people with higher levels of progesterone and estrogen, while also being sensitive to gender identity.
posted by Flight Hardware, do not touch at 7:34 AM on March 2, 2021 [2 favorites]
terretu, I think you have a very good point.
The brain system involved in the fight-or-flight response is activated more readily in women and stays activated longer than men, partly as a result of the action of estrogen and progesterone...Some evidence suggests that the female brain does not process serotonin as quickly as the male brain
soundguy99, this probably gets at the actual medical science of it (and thank you for actually referencing the article!) - at least the hormone part (estrogen and progesterone). I am very leery of the term "female brain." From what I understand, that has not been well defined in medical science.
There's definitely a 'how to do we handle gender now' aspect to this. In these situations, I tend to be a hormone essentialist, I must admit. While the root cause appears to be linked to estrogen and progesterone, I don't think we can have medical forms that ask what levels of estrogen and progesterone patients have.
We CAN have forms (and doctors questions) that provide a non-binary option. Not all non-binary people are "on" estrogen and progesterone (whether via ovaries or via medication), but many are (many others are "on" testosterone).
I would posit that a solution to terretu's concern would be to have non-binary individuals be included in the ACA coverage for anxiety screening. It would get to the root medical science raised by the article, by including a lot of people with higher levels of progesterone and estrogen, while also being sensitive to gender identity.
posted by Flight Hardware, do not touch at 7:34 AM on March 2, 2021 [2 favorites]
Screenings are generally questionnaires that answers are assigned point values and that determines if one needs further conversation. I use to work with the phq-9 screening which is for depression. Its a self screening meaning people fill out out themselves, you total it and it gives a score regarding depression. It's useful but it's also not a risk assessment tool for things like self harm or suicide risk. Which means doctors can over or under react regarding disclosure of depression which isn't great (which I've seen happen as a clinician in medical settings) It asks about suicidal thoughts, but really doesn't guide a physician on what to do if someone says yes.
I'm not sure if there is a particular anxiety screening instrument authorized. My guess is it is the GAD - 7. It's administered in pretty much the same fashion as the phq-9 and sometimes they are handed out together.
I was looking at population numbers, and it seems to be 3.4% women versus 1.9 percent men experience anxiety. Which is still 1 in every 50 men.
Yes, this is fantastic move forward to get these screenings and to treat anxiety disorders like the disorders they are. But there is so much to say about how the mental health system, diagnosis, and treatment is mired a history of misogyny, and that there's still so much work to be done to actually understand these disorders, presentation and what's actually happening.
posted by AlexiaSky at 7:36 AM on March 2, 2021 [7 favorites]
I'm not sure if there is a particular anxiety screening instrument authorized. My guess is it is the GAD - 7. It's administered in pretty much the same fashion as the phq-9 and sometimes they are handed out together.
I was looking at population numbers, and it seems to be 3.4% women versus 1.9 percent men experience anxiety. Which is still 1 in every 50 men.
Yes, this is fantastic move forward to get these screenings and to treat anxiety disorders like the disorders they are. But there is so much to say about how the mental health system, diagnosis, and treatment is mired a history of misogyny, and that there's still so much work to be done to actually understand these disorders, presentation and what's actually happening.
posted by AlexiaSky at 7:36 AM on March 2, 2021 [7 favorites]
First comment we derail into 'What about the men?' Good job, everyone.
I think a) a nonbinary person brought it up, so it doesn't feel to me like "oh we poor menz" and b) they brought it up in a way that reflects very specifically on women (i.e., nondiagnosed/nontreated anxiety in men can present as violence against women).
My own immediate reaction was to wonder whether the fact that women are diagnosed more with anxiety is due to stigmatization of anxiety and/or seeking treatment for men, and/or the difference in presenting characteristics. Plus, if this new screening procedure goes into effect only for women, it may well bump the female diagnoses even higher while the men's rate remains level. Altogether, it feels a little like a return to "hysteria" to me, and screening everybody could potentially cut down on these issues.
posted by dlugoczaj at 7:53 AM on March 2, 2021 [32 favorites]
I think a) a nonbinary person brought it up, so it doesn't feel to me like "oh we poor menz" and b) they brought it up in a way that reflects very specifically on women (i.e., nondiagnosed/nontreated anxiety in men can present as violence against women).
My own immediate reaction was to wonder whether the fact that women are diagnosed more with anxiety is due to stigmatization of anxiety and/or seeking treatment for men, and/or the difference in presenting characteristics. Plus, if this new screening procedure goes into effect only for women, it may well bump the female diagnoses even higher while the men's rate remains level. Altogether, it feels a little like a return to "hysteria" to me, and screening everybody could potentially cut down on these issues.
posted by dlugoczaj at 7:53 AM on March 2, 2021 [32 favorites]
Yeah, how much of this is going to end up becoming "Well, we screened you for anxiety, so that must be your problem"?
posted by Katemonkey at 7:56 AM on March 2, 2021 [8 favorites]
posted by Katemonkey at 7:56 AM on March 2, 2021 [8 favorites]
I agree that the screening should be offered to everyone. I am shocked that it is automatically being offered to anyone.
Well said. It's like a bunch of the ACA in general: it has flaws aplenty in implementation, further flaws in the good always seeming to collect permissions slips to be designated enemies of the perfect. A bit of progress wedged in against the many (actual) enemies of good who'd like to see even that small bit of progress reversed and made useless. The rhetorical judo to keep vigilance for is just how easily "it should be for everyone!" will be practically twisted by the powerful into "therefore it will be for no one again."
posted by Drastic at 8:02 AM on March 2, 2021 [4 favorites]
Well said. It's like a bunch of the ACA in general: it has flaws aplenty in implementation, further flaws in the good always seeming to collect permissions slips to be designated enemies of the perfect. A bit of progress wedged in against the many (actual) enemies of good who'd like to see even that small bit of progress reversed and made useless. The rhetorical judo to keep vigilance for is just how easily "it should be for everyone!" will be practically twisted by the powerful into "therefore it will be for no one again."
posted by Drastic at 8:02 AM on March 2, 2021 [4 favorites]
What about the men is important here, because the way the patriarchy intersects with mental health hurts everyone.
Men's mental health is consistently downplayed and opportunities for them to speak about and get help are minimized. Leading men to cope through anger (more socially acceptable/"masculine") or substance use or just silent suffering.
Women consistently have real physical issues attributed to mental health and thus real concerns are dismissed.
While more screening is great, limiting it to one gender really reinforces and perpetuates these harmful realities.
posted by EarnestDeer at 8:08 AM on March 2, 2021 [44 favorites]
Men's mental health is consistently downplayed and opportunities for them to speak about and get help are minimized. Leading men to cope through anger (more socially acceptable/"masculine") or substance use or just silent suffering.
Women consistently have real physical issues attributed to mental health and thus real concerns are dismissed.
While more screening is great, limiting it to one gender really reinforces and perpetuates these harmful realities.
posted by EarnestDeer at 8:08 AM on March 2, 2021 [44 favorites]
Offering these screenings only to women and girls strikes me as similar to the way we respond to sexual assault by teaching women how to protect themselves. It's not that women knowing how to protect themselves is bad or wrong. Making that the core of our efforts places the onus on women to fix a problem that isn't of their making, and also takes an individualistic approach to a systemic problem.
posted by zebra at 8:16 AM on March 2, 2021 [23 favorites]
posted by zebra at 8:16 AM on March 2, 2021 [23 favorites]
Yeah, I did not read this as a "what about the men."
If only half as many men have anxiety as women, that's still a lot of men. Yet we still think of mental health disorders like anxiety as a "woman's problem," which both makes it harder for men to get treatment and perpetuates the stereotype that women are uniquely emotionally unstable. I also cynically think that that the more a disorder is considered to be a woman's problem, the less seriously it will be treated.
It reminds me of the disastrous rollout of the Gardisil vaccine, a little bit - there was no reason to restrict it only to women, since men running around with HPV both do women harm and can end up with cancer themselves, even if at much lower rates. And people did not take the vaccine seriously - there was a lot puritan nonsense involve in that sure, but it was also because it was seen as a vaccine for a "female problem."
It's ridiculous that screenings are charged for at all, though.
posted by Kutsuwamushi at 8:18 AM on March 2, 2021 [22 favorites]
If only half as many men have anxiety as women, that's still a lot of men. Yet we still think of mental health disorders like anxiety as a "woman's problem," which both makes it harder for men to get treatment and perpetuates the stereotype that women are uniquely emotionally unstable. I also cynically think that that the more a disorder is considered to be a woman's problem, the less seriously it will be treated.
It reminds me of the disastrous rollout of the Gardisil vaccine, a little bit - there was no reason to restrict it only to women, since men running around with HPV both do women harm and can end up with cancer themselves, even if at much lower rates. And people did not take the vaccine seriously - there was a lot puritan nonsense involve in that sure, but it was also because it was seen as a vaccine for a "female problem."
It's ridiculous that screenings are charged for at all, though.
posted by Kutsuwamushi at 8:18 AM on March 2, 2021 [22 favorites]
Everyone should be screened for anxiety (and depression, and the other most common mental health conditions, and we should actually have a decent system in place wherein people can get treatment for those conditions) but aren't women actually more likely to be told that they have a mental health condition when they have an underlying physical health condition they are trying to be treated for? I get one physical a year if I even have health insurance and it's a fifty-fifty shot whether my doctor actually thinks I have a physical condition I should be on medication for, no wonder I'm anxious going into that appointment.
posted by matcha action at 8:42 AM on March 2, 2021 [4 favorites]
posted by matcha action at 8:42 AM on March 2, 2021 [4 favorites]
On the gender divide, when we say women have twice as much anxiety, how much of that is really about prevalence of mood disorders in men vs women, as opposed to pathologizing expressions of mood disorders more stereotypically found in women while normalizing toxic behaviors that men often adopt in response to psychological distress?
This seems a bit like one of those “patriarchy hurts everybody” things.
posted by gelfin at 9:09 AM on March 2, 2021 [13 favorites]
This seems a bit like one of those “patriarchy hurts everybody” things.
posted by gelfin at 9:09 AM on March 2, 2021 [13 favorites]
All this needs added is a screening for everyone at age 13 during a routine physical. But since this screening of girls could catch THE MAJORITY of the start of anxiety cases, I see no reason to knock it. That's how we attack medical problems - addressing the majority shareholders of the problems early.
posted by tiny frying pan at 9:42 AM on March 2, 2021
posted by tiny frying pan at 9:42 AM on March 2, 2021
You know, if a woman comes into a doctor's office and it turns out her whole problem is anxiety -- problem solved! So much more efficient than an MRI to find the source of her mysterious complaint.
posted by amtho at 9:43 AM on March 2, 2021 [6 favorites]
posted by amtho at 9:43 AM on March 2, 2021 [6 favorites]
Apart from the gender issues ... I don’t want to downplay a serious medical condition, or dismiss pharmaceutical solutions that work for many people, but (as a person with personal and family experience in this area - what I call “my unfortunate expertise”), I’m skeptical about the American medical establishment (including the APA) and their tendency to (a) promote profitable diagnoses, and (b) turn to drugs as a first resort. (See also Gail Hornstein’s Agnes’s Jacket and To Redeem One Person.)
posted by anshuman at 10:20 AM on March 2, 2021
posted by anshuman at 10:20 AM on March 2, 2021
You know, if a woman comes into a doctor's office and it turns out her whole problem is anxiety -- problem solved! So much more efficient than an MRI to find the source of her mysterious complaint.
Except when "you're too anxious" becomes the new "you're too fat" for doctors everywhere to skip the differential.
posted by Your Childhood Pet Rock at 10:42 AM on March 2, 2021 [6 favorites]
Except when "you're too anxious" becomes the new "you're too fat" for doctors everywhere to skip the differential.
posted by Your Childhood Pet Rock at 10:42 AM on March 2, 2021 [6 favorites]
Yeah...there are definitely potential downsides to this, though I appreciate that it'll now be free. It takes women with some autoimmune conditions (like a few that I have) more than a decade in many cases to even be diagnosed with them, with doctors so focused on easier answers like anxiety or obesity. I had a great primary care physician and OBGYN for a while as a young adult, but they both retired from their practices within the space of like 6 months around 2013. I found a new primary care physician in the same practice (and closer to my then-address) and she immediately diagnosed me with "metabolic syndrome" ("You have a BMI over a certain number but we don't want to bother figuring out why") and tried to put me on antidepressants for anxiety (I think she gave me a questionnaire on intake). I politely declined, as I've had to on many occasions over the years.
I switched doctors again. It took me until 2017 to get diagnosed with one autoimmune condition, until 2018 to be diagnosed with the next one (had to go to grand rounds for that one, just like my mom had for her autoimmune skin condition), and until 2020 to get diagnosed with a third one—and all three affect my physical appearance, especially my weight and skin, and the hormones that feed into my anxiety and OCD.
I also grew up in an area that has a cancer cluster and more women than average reporting certain autoimmune conditions, including some of the ones I have, due to exposure to radioactive waste in the soil and water. While some folks knew about that on some level decades before that, it didn't become a community health crisis until the kids who grew up in the area reached their thirties and forties and started to develop health problems. In 2013, they started to push for answers to why their friends were all dying. That's around when a lot of us in a slightly younger age cohort started to realize we were experiencing autoimmune issues.
I also didn't have the words as a kid to describe being genderqueer; it took me until 2016, really, to have the words for that and be able to say it out loud. I was starting to put words to it by around 2012, but yeah, I didn't talk about it much until after a lot of the reading I did surrounding the emotional labor discourse in 2015.
tl;dr, I don't always even mention anxiety when meeting new health-care providers, though I have a ton of anxiety about explaining myself to any new doctors, because it tends to become a fallback diagnosis for anything else that might be going on with my body, and I'm not sure being able to be diagnosed with anxiety earlier would have helped me with that. I'm sure it might help some, but really this should be available for everyone, not just women and girls.
posted by limeonaire at 11:00 AM on March 2, 2021 [10 favorites]
I switched doctors again. It took me until 2017 to get diagnosed with one autoimmune condition, until 2018 to be diagnosed with the next one (had to go to grand rounds for that one, just like my mom had for her autoimmune skin condition), and until 2020 to get diagnosed with a third one—and all three affect my physical appearance, especially my weight and skin, and the hormones that feed into my anxiety and OCD.
I also grew up in an area that has a cancer cluster and more women than average reporting certain autoimmune conditions, including some of the ones I have, due to exposure to radioactive waste in the soil and water. While some folks knew about that on some level decades before that, it didn't become a community health crisis until the kids who grew up in the area reached their thirties and forties and started to develop health problems. In 2013, they started to push for answers to why their friends were all dying. That's around when a lot of us in a slightly younger age cohort started to realize we were experiencing autoimmune issues.
I also didn't have the words as a kid to describe being genderqueer; it took me until 2016, really, to have the words for that and be able to say it out loud. I was starting to put words to it by around 2012, but yeah, I didn't talk about it much until after a lot of the reading I did surrounding the emotional labor discourse in 2015.
tl;dr, I don't always even mention anxiety when meeting new health-care providers, though I have a ton of anxiety about explaining myself to any new doctors, because it tends to become a fallback diagnosis for anything else that might be going on with my body, and I'm not sure being able to be diagnosed with anxiety earlier would have helped me with that. I'm sure it might help some, but really this should be available for everyone, not just women and girls.
posted by limeonaire at 11:00 AM on March 2, 2021 [10 favorites]
The great wolf that is the drug companies, is drooling in the corner, filing it's teeth, and so on...
posted by Oyéah at 12:01 PM on March 2, 2021 [3 favorites]
posted by Oyéah at 12:01 PM on March 2, 2021 [3 favorites]
I wonder how they are planning to treat the flood of newly diagnosed people. I suspect that suggestions for cutting back on the second-shift responsibilities that typically fall to women (let's repeat that one a few times) and getting oneself free of abusive work / partner / family situations won't be the go-to treatment options. Nothing like trying to solve a largely sociocultural issue with ... Western medicine.
I do believe there are bona fide mental health disorders that can be managed successfully with medication. But the pandemic of anxiety and depression among US women and girls has its roots in misogyny and heteropatriarchy to a large extent. (I'm not denying that there's a pandemic of these conditions regardless of gender.)
Also: "can be screened" has a high probability of turning into "be screened or else" in practice. And like some others have said, a mental health diagnosis, especially in women, can be a real obstacle to getting treatment for other health problems.
And another thing: as much as US doctors deny needed pain medication to BIPOC, they do exactly the opposite with white women. And anxiety medication adds to the mortality risk.
Thanks but I'll pass on that screening, and I hope I can continue to be able to do so.
posted by Sheydem-tants at 2:24 PM on March 2, 2021 [10 favorites]
I do believe there are bona fide mental health disorders that can be managed successfully with medication. But the pandemic of anxiety and depression among US women and girls has its roots in misogyny and heteropatriarchy to a large extent. (I'm not denying that there's a pandemic of these conditions regardless of gender.)
Also: "can be screened" has a high probability of turning into "be screened or else" in practice. And like some others have said, a mental health diagnosis, especially in women, can be a real obstacle to getting treatment for other health problems.
And another thing: as much as US doctors deny needed pain medication to BIPOC, they do exactly the opposite with white women. And anxiety medication adds to the mortality risk.
Thanks but I'll pass on that screening, and I hope I can continue to be able to do so.
posted by Sheydem-tants at 2:24 PM on March 2, 2021 [10 favorites]
I'm a woman with an anxiety disorder. I would 100% like to see any such screenings be available across the board, regardless of gender, and for there to be a plan in place for accessible follow-up care, since navigating getting into therapy or onto medication is incredibly difficult, even for adults with experience in the process. I'd also like to know how doctors plan to ensure that the screenings themselves aren't stigmatizing.
People have already touched on a whole lot of important stuff with regard to gender, so I'll just add that tying these screenings to ob-gyn visits seems like an especially bad idea. 13-year-olds typically do not have anything by way of an established relationship with their ob-gyn and are not in a position to assert themselves. Some teens may feel comfortable, but I'd wager that at a significant number of them will be mortified or otherwise not in a place where they're comfortable talking freely about their emotions.
And that's not to mention that obstetrics and gynecology have a pretty bad history of gaslighting patients and writing physical pain and conditions off as "stress" or "anxiety." Or that ob-gyn doctors might not be well placed to deliver the survey because adolescent psychology sits entirely outside of their field of expertise.
I could be alone in this, but I experience gynecological visits as a sort of complicated social dance in which I need to strategically assert my needs in a way that will be taken seriously and not dismissed as crankiness or nerves, all while I'm sitting half naked freezing my ass off in a paper gown. So it's not exactly a place where I, as a grown woman who has been going to gynecologists for two-thirds of my life, want to get into my feelings, and I could see in ways in which my doing so might actually detract from the medical care I receive.
posted by evidenceofabsence at 2:34 PM on March 2, 2021 [18 favorites]
People have already touched on a whole lot of important stuff with regard to gender, so I'll just add that tying these screenings to ob-gyn visits seems like an especially bad idea. 13-year-olds typically do not have anything by way of an established relationship with their ob-gyn and are not in a position to assert themselves. Some teens may feel comfortable, but I'd wager that at a significant number of them will be mortified or otherwise not in a place where they're comfortable talking freely about their emotions.
And that's not to mention that obstetrics and gynecology have a pretty bad history of gaslighting patients and writing physical pain and conditions off as "stress" or "anxiety." Or that ob-gyn doctors might not be well placed to deliver the survey because adolescent psychology sits entirely outside of their field of expertise.
I could be alone in this, but I experience gynecological visits as a sort of complicated social dance in which I need to strategically assert my needs in a way that will be taken seriously and not dismissed as crankiness or nerves, all while I'm sitting half naked freezing my ass off in a paper gown. So it's not exactly a place where I, as a grown woman who has been going to gynecologists for two-thirds of my life, want to get into my feelings, and I could see in ways in which my doing so might actually detract from the medical care I receive.
posted by evidenceofabsence at 2:34 PM on March 2, 2021 [18 favorites]
A recent ask here blew my mind. (I won't link out of respect to the asker.) But basically, I learned that low iron is linked to anxiety. As a monthly bleeder, suddenly lots of things make sense.
I wonder how much of the "extra" anxiety in women, girls, and other period havers is related to this.
As an aside, evidenceofabsence, this: "sitting half naked freezing my ass off in a paper gown." Is one of the weirder cultural things to do with American health care- I can think of a couple of times I've had to disrobe and gown, usually for imaging, but the majority of my medical care I've been clothed. I gave birth wearing my own clothes! So weird to think about sitting around in a gown chatting to the doctor.
posted by freethefeet at 2:46 PM on March 2, 2021 [2 favorites]
I wonder how much of the "extra" anxiety in women, girls, and other period havers is related to this.
As an aside, evidenceofabsence, this: "sitting half naked freezing my ass off in a paper gown." Is one of the weirder cultural things to do with American health care- I can think of a couple of times I've had to disrobe and gown, usually for imaging, but the majority of my medical care I've been clothed. I gave birth wearing my own clothes! So weird to think about sitting around in a gown chatting to the doctor.
posted by freethefeet at 2:46 PM on March 2, 2021 [2 favorites]
one of the weirder cultural things to do with American health care
Whaaaat. I had no idea it's a particularly American thing. Thanks for mentioning that!
posted by evidenceofabsence at 2:52 PM on March 2, 2021
Whaaaat. I had no idea it's a particularly American thing. Thanks for mentioning that!
posted by evidenceofabsence at 2:52 PM on March 2, 2021
Utah just made sure no one can talk about "Consent" in health classes. There is a broad, huge, underage group of girls who will never know that "Consent," is a right.
posted by Oyéah at 3:19 PM on March 2, 2021 [1 favorite]
posted by Oyéah at 3:19 PM on March 2, 2021 [1 favorite]
“Gals”?
posted by kdilla at 4:11 PM on March 2, 2021 [5 favorites]
posted by kdilla at 4:11 PM on March 2, 2021 [5 favorites]
A recent ask here blew my mind. (I won't link out of respect to the asker.) But basically, I learned that low iron is linked to anxiety. As a monthly bleeder, suddenly lots of things make sense.
I wonder how much of the "extra" anxiety in women, girls, and other period havers is related to this.
That was me! No worries, I don't mind. I was first diagnosed with (drastically) low iron in 2006 and had undoubtedly been suffering with it for at least a decade before that, but it was many years after diagnosis that I started getting intravenous iron infusions and noticed that they miraculously lifted my anxiety. If you have anxiety, get your iron checked. And if you have low iron, insist on effective treatment. If your ferritin is really low, oral supplementation alone is not going to bring it back up. Advocate for yourself. Get a referral to a hematologist. Ask about IV iron. Don't be like me. Don't fuck around.
posted by HotToddy at 6:02 PM on March 2, 2021 [11 favorites]
I wonder how much of the "extra" anxiety in women, girls, and other period havers is related to this.
That was me! No worries, I don't mind. I was first diagnosed with (drastically) low iron in 2006 and had undoubtedly been suffering with it for at least a decade before that, but it was many years after diagnosis that I started getting intravenous iron infusions and noticed that they miraculously lifted my anxiety. If you have anxiety, get your iron checked. And if you have low iron, insist on effective treatment. If your ferritin is really low, oral supplementation alone is not going to bring it back up. Advocate for yourself. Get a referral to a hematologist. Ask about IV iron. Don't be like me. Don't fuck around.
posted by HotToddy at 6:02 PM on March 2, 2021 [11 favorites]
Gals?
If gal is a slur, please let me know. I never knowingly use a slur; if that’s a slur, I will stop using it. But if you simply don’t happen to like my editorial choices, I invite you to craft your own headline however you choose on a different post.
This is what I have: an anxiety disorder, ADHD, chronic illness. This is what I do not have: the patience to deal with nitpicking. If I have fucked up, please tell me. If you just don’t like my choice of words, consider rolling with it anyway.
posted by Bella Donna at 5:07 AM on March 3, 2021 [21 favorites]
If gal is a slur, please let me know. I never knowingly use a slur; if that’s a slur, I will stop using it. But if you simply don’t happen to like my editorial choices, I invite you to craft your own headline however you choose on a different post.
This is what I have: an anxiety disorder, ADHD, chronic illness. This is what I do not have: the patience to deal with nitpicking. If I have fucked up, please tell me. If you just don’t like my choice of words, consider rolling with it anyway.
posted by Bella Donna at 5:07 AM on March 3, 2021 [21 favorites]
Apologies for being cranky above. If gal is racist, that is obviously not a nitpick and please please please tell me. I'm used to hearing the term in old movies featuring snappy patter and white people. If I didn't get the memo as a white person, please clue me in. Thanks.
posted by Bella Donna at 8:08 AM on March 3, 2021
posted by Bella Donna at 8:08 AM on March 3, 2021
There's nothing wrong with "gals". We need "gals" because currently there is no widely used female equivalent of "guys".
posted by LindsayIrene at 8:25 AM on March 3, 2021 [5 favorites]
posted by LindsayIrene at 8:25 AM on March 3, 2021 [5 favorites]
I do think that screening for common mental health disorders through a primary care physicians is a good thing, but I really really question implementing this only for women and girls.
Its convoluted. Anxiety disorders are more diagnosed to women, and there's definately some male doctors dismissing women's concerns by diagnosing them with anxiety going on, there's some very legitimate reactions to how prevalent violence against women is which isn't necessarily disordered, there's a bunch of socialization factors and gendered expectations about how men present with anxiety disorders. And the differences on a population level about how men/women seek out mental health care or just don't. I really dislike the medical anxiety description that people with anxiety disorders seek out care in emergency rooms, which it does happen, but anxiety is a huge spectrum and presents in thousands of different ways.
It seems like presenting this to just one half of the population (thereabouts) is a mistake that will continue to perpetuate beliefs and stereotypes about anxiety.
posted by AlexiaSky
...
First comment we derail into 'What about the men?' Good job, everyone.
posted by fluttering hellfire
Starting a derail by reducing the thoughtful comment by AlexiaSky to "What about the men?" and labelling their comment a derail so that you get a chance to dunk on...everyone (?) is a really shitty way to interact with the conversation here. Good job, fluttering hellfire.
posted by lazaruslong at 9:39 AM on March 3, 2021 [10 favorites]
Its convoluted. Anxiety disorders are more diagnosed to women, and there's definately some male doctors dismissing women's concerns by diagnosing them with anxiety going on, there's some very legitimate reactions to how prevalent violence against women is which isn't necessarily disordered, there's a bunch of socialization factors and gendered expectations about how men present with anxiety disorders. And the differences on a population level about how men/women seek out mental health care or just don't. I really dislike the medical anxiety description that people with anxiety disorders seek out care in emergency rooms, which it does happen, but anxiety is a huge spectrum and presents in thousands of different ways.
It seems like presenting this to just one half of the population (thereabouts) is a mistake that will continue to perpetuate beliefs and stereotypes about anxiety.
posted by AlexiaSky
...
First comment we derail into 'What about the men?' Good job, everyone.
posted by fluttering hellfire
Starting a derail by reducing the thoughtful comment by AlexiaSky to "What about the men?" and labelling their comment a derail so that you get a chance to dunk on...everyone (?) is a really shitty way to interact with the conversation here. Good job, fluttering hellfire.
posted by lazaruslong at 9:39 AM on March 3, 2021 [10 favorites]
I don’t think this has been covered (sorry if I missed it) but a strangeness that has arisen in the US due to the ACA is the free annual checkup that insurance is now required to provide for all patients. It used to be that one would usually pay the same copay for a checkup that is required for a simple office visit, but also I think there was a lot of variation. So now it’s all standardIzed and there can be no charge for a checkup. However, if any billing code used indicates that any sort of diagnosis happens during this visit, the visit no longer has to be free of charge to the patient. (So I for one now get a little flyer from my doctor that basically warns me not to look for a diagnosis during this visit or else I may have a copay.)
So my understanding here is that now the screening can be done during this visit and the billing code for it cannot trigger the diagnostic switch and thus cannot trigger a copay. Note that it’s only the ‘screening’ that’s now covered and not the diagnosis. It’s unclear to me what happens if you meet the screening criteria for anxiety...what happens next?
posted by Tandem Affinity at 9:43 AM on March 3, 2021 [3 favorites]
So my understanding here is that now the screening can be done during this visit and the billing code for it cannot trigger the diagnostic switch and thus cannot trigger a copay. Note that it’s only the ‘screening’ that’s now covered and not the diagnosis. It’s unclear to me what happens if you meet the screening criteria for anxiety...what happens next?
posted by Tandem Affinity at 9:43 AM on March 3, 2021 [3 favorites]
Re women being more prone to anxiety, in addition to all the good thoughts above: maybe this is related to having to be constantly vigilant in public lest we be attacked (and blamed for it). I began to have (what I now recognize as) anxiety symptoms when I was 11 and was getting hassled on metro transit by grown men.
posted by joannemerriam at 12:48 PM on March 3, 2021 [4 favorites]
posted by joannemerriam at 12:48 PM on March 3, 2021 [4 favorites]
Tandem Affinity to answer your question about what happens next,
After screening, there's a clinical indication for more testing and/or an interview to determine the level of anxiety or what kind of anxiety disorder might be present (if any!). Sometimes people have anxiety for generic reasons that aren't disordered (brief hypothetical scenario say one is doing a follow up for abnormal test results and reports to their doctor that they've been anxiously waiting), or there's no impact on their daily life. In the US, basically it means you get a referral somewhere else. In places like FQHCs or places that follow an integrated healthcare model, there might be someone at the clinic to speak to. In general, these should be done by a psychiatrist or someone licensed in behavioral health (depending on your state/country/region these people vary in titles with either master's degrees with associated licensures or doctorate degrees and may be called therapists, counselors, or psychologists. A regular physician is also able to diagnose, but they usually don't have the specialized training or know of the available instruments to do so (or quite frankly, the time). Differentiating between different disorders isn't simple. There are actually five different major anxiety disorders: Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD)Panic Disorder, Post-Traumatic Stress Disorder (PTSD) and Social Phobia (Social Anxiety Disorder). This is the DSM version, Europe uses the ICD and sometimes things don't align precisely the way you would expect. I think they are pretty similar in terms of anxiety disorders.
There are long administered questionnaire tests that can give some statistical likelihood of certain types of mental health disorders which can be done by psychologists in the US.
posted by AlexiaSky at 11:10 PM on March 3, 2021 [5 favorites]
After screening, there's a clinical indication for more testing and/or an interview to determine the level of anxiety or what kind of anxiety disorder might be present (if any!). Sometimes people have anxiety for generic reasons that aren't disordered (brief hypothetical scenario say one is doing a follow up for abnormal test results and reports to their doctor that they've been anxiously waiting), or there's no impact on their daily life. In the US, basically it means you get a referral somewhere else. In places like FQHCs or places that follow an integrated healthcare model, there might be someone at the clinic to speak to. In general, these should be done by a psychiatrist or someone licensed in behavioral health (depending on your state/country/region these people vary in titles with either master's degrees with associated licensures or doctorate degrees and may be called therapists, counselors, or psychologists. A regular physician is also able to diagnose, but they usually don't have the specialized training or know of the available instruments to do so (or quite frankly, the time). Differentiating between different disorders isn't simple. There are actually five different major anxiety disorders: Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD)Panic Disorder, Post-Traumatic Stress Disorder (PTSD) and Social Phobia (Social Anxiety Disorder). This is the DSM version, Europe uses the ICD and sometimes things don't align precisely the way you would expect. I think they are pretty similar in terms of anxiety disorders.
There are long administered questionnaire tests that can give some statistical likelihood of certain types of mental health disorders which can be done by psychologists in the US.
posted by AlexiaSky at 11:10 PM on March 3, 2021 [5 favorites]
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This thread has been archived and is closed to new comments
Its convoluted. Anxiety disorders are more diagnosed to women, and there's definately some male doctors dismissing women's concerns by diagnosing them with anxiety going on, there's some very legitimate reactions to how prevalent violence against women is which isn't necessarily disordered, there's a bunch of socialization factors and gendered expectations about how men present with anxiety disorders. And the differences on a population level about how men/women seek out mental health care or just don't. I really dislike the medical anxiety description that people with anxiety disorders seek out care in emergency rooms, which it does happen, but anxiety is a huge spectrum and presents in thousands of different ways.
It seems like presenting this to just one half of the population (thereabouts) is a mistake that will continue to perpetuate beliefs and stereotypes about anxiety.
posted by AlexiaSky at 2:01 AM on March 2, 2021 [104 favorites]