May is Women’s Health Month and Mental Health Awareness Month, and many providers are renewing their efforts to meet the comprehensive physical and behavioral needs of women throughout their lives. This gender-focused attention is warranted because science tells us that women have unique factors related to their physiology and their lifestyles that should be considered when creating care plans.
Primary care providers (PCPs) play an especially critical role in ensuring women get connected to integrated health services. Conditions such as depression, anxiety, and eating disorders have a negative effect on a woman’s overall health status as well as on comorbid chronic conditions like diabetes and heart disease, leading to higher costs and worse outcomes.
As more PCPs adopt value-based care models, they are taking advantage of the increased flexibility to deliver care with new modalities such as tele-behavioral health and to expand services to address the needs of women. Integrating physical and behavioral services becomes easier under value-based contracts because the interventions are driven by best outcomes rather than by billing conventions.
More women receive behavioral health services
According to SAMHSA, men and women experience behavioral health conditions at a nearly equal rate. However, in its most recent national health barometer, the agency noted that 5.1 percent of women demonstrated thoughts of suicide within the past year compared to 4.5 percent of men. Women also had higher rates of serious mental illness at 6.5 percent, compared to men at 3.9 percent.
And compared to men, more women access behavioral health services. Among those with serious mental illness, 56.5 percent of men and 70.5 percent of women received care. The data provides a strong motivator for PCPs to advance their integration efforts and ensure women who want and need behavioral health services can rely on the PCP’s own care teams or a coordinated effort among physicians, psychiatrists, psychologists, social workers, and other specialty providers.
Ideally, all women who experience a mental health or substance use disorder would seek treatment early, but often a medical professional will identify a woman’s risk factors and potential need for treatment. For PCPs placing greater focus female patients’ wellbeing, some recent trends provide clues that might prompt additional behavioral health screenings.
3 Trends in Behavioral Health for Women
From the unique role of being a mother to a woman’s hectic lifestyle, PCPs must factor in a wide range of situations that might serve as a reason to ask a patient how she’s feeling mentally and emotionally. These important conversations can open the door to addressing care gaps and improving outcomes in whole-person health.
1. Women fare worse in today’s pandemic era
COVID-19 remains a major health concern, but its reach stretches beyond physical health to include social, societal, and economic effects. According to research, the pandemic has disrupted the lives of women more than men.
For example, the unemployment rate for women increased more than it did for men in 2020, and about 2.3 million women left the workforce between February 2020 to March 2021. Observers believe women are opting to stay home and care for children instead of looking for work. That loss of income can easily translate to increased stress.
The American Psychiatric Association notes that poverty is a risk factor for mental health disorders, and women disproportionately experience poverty — a situation made worse now by the economic upheaval of the pandemic. According to U.S. Census Bureau data, the poverty rate for women in 2018 was 12.9 percent, compared to 10.6 percent for men.
In addition, women also face more barriers to care, not the least of which is time and money. To access care, women might need supports that are beyond the usual scope of medical services, such as transportation or child care.
PCPs should be mindful of the connection between financial stressors for women and their behavioral health. It’s all too easy to assume a married woman is fine staying home with the kids while her husband works, or that a woman without children has few financial concerns. During Women’s Health Month, providers should challenge their assumptions and reconsider what women need.
2. Postpartum depression can be difficult to recognize
The United States has the highest maternal mortality rate among developed nations, which speaks to the critical need to address women’s health during pregnancy, childbirth, and in the first few months after. Health interventions should also include screening for postpartum depression.
As many as 1 in 7 women experience postpartum depression. It can begin days or weeks after the baby is born and can affect a mother’s ability to care for her child if left untreated. However, women don’t always speak up about their feelings, and as many as 1 in 8 moms with postpartum depression say their healthcare provider didn’t ask them about it.
The Centers for Disease Control and Prevention recommends that providers screen moms with new babies for depression. However, the condition can last for years. About 5 percent of women still experience symptoms three years later.
While motherhood can be exhausting and stressful, it’s always a good idea to ask women how they’re feeling. PCPs caring for new moms can collaborate with OB/GYN and behavioral health specialists when they notice risk factors or when a screening indicates depression symptoms — even months or years after the baby is born.
3. Potential to experience medication side effects
Hormonal contraceptives are thought to be associated with higher rates of depression, anxiety, fatigue, and other symptoms, however, more scientific study is needed to determine whether there is a clear association. In one Danish study of more than 1 million women, researchers found women age 15 to 34 who used hormonal birth control were at somewhat higher risk of developing depression.
A wide variety of other medications can potentially cause depression too. Everything from commonly prescribed statin drugs to antibiotics and corticosteroids. The symptoms of drug-induced depression are the same as for any kind of depression, so the screening tools a PCP might use remain the same.
Optimize whole-person care for women
Comprehensive, proactive care is the goal for all PCPs. Taking women’s health needs into consideration, many will find the gender-specific focus aligns with collaborative care models supported by value-based payment structures.
And technology-enabled tools for screening, treatment progress tracking, and population health analytics will help PCPs be more efficient and effective in their care. Measurement-based care and tele-behavioral health can be key facilitators of collaborative processes among extended care teams as well as community services that can help women overcome barriers to care.
As Women’s Health Month presents the opportunity to engage in important discussions among healthcare stakeholders, PCPs can also involve their own patients in the process. By asking women questions about how they feel mentally and emotionally, they will invite more trust into the patient-provider dynamic.