Essential Health Care Services Related to Anxiety and Mood Disorders in Women: Proceedings of a Workshop (2024)

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Essential Health Care Services Related to Anxiety and Mood Disorders in Women Alexandra Andrada, Melissa Maitin-Shepard, Marian Flaxman, and Sharyl J. Nass, Rapporteurs Forum on Mental Health and Substance Use Disorders Board on Health Care Services Health and Medicine Division Proceedings of a Workshop 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Health Resources and Services Administration (contract no. 75R60221D00002, purchase order no. 75FCMC22P0038). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978–0-309-72457-9 International Standard Book Number-10: 0–309-72457-0 Digital Object Identifier: https://doi.org/10.17226/27912 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Essential health care services related to anxiety and mood disorders in women: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27912. 

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WORKSHOP PLANNING COMMITTEE COLLEEN GALAMBOS (Co-chair), Helen Bader Endowed Chair in Applied Gerontology and Professor, Helen Bader School of Social Welfare, University of Wisconsin—Milwaukee VIVIAN W. PINN (Co-chair), Former Director, Office of Research on Women’s Health, National Institutes of Health (Retired); Former Senior Scientist Emerita, Fogarty International Center, National Institutes of Health JAMILLE FIELDS ALLSBROOK, Assistant Professor, School of Law, Center for Health Law Studies, Saint Louis University JOY BURKHARD, Founder and Executive Director, Policy Center for Maternal Mental Health JILL M. EMANUELE, Vice President, Clinical Training, Child Mind Institute; Board Member and Secretary, Anxiety and Depression Association of America TAMARA LEWIS JOHNSON, Program Director, Women’s Mental Health Research Program, Office of Disparities Research and Workforce Diversity JENNIFER LEONARDO, Director, Children’s Safety Network, Education Development Center HEIDI NELSON, Professor, Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine J. NWANDO OLAYIWOLA, Chief Health Equity Officer and Senior Vice President, Humana, Inc. GEORGE M. SLAVICH, Professor of Psychiatry and Biobehavioral Sciences; Director, Laboratory for Stress Assessment and Research; Investigator, Staglin One Mind Center for Cognitive Neuroscience; Research Scientist, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles Staff ALEXANDRA ANDRADA, Forum Director/Program Officer VIOLET BISHOP, Research Assistant ANESIA WILKS, Senior Program Assistant SHARYL J. NASS, Senior Director, Board on Health Care Services v 

Consultants MELISSA MAITIN-SHEPARD, MMS Health Strategies, LLC MARIAN FLAXMAN, Informed Solutions, LLC vi 

Reviewers This Proceedings of Essential Health Care Services Related to Anxiety and Mood Disorders in Women was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in mak- ing each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: KRYSTAL M. LEWIS, National Institute of Mental Health MARY-FRANCES O’CONNER, University of Arizona Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRUCE CALONGE, University of ­Colorado School of Medicine. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. vii 



Acknowledgments The National Academies of Sciences, Engineering, and Medicine are grateful for the support of the Health Resources Services Administration, which sponsored this workshop. The Forum on Mental Health and Substance Use Disorders wish to thank the planning committee cochairs Vivian W. Pinn and Colleen Galambos for their valuable contributions to the field of women’s health and the development and organization of this workshop, in addition to the members of the planning committee, who collaborated to ensure a work- shop complete with informative presentations and rich discussions. The forum wishes to thank all the speakers who shared personal a­ necdotes and a lived experience perspective during the event: Schroeder Stribling, Ebony Carter, Tory Eisenlohr-Moul, Carla Perissinotto, Joy Burkhard, Alex Sheldon, Kimberly Aguillard, and Nicolle L. Arthun. Finally, the forum wants to thank all the speakers and moderators, who generously shared their exper- tise and their time with workshop attendees. Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, National Association of Addiction Treatment ­Providers, National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), Office of the Assistant Secretary for Planning and Evaluation, and Substance Abuse and Mental Health Services Administration. ix 



Contents ACRONYMS AND ABBREVIATIONS xv PROCEEDINGS OF A WORKSHOP 1 INTRODUCTION 1 OVERVIEW OF WOMEN’S MENTAL HEALTH IN THE UNITED STATES 2 THE PERINATAL PERIOD 4 PMADs: Understanding Risk and Moving Toward Solutions, 4 Prevention, Treatment, and Impact of PMADs, 7 Elevating Reproductive Health Equity, 10 Discussion, 13 CHILDHOOD AND ADOLESCENCE 15 POSTADOLESCENCE 19 The Developmental Period of Postadolescence is Often a Dynamic Time: The Menstrual Cycle and Mental Health, 19 Associations Between Hormonal Contraceptive Use and Depression, 23 Intersectionality of Social and Environmental Stressors and Mental Health, 25 Discussion, 27 MIDLIFE AND MENOPAUSE 28 Menopause and Mental Health, 29 SWAN, 31 xi 

xii CONTENTS Depression in the Menopause Transition, 33 Discussion, 34 HEALTHY APPROACHES TO MENTAL HEALTH AND AGING 35 Loneliness and Isolation in Women, 35 The Dark Triad: Depression, Anxiety, and Dementia, 38 Prolonged Grief Disorder (PGD): A Mental Health Disorder Distinct from Depression, 40 Holistic Approaches for Women’s Mental Health, 42 Discussion, 45 EXPLORING POLICY OPTIONS 46 Discussion, 50 SPECIAL POPULATIONS 51 The LGBTQ+ Community, 51 Women and Girls with Disabilities, 54 Indigenous Women’s Mental Health, 56 Discussion, 57 IMPROVING CARE PROVISION 58 Implementing Screening Guidelines for Anxiety, Depression, and IPV, 58 Improving Access to Mental Health and SUD Treatment and Support Services, 60 Improving the Provision of Care: Beyond Screening, 61 Discussion, 62 CLOSING REMARKS 63 REFERENCES 64 APPENDIXES Appendix A: Statement of Task 79 Appendix B: Workshop Agenda 81 Appendix C: Readings and Resources 89 

Figures FIGURES 1 Levels of trauma experience, 8 2 Overview of potential emotional and behavioral changes by phase of the menstrual cycle, 20 3 Overlapping mechanisms contributing to high rates of female ­depression, 24 4 Vasomotor symptoms (VMS) by race/ethnicity during various stages of ­perimenopause, 32 5 The intersection of loneliness, isolation, and disconnection, 36 6 Equity maps snapshot: LGBTQ equality by state data as of April 30, 2024, 53 xiii 



Acronyms and Abbreviations ACE adverse childhood experience ADHD attention deficit hyperactivity disorder AI/AN American Indian and Alaska Native CBT cognitive behavioral therapy CDC Centers for Disease Control and Prevention CMS Centers for Medicare and Medicaid Services CVD cardiovascular disease DBT dialectical behavioral therapy DSM-5 Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition EHR electronic health record FDA U.S. Food and Drug Administration HC hormonal contraceptive HRSA Health Resources and Services Administration IHS Indian Health Service IPT interpersonal therapy IPV intimate partner violence xv 

xvi ACRONYMS AND ABBREVIATIONS LGBTQ+ lesbian, gay, bisexual, transgender, queer, intersex, or asexual MA meta-analysis MDD major depressive disorder MHA Mental Health America MIND Mediterranean Intervention for Neurodegenerative Delay diet NA nucleus accumbens NIH National Institutes of Health NIMH National Institute of Mental Health PGD prolonged grief disorder PMAD perinatal mood and anxiety disorder PMDD premenstrual depressive disorder PME premenstrual exacerbation PMS premenstrual syndrome PSWQ Penn State Worry Questionnaire PTSD posttraumatic stress disorder RCT randomized controlled trial SAMHSA Substance Abuse and Mental Health Services Administration SDOH social determinants of health SNRI serotonin norepinephrine reuptake inhibitor SSRI selective serotonin reuptake inhibitor SUD substance use disorder SWAN Study of Women’s Health Across the Nation UCLA University of California, Los Angeles UCSF University of California, San Francisco UPSM University of Pittsburgh School of Medicine VMS vasomotor symptoms