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.”
Sayres Van Niel, who served on the steering committee of the U.S. Department of Health and Human Services’ Women’s Preventive Services Initiative in 2019 when the screenings were proposed, says it’s a big step.
“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.
The screening can now be included in well-woman checkups, so it is covered by insurance without additional cost to the patient. Depression screenings are already part of the recommendation for the general adult population.
An anxiety screening “means more equitable care for women who are living with anxiety today. This is especially important at a time when anxiety is high as a result of the ongoing coronavirus pandemic — and, as data show, disproportionately impacting women,” said Kimberly D. Gregory, an OB/GYN who is chair of the WPSI advisory panel, said in June.
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, followed by treatment.
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.
Anxiety disorders refer to excessive, uncontrollable worry that interferes with daily life, Sayres Van Niel said.
“Some people have anxiety that causes them chest pains and end up in the emergency room constantly. Some people feel heart racing and sweating and an uncomfortable feeling,” Sayres Van Niel said. “Just finding anxiety on one of these screenings does not mean that you absolutely have an anxiety disorder.”
But it’s an important move, she said.
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.”
Though the policy was proposed in 2019, its implementation is timely as we enter the second year of a pandemic that has upended life.
“Because of covid, it’s so much more important now to be screening for anxiety disorders because both in adolescents and in adult women, the rates of anxiety have increased significantly,” said Sayres Van Niel.
Mental-health-related visits to emergency rooms for children ages 12 to 17 jumped approximately 31 percent from April to October 2020 compared to the same period in 2019, according to the Centers for Disease Control and Prevention.
The screenings themselves are not a cure-all. Some doctors worry that this further stresses a health-care ecosystem already lacking sufficient mental health resources.
“We recognize that there are not enough mental health professionals and the distribution of those certainly is not optimal. So many primary care providers are starting to do more work around mental and behavioral health,” said Michael Warren, a pediatrician and an associate administrator at the Health Resources and Services Administration.
With these routine screenings, medical experts hope to increase early detection of anxiety disorders, which include diagnoses such as generalized anxiety disorder, panic disorder, and social or school anxiety disorder — and start treatment earlier.
“Having a clinician acknowledge your anxiety and give you permission and a recommendation to seek help or treatment could help a lot of people,” Gregory said.
Lori Kerfren says such a screening would have made a difference for her. She was diagnosed with a panic disorder 21 years ago, only after landing in the emergency room from panic attacks.
“I had spent many trips to the ER thinking I was dying,” Kerfren said. In hindsight, the 42-year-old mother of two thinks she always had anxiety, but it was never discussed, despite documented weight loss from disordered eating.
Kerfren, who has a 9-year-old daughter, said receiving an earlier diagnosis could be a game-changer for many like her.
“I’m super excited to hear that others will be diagnosed and treated sooner and it will continue to remove shame for people. There should be none,” she said.
Warren recommends that parents and patients raise concerns with their doctors, no matter how large or small they are.
“If something just doesn’t feel right or you’ve got a question, ask and don’t feel bad about that.”