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
Epub ISBN: 978-0-309-72460-9

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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

Consultants

MELISSA MAITIN-SHEPARD, MMS Health Strategies, LLC

MARIAN FLAXMAN, Informed Solutions, LLC

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 making 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 comments 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.

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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 workshop complete with informative presentations and rich discussions.

The forum wishes to thank all the speakers who shared personal anecdotes 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 expertise 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.

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Contents

ACRONYMS AND ABBREVIATIONS

PROCEEDINGS OF A WORKSHOP

INTRODUCTION

OVERVIEW OF WOMEN’S MENTAL HEALTH IN THE UNITED STATES

THE PERINATAL PERIOD

PMADs: Understanding Risk and Moving Toward Solutions

Prevention, Treatment, and Impact of PMADs

Elevating Reproductive Health Equity

Discussion

CHILDHOOD AND ADOLESCENCE

POSTADOLESCENCE

The Developmental Period of Postadolescence is Often a Dynamic Time: The Menstrual Cycle and Mental Health

Associations Between Hormonal Contraceptive Use and Depression

Intersectionality of Social and Environmental Stressors and Mental Health

Discussion

MIDLIFE AND MENOPAUSE

Menopause and Mental Health

SWAN

Depression in the Menopause Transition

Discussion

HEALTHY APPROACHES TO MENTAL HEALTH AND AGING

Loneliness and Isolation in Women

The Dark Triad: Depression, Anxiety, and Dementia

Prolonged Grief Disorder (PGD): A Mental Health Disorder Distinct from Depression

Holistic Approaches for Women’s Mental Health

Discussion

EXPLORING POLICY OPTIONS

Discussion

SPECIAL POPULATIONS

The LGBTQ+ Community

Women and Girls with Disabilities

Indigenous Women’s Mental Health

Discussion

IMPROVING CARE PROVISION

Implementing Screening Guidelines for Anxiety, Depression, and IPV

Improving Access to Mental Health and SUD Treatment and Support Services

Improving the Provision of Care: Beyond Screening

Discussion

CLOSING REMARKS

REFERENCES

APPENDIXES

Appendix A: Statement of Task

Appendix B: Workshop Agenda

Appendix C: Readings and Resources

Figures

FIGURES

1 Levels of trauma experience

2 Overview of potential emotional and behavioral changes by phase of the menstrual cycle

3 Overlapping mechanisms contributing to high rates of female depression

4 Vasomotor symptoms (VMS) by race/ethnicity during various stages of perimenopause

5 The intersection of loneliness, isolation, and disconnection

6 Equity maps snapshot: LGBTQ equality by state data as of April 30, 2024

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Acronyms and Abbreviations