Should Routine Anxiety Screenings Be a Thing?
The Women’s Preventive Services Initiative is recommending that all women over 13 years old get screened for anxiety, due to its prevalence and far-reaching impacts on quality of life.
There are so many reasons to feel anxious these days. We’re living in what many are calling a “dual pandemic,” with the two overwhelming crises of COVID-19 and systemic racism at the forefront of cultural conversation. It’s normal to feel worried about what the future will look like. It’s normal to wonder when your life will go back to old routines, or if it even should. If those worries are beginning to take over your life, it can feel debilitating, and—in case you’re wondering—it’s completely okay to ask for help.
In fact, the next time you speak with a doctor, you may want to ask about getting an anxiety screening. In a new report, the Women’s Preventive Services Initiative (a government-supported coalition of women’s health organizations) is recommending that every woman over the age of 13 be screened for anxiety disorders, in an effort to improve early detection and help women get treatment ASAP.
“Routine screening means we don’t have to wait for girls and women to recognize their own anxiety and report it,” says Jeanne Conry, M.D., former president of the American College of Obstetricians and Gynecologists and a principal author of the report. She notes that girls and women don’t often mention their mental health struggles to their doctor unless prompted to do so. “I also find that screening validates for women that their symptoms are of concern, and they are not alone,” Dr. Conry says. “By integrating anxiety screening into our practices, we have the potential to help our patients sooner, avoiding pain and suffering.”
Anxiety Facts and Figures
When your anxiety is particularly bad, it can feel like no one in the world understands what you’re going through. And yet, anxiety is much more widespread than you probably realize. One in five U.S. adults live with an anxiety disorder, and women are more than twice as likely as men to be affected. Eight percent of teens ages 13 to 18 have anxiety disorders, and symptoms can start young—even around age six.
There are several different types of anxiety disorders, the most common being generalized anxiety disorder (GAD), panic disorder, and social phobia. They all manifest slightly differently but are characterized by feelings of fear, muscle tension, obsessing about the past, worrying about the future, and other physical symptoms like sleep issues and stomach problems. Sometimes, anxiety gets so serious that it prevents you from doing your work, maintaining healthy relationships, and generally enjoying your life.
Karen Martinez, M.D., chair of the Women’s Special Interest Group of the Anxiety and Depression Association of America, explains that women are at higher risk of anxiety disorders for a variety of reasons, both biological and social. “Biologically, some of the areas of the brain involved in the development of anxiety symptoms respond to hormones,” she says. “As women have changes in their hormones every two weeks, these areas of the brain receive more changing signals in women. This explains why periods of extreme hormonal changes in women (puberty, pregnancy, post-partum, and menopause) are usually when anxiety disorders emerge or worsen in women.”
If anxiety disorders run in your family, you are more likely to develop them yourself. Children of parents with GAD have a 30% chance of inheriting it. There’s also a cultural explanation for why women experience more worry and stress than men. “The traditional role of women in our society also poses increased demands that lead to anxiety,” Dr. Martinez explains. “Some of the risk factors for anxiety, such as exposure to interpersonal violence and trauma, are also more common in women.”
Black Women and Anxiety
In the U.S., Black women have their own unique struggles with anxiety, exacerbated by the discrimination they face in their everyday lives. Angela Neal-Barnett, Ph.D., psychology professor at Kent State University and leading expert on anxiety disorders in Black Americans, explains that Black women experience more chronic and intense anxiety than white women, yet are less likely to recognize it and seek help. A 2010 study in Research in Nursing & Health noted that factors like stigma and access to care prevent Black women from getting the support they need.
“Anxiety is this perception of threat,” Neal-Barnett says, and “for Black girls and women, oftentimes the threat is real.” Black women are more likely than women of other races to experience intimate partner violence, and two to three times more likely to die in childbirth of preventable causes. They experience the dual challenges of sexism and racism in their daily lives, which can impact their workplace and personal experiences. A 2019 report in the Harvard Business Review looked at the impacts of code-switching (changing behavior to appear more ‘appropriate’ according to white norms), and found that it can lead to burnout, exhaustion, and hostility from peers.
There’s also the issue of stereotypes that tell Black women to be strong and take care of themselves. “If we show any sign of vulnerability, if we show any sign of weakness, we’re no longer ‘strong Black women,’” Neal-Barnett says. “To be ‘weak’ and a Black woman is basically an oxymoron. Those stereotypes—racism, attacks on our racial identity—all become things that place us at higher risk for anxiety.” Because of all of this, it’s especially important that Black women seek care and professional advice for dealing with their anxiety.
This all begs the question, “What does anxiety screening look like, and how can it help me?” Ideally, when you go see a doctor for a physical exam, gynecologic visit, or any other regular health concern, they’ll ask how you’re doing mentally. They may ask you questions from a list or have you fill out a questionnaire yourself, which can be used to determine whether you have any noticeable symptoms of anxiety.
From there, if your doctor determines that you do suffer from clinical anxiety, they’ll recommend you to a mental health professional. Screening itself isn’t enough to make a change in your symptoms; action is critical. “Anxiety that goes untreated for a long period of time is more difficult to treat as the person develops ways to cope with the anxiety that become ingrained in their lifestyle,” Dr. Martinez notes. “In addition, some people who have untreated anxiety for long periods of time can develop depression, as the stress response system can no longer respond to threats.”
The sooner you can recognize the anxiety you’re dealing with and take steps to counteract it, the better. This explains why this recommendation is especially relevant for teenage girls. “The age of 13 is important, as it is an age where most girls will be entering puberty and thus starting the hormonal changes that can have a role in the development of anxiety disorders,” Dr. Martinez explains. “By screening for anxiety and referring to treatment, we are giving tools to women in their prime age of development into healthy adults and thus ensuring that anxiety does not affect their functioning.”
Treatments for Anxiety
Treatment can be done using a variety of methods, from therapy to medication. The new report noted that cognitive behavioral therapy (CBT) and anti-depressants can both be helpful tools to fight anxiety and should be administered differently on a case-to-case basis.
CBT, particularly, can help women learn long-term coping strategies for their anxiety triggers, so they can change the way their mind responds to these points of stress. (A 2018 letter in Frontiers in Psychiatry referred to CBT as the “gold standard of psychotherapy” due to its widely documented effectiveness.) “CBT is really putting actions and words together,” Neal-Barnett says. Rather than simply talking to your therapist about what you’re going through, you’ll practice specific strategies to relearn your old ways of thinking, almost like becoming your own therapist in your day-to-day life.
For Black women who experience persistent racism and discrimination, it’s especially crucial to find a therapist you naturally connect with. “No one wants to go in to see a therapist and have to explain what racism is, or what acting white is, or what it means to be the only Black in the room or at work,” Neal-Barnett says. The more you feel understood by your provider, the easier it will be to open up to them from the get-go.
There’s also the issue of access in some communities. “Money should never preclude you from getting therapy,” Neal-Barnett says. If you don’t have access to mental health care through your insurance, she suggests looking into therapy programs at universities in your area. Some of these programs have training clinics where you can get therapy for free or on a sliding scale.
“Your therapists in training are being trained by licensed therapists,” she notes—so you know you’ll be getting good care. You can also check out community centers or group therapy programs in your area, which are often lower cost than one-on-one therapy. Read books about coping with anxiety—Neal-Barnett’s book Soothe Your Nerves is geared specifically toward Black women. Put coping strategies in place in your life, including a mindfulness practice, a healthy diet, limited alcohol and caffeine, daily exercise, and positive self-talk.
The main takeaway? While it remains up to individual clinicians whether or not they implement these routine anxiety screenings, it’s imperative to seek help and don’t give up on finding care. Dr. Conry notes that while this new recommendation is not connected to the current cultural crises, the events of this year have proven just how prevalent anxiety is. “The last few months have shone a light on anxiety and how women are disproportionately affected by it,” she says. “So, it’s really important that we are able to put routine screening into practice immediately, because so many women are in need of it now.”
WPSI Recommendation: Annals of Internal Medicine. (2020.) “Screening for Anxiety in Adolescent and Adult Women: A Recommendation from the Women's Preventive Services Initiative.”
Anxiety Stats: U.S. Department of Health and Human Services, Office on Women’s Health. (n.d.) “Anxiety disorders.”
Genetic Predisposition: Dialogues in Clinical Neuroscience. (2017.) “Genetics of generalized anxiety disorder and related traits.” ncbi.nlm.nih.gov/pmc/articles/PMC5573560/
Black Women and Anxiety: Research in Nursing & Health. (2009.) “African American Women's Beliefs About Mental Illness, Stigma, and Preferred Coping Behaviors.” ncbi.nlm.nih.gov/pmc/articles/PMC2854624/
Black Women and Domestic Violence: The National Center on Violence Against Women In The Black Community. (2018.) “Intimate Partner Violence in the Black Community.”