Mental/Behavioral Health - Women's Health Highlights: Recent Findings (continued)

Mental/Behavioral Health

•Psychological distress may cause women to delay getting regular medical care.
The stress of juggling work and family roles may lead some women to delay or skip regular preventive care, such as routine physicals, mammograms, and other screening tests. In this study of 9,166 women aged 18-49, over 13 percent of them reported experiencing signs of psychological distress, including feeling nervous, hopeless, restless, fidgety, or depressed. These distressed women were more likely to delay getting health care than women who did not have distress symptoms (27 percent vs. 22 percent, respectively). Bonomi, Anderson, Reid, et al., Arch Intern Med 169(18):1692-1697, 2009 (AHRQ grant HS10909).

•Nearly two-thirds of mothers with depression do not receive adequate treatment for their condition.
Nearly 10 percent of the 2,130 mothers in this study reported experiencing depression. More than one-third of those with depression did not receive any treatment for their condition, 27.3 percent received some treatment, and just 35 percent received adequate treatment for depression. Mothers who received treatment were more likely than other mothers to be age 35 or older, white, and have some college education, and they were less likely to be in the paid workforce. Surprisingly, more than 80 percent of mothers who did not receive any treatment for their depression reported having insurance. Witt, Keller, Gottlieb, et al., J Behav Health Serv Res 2009 (AHRQ grants T32 HS00063, T32 HS00083).

•Nearly half of homeless women are in need of mental health services.
Researchers conducted face-to-face interviews with 821 homeless women in the Los Angeles area, and found that nearly half of the women had a mental distress score indicating the need for further evaluation and possible clinical intervention. Sixty-seven percent of the women were black, 17 percent were Hispanic, and 16 percent were white. Black women reported the lowest overall mental distress scores; nearly twice as many white women as Hispanic or black women reported childhood or recent physical or sexual assault. Austin, Andersen, and Gelberg, Women's Health Issues 18:26-34, 2008 (AHRQ grant HS08323).

•Dysthymia may be a barrier to use of recommended HIV medications by women.
Dysthymia—a chronic, low-level daily depression that lasts at least 2 years—is prevalent among women and minorities with HIV and may be a barrier to their use of highly active antiretroviral therapy (HAART). The feelings of hopelessness, indecision, and mental inflexibility that commonly occur in people with dysthymia could reduce the likelihood that they would be offered or accept HAART, according to this study. Researchers analyzed 1997 data on 1,982 adults with HIV; white men were the most likely to receive HAART (69 percent), while Hispanic women (53 percent) and black women (55 percent) were the least likely to receive this lifesaving therapy. Turner and Fleishman, J Gen Int Med 21:1235-1241, 2006 (AHRQ Publication No. 07-R021)* (Intramural).

•Study reveals differences between male and female providers in behavioral counseling.
According to this study, female providers are more likely than male providers to counsel depressed patients about anxiety and less likely to provide counseling on alcohol or drug use. Also, female patients are less likely than male patients to be counseled by providers of either sex. Male patients of male providers reported the most counseling, and female patients of female providers reported the least counseling about alcohol or drug use. Rates of depression diagnosis and care were comparable regardless of the provider's sex or whether the provider and patient were of the same sex. Chan, Bird, Weiss, et al., Women's Health Issues 16:122-132, 2006 (AHRQ grant HS08349).

•Longitudinal study identifies patterns of tobacco use among young women.
Researchers conducted a study of 443 Midwestern women who smoke, beginning in 1980, with followup in 1987, 1993, and 1999. They identified three subgroups among the women who smoked daily: the first group (48 percent) worked full time, were heavy smokers, and were generally happy. The second group (19 percent) started smoking casually in college and exercised regularly. The third group (33 percent) were mothers who smoked because they were addicted and received a psychological boost from smoking. Identifying these groups may help in tailoring smoking cessation interventions and messages appropriate for reaching them. Rose, Chassin, Presson, et al., Addiction 102(8):1310-1319, 2007 (AHRQ grant HS14178).

Other
•Women account for almost 90 percent of all hospital stays for injuries related to osteoporosis.
An estimated 10 million Americans suffer from osteoporosis, and women are four times as likely as men to be diagnosed with the condition. In 2006, the rate of hospitalization for an injury related to osteoporosis was 149 stays per 100,000 population compared with 20 stays per 100,000 population for men—a rate more than six times as high for women as for men. See U.S. Hospitalizations Involving Osteoporosis and Injury, 2006, HCUP Statistical Brief No. 76; online at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb76.jsp (Intramural).

•Medicare reimbursement for bone density scans varies by diagnosis codes and Medicare carrier.
Researchers analyzed Medicare claims data from 1999 to 2005 for a 5 percent national sample of enrollees with part A and part B coverage who were not in HMOs to analyze denial of Medicare coverage for bone density (DXA) scans. They found that although Medicare reimbursement for DXA is covered as part of the "Welcome to Medicare" exam and for certain indications (e.g., screening for estrogen-deficient women and conditions that lead to bone loss), DXA claims were denied from 5 to 43 percent of the time. Variations in reimbursement were related to diagnosis code submitted, place of service, local Medicare carrier, and several other factors. Curtis, Laster, Becker, et al., J Clin Densitom 11(4):568-574, 2008 (AHRQ grant HS16956).

•Millions of women are treated for high blood pressure each year.
According to an analysis of data from AHRQ's Medical Expenditure Panel Survey (MEPS), approximately 25 million women in the United States— most older than 45—were treated for high blood pressure in 2006, making it the most common condition for which women sought treatment that year. The other most common conditions for which women sought treatment that year, by age group, included: for age 65 and older, hyperlipidemia, osteoarthritis, heart disease, and chronic obstructive pulmonary disease (COPD); ages 45-65, depression, COPD and asthma, hyperlipidemia, and osteoarthritis; ages 30-44, depression, COPD and asthma, female genital disorders, and bronchitis. Go to http://www.meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=18Z-1 (Intramural).

•Lupus involves higher health care costs and leads to lower work productivity.
In this study of 812 individuals diagnosed with systemic lupus erythematosus (SLE), researchers found that direct health care costs for each person were $12,643, and their employment rate dropped from 76.8 percent of individuals at the time of diagnosis to 48.7 percent at study enrollment. The majority of study participants (92.6 percent) were female, since lupus mostly affects women. Panopalis, Yazdany, Gillis, et al., Arthritis Rheum 59(12):1788-1795, 2008 (AHRQ grant HS13893).

•Socioeconomic status is related to physical and mental health outcomes of women with lupus.
Researchers examined data on 957 patients with lupus to assess symptoms, physical functioning, and signs of depression, as well as neighborhood and socioeconomic status (SES). The majority of patients were female (91 percent) and white (66 percent). Three factors were associated with increased disease activity: lower education level, lower income level, and poverty status. There was a significant association between lower SES, worse functioning, and increased depressive symptoms. Patients who were poor and lived in high poverty neighborhoods had a depression rate of 76 percent, compared with 32 percent for patients who were not poor and did not live in high poverty areas. Trupin, Tonner, Yazdany, et al., J Rheumatol 35(9):1782-1788, 2008 (AHRQ grant HS13893).

•Mycobacterial pulmonary disease affects more women than men.
Nontuberculous mycobacteria (NTM) are an important cause of disease and death, most often in the form of progressive lung disease. Long thought to be more common in men, this study found that the epidemiology of this disease has changed in the last several decades, and it now affects women more often than men. Of the 933 patients with NTM isolated by culture, 56 percent met the microbiologic criteria for NTM disease. Pulmonary cases predominated, and skin/soft tissue infections were the second most common form of NTM disease. Cassidy, Hedberg, Saulson, et al., Clin Infect Dis 49:e124-e129, 2009 (AHRQ grant HS17552).

•Osteoporosis and low bone density affect many postmenopausal women.
Although osteoporosis affects both women and men, it occurs most often in postmenopausal women. It increases bone fragility and susceptibility to fracture; each year in the United States, about 1.5 million people experience a fracture related to osteoporosis. These three documents present information about osteoporosis and low bone density. Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis presents a review of the evidence comparing the efficacy and safety of agents used to treat low bone density (AHRQ Publication No. 08-EHC008-1). Fracture Prevention Treatments for Postmenopausal Women with Osteoporosis: Clinician's Guide presents information for doctors and other providers on the effectiveness and safety of various treatments for preventing fractures in postmenopausal women (AHRQ Publication No. 08-EHC008-3). Osteoporosis Treatments that Help Prevent Broken Bones: A Guide for Women After Menopause describes the effectiveness, side effects, and costs of the various treatments for low bone density (AHRQ Publication 08-EHC008-2A).* These publications are also available on the AHRQ Web site at http://effectivehealthcare.ahrq.gov/.

•Management of gout differs for women and men.
About 5 million Americans suffer from gout, a painful inflammation of the joints. According to this study, factors leading to gout, as well as its management, are different in women and men. Researchers examined data on 1.4 million members of seven managed care plans from 1999 to 2003 and identified 6,133 adult members with gout. Women with gout were older than men (mean age of 70 vs. 58), had a greater number of coexisting medical conditions, and received diuretics more often (77 vs. 40 percent), respectively. Harrold, Yood, Mikuls, et al., Ann Rheum Dis 65:1368-1372, 2006 (AHRQ grants HS10391, HS10389).

•Young women of low to normal weight with GI complaints should be screened for eating disorders.
This study found that young men and women (average age of 26) who were hospitalized for an eating disorder were three times as likely as other young people to seek health care for gastrointestinal problems during their illness. Over 90 percent of the individuals studied were women. Thus, the researchers recommend that primary care physicians and gastroenterologists screen young women of low to normal weight who present with GI complaints for possible eating disorders. Simple questionnaires that address issues such as body image, weight loss, and vomiting can be used. Winstead and Willard, J Clin Gastroenterol 40:678-682, 2006 (AHRQ grant HS13852).

•Checklists help women know which medical tests are needed to stay healthy at any age.
Two checklists from AHRQ show at a glance what the U.S. Preventive Services Task Force recommends for screening tests and preventive services, as well as what constitutes a healthy lifestyle and healthy behaviors. Women: Stay Healthy at Any Age is available in English (AHRQ Publication No. 07-IP005-A) and Spanish (AHRQ Publication No. 07-IP005-B). Women: Stay Healthy at 50+ is also available in English (AHRQ Publication No. 08-IP001-A) and Spanish (AHRQ Publication No. 08-IP001-B).* These publications are also available online at http://www.ahrq.gov/clinic/prevenix.htm (Intramural).

•Weight-loss surgery can lead to dramatic weight loss, but it remains a high-risk procedure.
In this commentary, AHRQ director Carolyn Clancy, MD, discusses the pros and cons of bariatric surgery for women, including the necessary lifestyle changes that must be made. She also examines the important role of nurses in helping women achieve success with bariatric surgery. Clancy, Women's Health 12(1):21-24, 2008 (AHRQ Publication No. 08-R061)* (Intramural).

•Women with HIV receive poorer quality of care than men with HIV.
Critical health care services for women infected with HIV continue to lag behind services for men with HIV, according to this study. Researchers examined data on care provided to more than 9,000 patients at HIV clinics and found that women were less likely than men to receive highly active antiretroviral therapy (78 vs. 82 percent, respectively) or prophylaxis for pneumonia (65 vs. 75 percent, respectively). They also were less likely than men to have been assessed for their hepatitis C virus status (87 vs. 88 percent, respectively). Hirschhorn, McInnes, Landon, et al., Women's Health Issues 16:104-112, 2006 (AHRQ grants HS10227, HS10408).

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Women's Health Highlights: Recent Findings (continued)