Tag: psychiatry

Data Point | The gender disparity in healthcare

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The Data Point is a bi-weekly newsletter in which The Hindu’s Data team decodes the numbers behind today’s biggest stories.  

(This article forms a part of the Data Point newsletter curated by The Hindu’s Data team. To get the newsletter in your inbox, subscribe here.)

The difference in the anatomy between various genders implies that diseases and their symptoms may affect them differently. Moreover, some diseases affect certain genders more than others, while a few are gender-specific conditions. Thus, it is imperative to look through a gendered lens for a better understanding of diseases.

Equal representation of genders in clinical trials, and impartiality and unbiasedness in testing and diagnosis help in creating a healthcare system that addresses the needs of all genders.

Yet, various studies conducted in the U.S. reveal that in some fields of medicine such as oncology, psychiatry, neurology and cardiology, the disease burden was higher among women while their share in clinical trials was not proportionate. 

In a study where 1,433 trials were conducted from 0.3 million people in the U.S. between 2016 and 2019, the average share of women was  41.2%. In psychiatry, where women comprised 60% of patients, the share of women participating in clinical trials was 42%. Similarly, the difference was significantly high in the case of cardiovascular diseases (41.9% female participants vs. 49% female patients) and cancer trials (41% female participants vs. 51% female patients)

Gender disparity is also observed in research funding. For instance, according to the National Institutes of Health (NIH) data, the 2023 research funding estimate for substance misuse (a condition more prevalent among men) was $2,583 million while that for depression (a condition more prevalent among women) was $664 million. Similarly, research funding in 2022 for HIV/AIDS, a disease more prominent among men (DALY of 0.361 million in 2015) was $3,294 million, while that for inflammatory bowel disease (IBD), a disease dominant among women (DALY of 0.475 million) was $203 million. (expand DALY somewhere)

To know more about the gender gap in clinical trials and research funding, click here

Women faced the challenge of a gender gap in testing, diagnosis and treatment, which arose from a lack of comprehensive research about conditions dominant among women and biases toward women in healthcare.

In a multicentre observational study published in 2023, it was revealed that the median time taken to diagnose IBD from the onset of a symptom was more prolonged in women than in men. For instance, it took about 12.6 months to diagnose Crohn’s disease (a type of IBD) for women, while it only took 4.5 months for men. Similarly, it took 6.1 months for women and 2.7 months for men, in the case of ulcerative colitis.

NIH data also revealed that funding given for women’s reproductive disorders was significantly lower than that for conditions with a similar disease burden. 

Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic abnormality among women with a worldwide prevalence of up to 21%, depending on diagnostic criteria. Yet, while diseases with equal or lesser disease burden like rheumatoid arthritis, tuberculosis, and systemic lupus erythematosus, were awarded funds worth $454.39 million, $773.77 million, and $609.52 million respectively, the funding for PCOS research between 2006 and 2015 was limited to $215.12 million. 

Thus, a limited understanding of disease further delays diagnosis, especially for diseases affecting women’s reproductive system. 

In the Indian context, the taboo towards menstrual health in society, which extends to the health sector adds to this problem. Endometriosis, a disease that affects roughly 10% (190 million) of women and girls of reproductive age worldwide according to the WHO, is highly underreported in the country. 

Despite persistent visits to multiple gynaecologists over a decade, my journey to obtain a proper diagnosis for endometriosis was marked by significant delays. My experiences of enduring intense menstrual cramps, accompanied by nausea and bowel disorders, were consistently dismissed by doctors who attributed them to natural menstrual processes. Prescription of painkillers became routine without a genuine effort to comprehend the severity of my discomfort or suggest diagnostic scans for underlying issues. Only after my insistence, despite initial reluctance from doctors, did I finally receive a diagnosis. Regrettably, by that time, the lesions within my ovaries had grown larger than the organs themselves.

Even with a diagnosis, treatment options remain limited due to the narrow understanding of this condition. While invasive surgeries like laparoscopic procedures and hormonal medications seem to be the only options, these treatments come with significant side effects and cannot guarantee the complete eradication of recurring lesions.

In an article titled, “Male-centric medicine is affecting women’s health” in The Hindu, the author explains that women are less likely to receive appropriate medications, diagnostic tests and clinical procedures even in developed countries such as Canada and Sweden as the stereotype of the “hysterical woman” continues to haunt women even when they need urgent clinical interventions. 

Therefore, it is crucial to implement appropriate interventions, create awareness within the medical community to mitigate bias and push for gender-sensitive clinical trials and equitable allocation of research funding. These measures are imperative to ensure equal and unbiased healthcare for all individuals, regardless of their gender among other identities.

Fortnightly figures

  • 10.3% was the decrease in India’s merchandise exports in May 2023 at $34.98 billion from $39 billion in May 2022. Imports contracted at a slower 6.6% rate to $57.1 billion, lifting the trade deficit to a five-month high of $22.1 billion. This is the sixth time in the last eight months that goods exports have declined year-on-year, although May’s decline was lower than the 12.6% fall recorded in April.
  • 110 million people have had to flee their homes because of conflict, persecution, or human rights violations, the UN High Commissioner for Refugees (UNHCR) said. The war in Sudan, which has displaced nearly 2 million people since April, is but the latest in a long list of crises that have led to the record-breaking figure. Last year alone, an additional 19 million people were displaced, including more than 11 million who fled Russia’s invasion of Ukraine in the fastest and largest displacement of people since World War II.
  • 1 lakh people were shifted to approximately 1,500 temporary shelters set up as part of the disaster management efforts by the Gujarat State against Cyclone Biparjoy before the cyclone made landfall. Cyclone Biparjoy caused widespread damage in Gujarat’s Kutch-Saurashtra region as it made landfall late on June 15, Thursday. The Gujarat government also shut schools and other educational institutions for the next day as the State received heavy downpours in the aftermath of the cyclonic storm.
  • 4.25% was India’s retail inflation in May from 4.7% in April this year, a 20-month low. The price rise in food items faced by consumers moderated to 2.91%. This is the third successive month that inflation has remained below the Reserve Bank of India’s (RBI’s) upper tolerance limit of 6% after a prolonged streak above it. Base effects from May 2022 when retail inflation was over 7% also played a role in lowering the inflation rate this May.
  • ₹1.13 lakh crore was the third instalment of tax devolution released by the Centre to States, according to the Finance Ministry. This surpasses the normal monthly devolution of  ₹59,140 crore. The additional advance aims to enable expedited capital spending, financing of development/welfare-related expenditure and increased resource availability for projects and schemes of the States.

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Older people with anxiety frequently don’t get help. Here’s why | CNN

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CNN
 — 

Anxiety is the most common psychological disorder affecting adults in the United States. In older people, it’s associated with considerable distress as well as ill health, diminished quality of life and elevated rates of disability.

Yet when the US Preventive Services Task Force, an independent, influential panel of experts, suggested last year that adults be screened for anxiety, it left out one group — people 65 and older.

The major reason the task force cited in draft recommendations issued in September: “(T)he current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety” in all older adults. (Final recommendations are expected later this year.)

The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening entails evaluating people who don’t have obvious symptoms of worrisome medical or psychological conditions.

“We recognize that many older adults experience mental health conditions like anxiety,” and “we are calling urgently for more research,” said Lori Pbert, associate chief of the preventive and behavioral medicine division at the University of Massachusetts Chan Medical School and a former task force member who worked on the anxiety recommendations.

This “we don’t know enough yet” stance doesn’t sit well with some experts who study and treat older people with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the task force’s position baffling because “it’s well-established that anxiety isn’t uncommon in older adults and effective treatments exist.”

“I cannot think of any danger in identifying anxiety in older adults, especially because doing so has no harm and we can do things to reduce it,” said Dr. Helen Lavretsky, a psychology professor at UCLA.

In a recent editorial in JAMA Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors with generalized anxiety disorder — intense, persistent worry about everyday matters — receive treatment. That’s concerning, they said, considering evidence of links between anxiety and stroke, heart failure, coronary artery disease, autoimmune illness and neurodegenerative disorders such as dementia.

Other forms of anxiety commonly undetected and untreated in older adults include phobias (such as a fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear of being assessed and judged by others) and post-traumatic stress disorder.

The smoldering disagreement over screening calls attention to the significance of anxiety in later life — a concern heightened during the Covid-19 pandemic, which magnified stress and worry among older people. Here’s what you should know.

According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety condition.

As many as half have symptoms of anxiety — irritability, worry, restlessness, decreased concentration, sleep changes, fatigue, avoidant behaviors — that can be distressing but don’t justify a diagnosis, the study noted.

Most senior citizens with anxiety have struggled with this condition since earlier in life, but the way it manifests may change over time. Specifically, older adults tend to be more anxious about issues such as illness, the loss of family and friends, retirement and cognitive declines, experts said. Only a fraction develop anxiety after turning 65.

Older adults often minimize symptoms of anxiety, thinking “this is what getting older is like” rather than “this is a problem that I should do something about,” Andreescu said.

Also, they are more likely than younger adults to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath and gastrointestinal problems — that can be difficult to distinguish from underlying medical conditions, according to Gretchen Brenes, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

Some types of anxiety or anxious behaviors — notably, hoarding and fear of falling — are much more common in older adults, but questionnaires meant to identify anxiety don’t typically ask about those issues, said Dr. Jordan Karp, chair of psychiatry at the University of Arizona College of Medicine in Tucson.

When older adults voice concerns, medical providers too often dismiss them as normal, given the challenges of aging, said Dr. Eric Lenze, head of psychiatry at Washington University School of Medicine in St. Louis and the third author of the recent JAMA Psychiatry editorial.

Simple questions can help identify whether an older adult needs to be evaluated for anxiety, he and other experts suggested: Do you have recurrent worries that are hard to control? Are you having trouble sleeping? Have you been feeling more irritable, stressed or nervous? Are you having trouble with concentration or thinking? Are you avoiding things you normally like to do because you’re wrapped up in your worries?

Stephen Snyder, 67, who lives in Zelienople, Pennsylvania, and was diagnosed with generalized anxiety disorder in March 2019, would answer “yes” to many of these queries. “I’m a Type A personality and I worry a lot about a lot of things — my family, my finances, the future,” he told me. “Also, I’ve tended to dwell on things that happened in the past and get all worked up.”

Psychotherapy — particularly cognitive behavioral therapy, which helps people address persistent negative thoughts — is generally considered the first line of anxiety treatment in older adults. In an evidence review for the task force, researchers noted that this type of therapy helps reduce anxiety in older people seen in primary care settings.

Also recommended, Lenze noted, is relaxation therapy, which can involve deep breathing exercises, massage or music therapy, yoga and progressive muscle relaxation.

Because mental health practitioners, especially those who specialize in geriatric mental health, are extremely difficult to find, primary care physicians often recommend medications to ease anxiety.

Two categories of drugs — antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — are typically prescribed, and both appear to help to older adults, experts said.

Frequently prescribed to older adults, but to be avoided by them, are benzodiazepines, a class of sedating medications such as Valium, Ativan, Xanax, and Klonopin. The American Geriatrics Society has warned medical providers not to use these in older adults, except when other therapies have failed, because they are addictive and significantly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairments.

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