Dr. Swiner’s Medical Note of the Month-November 2009-Healthy Women, Sound Minds

Recently, I spoke to the ladies of Triumphant Tabernacle Church in Durham for their Empowered Women conference. I was given the theme of “Healthy Women, Sound Minds,” which was a timely topic to speak on and around. We had some fruitful conversations, and I thought I’d share a bit about what these wonderful women shared with me.

amily doctor, which means I care for the entire family – from newborns to the elderly. Since practicing in the Durham community for the past two years, I’ve seen a large amount of young and older black women for a variety of reasons. Recently, with the economy failing and making a slow comeback, I’ve seen a rash of women – married and single, young and old – who all feel the weight of the world on their shoulders right now.

Some of the medical and emotional trends that seemed to have spiked at this time include domestic abuse, sexually transmitted disease, high blood pressure, depression and anxiety. The STDs in particular seemed to be at a high during the summer for some reason. Because of my frustration and sadness as I saw these women and attempted to help in some way, I took a step back to see if I could find similarities with these patients and what research there is on the link between emotional and medical health.

I began my talk about depression and anxiety, and reviewed the cardinal signs and symptoms of depression in particular. You may have heard of the “SIGE-CAPS” method before as a screen for depression (using each first letter of the list to make up the acronym). Because we were discussing women specifically, I put a star next to those that seem to appear in women more: sleeping problems*, interest decreasing in social activities, guilt and self-worthlessness*, energy decrease or fatigue, concentration problems, appetite or weight changes (up or down)*, psychomotor slowing (moving more slowly, decreased motivation) and suicidal thoughts.

One out of 10 Americans admit to some form of mental illness-depression, anxiety, schizophrenia, etc., each year. Women suffer from depression two times more than men. Why is there a difference? Studies say a definitive answer is unknown. However, with research, I found similar theories, including the following: higher incidence of physical or sexual abuse, use of birth control and having hormones in general, and persistent psychosocial stressors such as loss of job.

Untreated emotional or mental illness can lead to suicide attempts – more women attempt suicide, but more men complete it. The likelihood is four-to-one that a man will be successful with suicide. Why? My theory is women use it more as a cry for help than men do. Women also use self-poisoning or drug overdose as the usual tactic, and that’s 70 percent of the time. However, that does not mean we should ever take threats of suicide from a female patient any less serious than from a male.

We then moved onto discrepancies in health in African-Americans versus the rest of the population. (From the Center of Disease Control and Prevention). Points that I wanted to address were the differences in HIV stats. Interesting, with all the safe sex campaigns since the 1980s, HIV is still the leading cause of death for black women aged 25-34 years. Another point to make is that black women have a lower rate of getting breast cancer, however, they are more likely to be diagnosed in later stages and more likely to die from it. We must figure something out!

So what can we do to have healthy bodies and more sound minds? Together, we identified a couple of ideas: • The majority of medical studies confirm that spirituality or religion is associated with better outcomes in many cases. • Have your annual check ups. Take care of yourself. • Have a great support system: family, friends, faith group/community • Get more exercise and movement. • Eat “happy foods” – less caffeine/alcohol, more omega 3 fatty acids (salmon, cod, sardines, nuts, help brain and nerve cells), reduce intake of refined carbs that cause sugar highs and then severe crashes, and eat more veggies and vitamins. • Pay attention to yourself and your moods. Recognize your symptoms early.

* Resources: Am Fam Physician 1999; 60:225-40, Depression in Women: Diagnostic and Treatment Considerations. Center for Disease Control andPrevention-www.cdc.gov

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