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Anxiety Is a Predictor of Death in Middle-aged Women
Women in midlife commonly present with anxiety, yet research on emotional distress and mortality has largely focused on depression in men. Should we be concerned about these anxious women? Now investigators in Holland report in the
Journal of Clinical Epidemiology a 10-year follow-up study of 5,073 healthy Dutch women aged 46-54 years. Secondary outcomes were cardiovascular and lung or breast cancer death. At follow-up, 114 women (2.2%) had died. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. The authors found that smoking, living alone, and lower education were related to mortality, but depression was not.
Adjusting these variables, anxiety was associate with a 77% increase in mortality risk, particularly in those with cardiovascular disease cause of death. The authors concluded that anxiety did predict premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.
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Q: Any specific reasons that women should be concerned regarding health care reform?
A: Women typically require more health care than men because of the combined demands of pregnancy and family planning. The average American woman who has two children will spend 5 years being pregnant, trying to get pregnant, or recovering from pregnancy. More than 30 years are spent trying to avoid pregnancy.
Therefore, young women typically pay more than young men for individual health insurance. Mothers often take primary responsibility for meeting children’s health care needs. Over 23% of all children are cared for by single mothers. Many women gain access to health insurance through their husbands. Male job losses and divorce leave women vulnerable.
Studies indicate that over 50% of working-age women, compared to 39% of working men, forgo filling a prescription, seeing a specialist, or seeing a doctor at all as a result of medical costs. More than one-half of all bankruptcies related to medical costs in the United States were filed by female-headed households.
Women are important health care providers as well as consumers. Over 59% of informal, unpaid care givers are women, and women devote significantly more time to take care of sick, disabled, and elderly family members than men do. These commitments help to explain why women are more likely than men to work part-time and to exit the labor force for longer periods of time.
Please educate yourself regarding the health care debate. I suggest checking the American College of OB/GYN website to educate yourself about women’s legislative issues,
www.obgynsforwomenshealth.org.
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Q: How much of my health issues are related to stress?
A: Daily, I see manifestations of stress on the physical and psychological health of my patients. Stress reduction is a key component to better health outcomes. Diminished stress levels are associated with lower blood pressure, decreased risk of substance abuse, less cardiovascular disease, less depression, less anxiety, improved ability to fight disease, and a longer life. Stress reduction relieves over 50% of medical problems that people present to the doctor’s office. Problems such as chronic pain, anxiety, insomnia, menopausal issues, menstrual disorders, and premenstrual syndrome are diminished by stress relief. There are many ways to manage stress. Not all of these appeal to everyone. Rarely, I will prescribe anti-anxiety medications. I believe the key to stress reduction lies within yourself. Various methods might or might not fit with your personality and lifestyle. These must become second nature to you and part of your daily life. I will list stress reduction strategies in future articles as well as at your office visit.
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Q:
How do I lose the weight I gained from my pregnancies over five years ago?
A:
More than half of all adults in the U.S. are overweight. We define overweight by your body mass index (BMI). A BMI over 25 is overweight. Be sure to ask your doctor what your BMI is. You can also determine this yourself if you know an accurate height and weight.
I will do a nutritional assessment when you come for an annual exam or request a weight consultation. Basically this determines how much and what kinds of food you eat. Also, your family history and activity level play a role. A thorough physical exam is mandatory to rule out the consequences of being overweight, such as high blood pressure and heart disease. Lab evaluation is also important to rule out accompanying diseases such as diabetes, cholesterol issues, and thyroid ailments.
Then, I will suggest specific dietary guidelines and nutritional supplements specific to your needs and age.
Weight loss is never easy. It requires dedication and realization that this is a life-long process. Diets that take weight off quickly will all fail. We need to realize that this issue will only be deflated if we change our lifestyle. We need to think about our eating differently. We need to learn discipline in our food choices and portion control, always, and forever. Whether it be low fat, low carb, or high protein makes no difference. You have to eat a diet you can eat daily, forever. This means paying attention to food labels. Calorie intake is the primary factor. To lose weight, you must not consume more than 1,500 calories per day. To maintain, no more than 2,000 calories per day.
Also, physical activity plays a role, although weight loss primarily occurs because of decreased calorie intake. Sustained physical activity improves heart function, reduces the risk of heart disease, stroke and certain forms of cancer. Sustained physical activity also helps prevent weight gain. A simple, vigorous 30-45 minute walk four times per week should suffice.
Medications are available to assist in weight loss under the physician’s guidance.
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concerns here. I will post answers periodically.
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