Screening for mental health and safety issues when visiting healthy women


Kling JM. Mental health and psychosocial considerations when examining women’s health. Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago.

Disclosures: Kling reports having consulted in the past for Triangle Insights Group and Procter & Gamble.

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CHICAGO — In addition to routine medical screening, clinicians should assess women for life factors that may affect their overall well-being during regular well-being visits, according to a presenter here.

Specifically, patients should be screened for mental health issues, alcohol use, and safety issues.

Data derived from Kling JM.  Mental health and psychosocial considerations when examining women's health.  Presented at: ACP Internal Medicine Meeting;  April 28-30, 2022;  Chicago.
Data derived from Kling JM. Mental health and psychosocial considerations when examining women’s health. Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago.


Depression is prevalent in 10% of the population of the United States and in 21% of the population throughout life, according to Juliana (Jewel) M. Kling, MD, MPH, NCMP, FACP, Associate Professor of Medicine, Chair of the Women’s Health Division of Internal Medicine, Associate Director of the Women’s Health Center and Associate Chair of Equity, Inclusion and Diversity for the Clinic’s Department of Medicine Mayo in Scottsdale, Arizona.

However, without screening, only half of patients suffering from major depression would be diagnosed.

“One of the reasons we talk about screening is that, unfortunately, about two-thirds of patients don’t come straight to the office, sit down and say, ‘Hey doctor, I think I’m depressed.'” Kling said during his presentation at the CPA internal medicine meeting. “They come into the office and they have headaches, abdominal pain, bloating, not sleeping well – so, somatic symptoms.”

When screening, Kling advised to consider reproductive lifespan, as 45% to 68% of perimenopausal women have high depressive symptoms, compared to 28% to 31% of premenopausal women and 28% to 47% of women. in early perimenopause.

Kling added that screening alone cannot improve clinical outcomes and must be combined with treatments such as antidepressants, cognitive behavioral therapy and psychotherapy, which can also help relieve menopausal symptoms. Estrogen therapy may improve depressive symptoms in perimenopausal women, although it is not an FDA-approved treatment for depression and is ineffective in postmenopausal women.

Alcohol consumption

Additionally, routine screening should include an assessment of alcohol consumption. In the United States, 28% of adults have unhealthy drinking – defined as an average of more than seven standard drinks per week or more than three drinks per day for women – and 14% meet the criteria for a disorder. related to alcohol consumption.

The USPSTF recommends that all adults in primary care be screened annually to identify unhealthy alcohol useand for those we flag as having unhealthy drinking habits, we do a brief counseling intervention,” Kling said.

Screening with short questionnaires — even single-item ones — is “ideal in this context,” Kling said. If patients screen positive for unhealthy drinking, it is important to assess whether they have a substance use disorder.

“You want to take the opportunity in this setting to ask about the consequences of use, including medical risks,” Kling added. “Does she get in her car and drive after drinking? Is it appropriate with the medications she takes? This kind of things.

Security concerns

Kling also recommended evaluating patients for intimate partner violence (IPV) on an annual basis, taking into account risk factors and potentially indicative symptoms.

Risk factors for IPV include individual, relationship, community, and societal factors. Kling emphasized that these are not causes or justifications for domestic violence, and that they can also be risk factors for the perpetration of domestic violence.

She also added that household gun ownership increases the risk of injury and death among victims of IPV.

Physical and psychological symptoms such as headaches, chest pain, STIs, substance use, anxiety and depression can indicate IPV, Kling added. IPV may also be correlated with pregnancy-related morbidity and mortality, high-risk sexual behaviors, and child abuse.

How providers frame questions around IPV is important, Kling says, and they need to make sure patients feel safe and comfortable disclosing information. “You’re going to want to normalize this,” Kling said. “[Say] something like, ‘You know, there are high rates of intimate partner violence in our community and it impacts everyone.’

If women report IPV, make sure they stay safe and have access to resources such as counselling. It is also important to ensure that the perpetrators are held accountable and to keep careful records if the patient decides to take legal action.

However, if patients deny IPV, continue to screen for it at future visits, Kling said.

Another security issue to track down is exploitation, such as sex trafficking. Risk factors for sex trafficking include childhood sexual abuse, identification as LGBT, and having been involved in the child welfare system.

To screen for trafficking, be sure to talk to patients one-on-one, let them know what you need to report, ask about immediate safety needs and provide resources, Kling explained.

Also, “avoid the rescue fantasy,” she said.

“A lot of us went into medicine because we wanted to make a difference and help our patients, but the idea that in a situation like sex trafficking or domestic abuse, that whatever we say in that short 15-minute visit is going to cure them or pull them out of life or make them safe forever is just not realistic,” Kling said. “So it’s not up to us to rescue them. to filter, identify and share information and resources, and then be there to be a trusted partner in their lives.

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