Your alarm goes off. You roll over and glance at your phone screen. A New York Times email comes through. The Arizona Supreme Court has ruled a near-total abortion ban, including in cases of rape and incest. Great. You open Instagram and you’re hit with a slew of stories from a girls’ night you weren’t invited to…another engagement announcement pops up. Wonderful, you went on three first dates last month, no second dates. You close Instagram and click on Slack. Seventeen mentions about a fire at work. Shit, it’s Wednesday. Your period starts today. And you’re two days away from going on a trip that you’re not even sure you can afford. It’s not even 9AM and you’re already riddled with anxiety. Does it ever end?

Can I ask you a personal question?

The gender anxiety gap

Four years after the onset of the COVID-19 pandemic, one thing is abundantly clear: we’re not alright. In the first year of the pandemic alone, WHO reported that global levels of anxiety and depression rose by 25%. Rates of anxiety and depression remain high even in a post-pandemic world, with 37% of Americans diagnosed with anxiety or depression (up from 32% pre-COVID). In 2021, Project Healthy Minds surveyed 1300+ 18 to 34-year-olds and found that 96% feel anxious sometimes and 46% feel so frequently or all the time. And unsurprisingly, women are disproportionately impacted. Even before the pandemic, a systematic literature review of 48 scientific papers revealed that women were twice as likely to suffer from anxiety disorders compared to men. Project Healthy Minds’ findings reflect something similar, with the majority of women reporting (54%) feeling anxious frequently or all the time.

Why does this gap exist?

It’s complicated. It may partly concern our biological makeup - specifically regarding hormones. As women experience more reproductive life events, we deal with more hormonal fluctuations that may be linked to anxiety. The postpartum period is a particularly vulnerable time as we experience a rollercoaster of hormonal changes – along with the drastic physical, emotional, and life-related transitions – with an estimated 17% of moms experiencing postpartum anxiety (usually undiagnosed since there’s still no clinical definition for it in the DSM). But we also cope with stress differently. When it comes to stress, men are more likely to dissociate or problem-solve their way out of stress, whereas women are more likely to internalize it and ruminate, sometimes leading to anxiety disorders. 

And then of course, there’s the reality that we can’t ignore - we live in a man’s world, so there’s a lot to worry about from money (thank you, gender pay gap), to our safety, to our rights, and more. According to the American Psychological Association (APA)’s 2023 Stress in America survey, women are more likely than men to be “consumed” by money (50% vs. 44%). And more women than men cited family responsibilities (58% vs. 52%) and relationships (49% vs. 44%) to be key stressors in their lives. 

We also don’t need to tell you about the negative effects of social media. And since women spend 25% more time on social media apps daily than men and account for 10% more of Instagram’s U.S. user base than men, we’re confronted with them more. These platforms are built to be addictive - developers know that users get a surge of dopamine (aka the “happy hormone”) when they receive likes, comments, etc., making them stay engaged. With apps like TikTok, where most of us might primarily be consumers (vs. creators or contributors), we get that dopamine kick via entertainment from short-form videos. But it’s short-lasting. Social media has been shown to worsen our anxiety as it can fuel the comparison trap making us feel inadequate, and contribute to isolation making us feel more lonely.  It can also negatively impact our sleep.

Can we get some peace of mind?

On the bright side, mental health solutions at large are becoming far more accepted and accessible - what used to be considered taboo is now mainstream. Last year, the Thriving Center of Psych surveyed 1000+ GenZs and Millennials and found that 55% have been to therapy and 39% plan to go in 2024. Of those who go to therapy, most (83%) openly talk about it. In 2023, Grow Therapy surveyed 230+ therapists and found something similar - 83% of them have seen an increase in patients seeking therapy for the first time. But is therapy enough? Ariela Safira, founder of Zeera, doesn’t think so. In 2020, she launched an on-demand mental health app on the premise that there are only enough therapists for 7% of the U.S. population to attend weekly therapy.

But it’s not just a supply problem. Because as the percentage of Americans getting mental healthcare has risen by 32.81%, the share of people reporting they’re in “excellent” mental health has fallen by 20.93%. The reason is complex, but critics argue that part of it has to do with the inadequacies of therapy and the entire psychiatry profession - which unlike every other part of medicine is largely subjective and void of any biomarkers or hard data. With the patient-provider relationship playing arguably the most important role in therapy’s success, there’s also a demographic supply issue as most people feel most comfortable around people who look like them. When it comes to therapists of color, there’s only enough to serve 1.7% of the people of color in this country. And let’s say you can find a therapist who shares your demographics - there’s a good chance it’ll take you several tries before you find someone you mesh well with. Therapy also takes work - some will have to go through as many as 15-20 sessions before they hit a breakthrough. So if people are leaving before that, they’re missing out on the benefits. However, the American Psychiatric Association reports that about 75% of people will see benefits from therapy - so there’s generally no harm in trying it. 

But unfortunately, there is a dark side to therapy going mainstream - now everyone thinks they’re a therapist. Hop over to TikTok and you’ll find 22.3B views on videos labeled #therapy (still just a fraction of the 430B views related to those marked #fitness). On the surface, that sounds great. But a recent study examining 500 TikTok videos led by PlushCare found that 84% of therapy videos on TikTok are misleading. And worse, people are misusing and even weaponizing therapy language to manipulate people (throwback to Jonah Hill’s misuse of “boundaries”) creating a vicious cycle that makes us feel even more anxious than we were before. 

The other commonly used solution for anxiety is SSRIs - colloquially known as antidepressants (note: the same SSRIs are used to treat both anxiety and depression as they increase our levels of serotonin and can be effective in quieting anxious and depressive thoughts, among other benefits). Just as women are twice as likely to be diagnosed with anxiety, we’re twice as likely to be using antidepressants, with about 1 in 5 women being on them (aka you are not alone!). Since we’re more likely to have anxiety, this makes sense.  However, some research suggests that this could be due to over-diagnosing and over-treating women as women are more likely to be prescribed without showing signs of needing them. What’s interesting about this is that in our recent Not That Personal article on women’s pain being dismissed, we shared that women are less likely than men to be prescribed painkillers. So when it comes to our mental health, we’re taken seriously (maybe even too seriously?), but with our physical health, we’re at risk of being ignored. It’s absolutely a good thing that women’s mental health is getting the attention and care it deserves, but it also begs the question as to why doctors are so quick to diagnose us with emotional disorders but slower to diagnose us with… everything else. 

And while SSRIs can be incredibly helpful and even life-changing for many, they’re not a silver bullet. One study estimates that only 60% of people respond to a significant degree, leaving 40% hanging. Why? Mainly it’s because a serotonin deficiency isn’t the only thing contributing to anxiety. So just like our anxiety is complex, so is the solution. And on the topic of the gender health gap, what’s a bit concerning is that there’s very little research that shows what happens when people go off these medications (which until recently, was recommended during pregnancy before modern research confirmed that it is, in fact, OK to stay on them during pregnancy). Per everything when it comes to women’s health, it seems that we really need more investments in research to understand how anxiety shows up in women and what we can do about it.

Let us know what you think by voting in our poll and leaving an anonymous comment.

💭 Our two cents

We get it, women are anxious - and it’s getting worse. Partly due to our biology and partly due to the anxiety-inducing world that we live in. Yet what this research made me question is two things: 1) Do we actually have more anxiety than men, or are we just being over-diagnosed because we haven’t researched women’s health enough to know what’s actually happening? I also wonder if men are being under-diagnosed. Or, alternatively, 2) If anxiety does show up in women 2x as much as men, why aren’t there more mental health solutions specifically targeting us? 

It seems odd to me that with such a large portion of our population suffering from something that impacts our ability to live full lives, the solutions haven’t changed in decades. And there’s still little data to back up exactly what would serve each individual best - especially when you take into account women’s numerous reproductive life stages that shift the composition of our hormones dramatically and likely have a major impact on our anxiety. While I’m not sure there’s much we can do to solve the causes of anxiety, I do think we need better solutions. Talk therapy and SSRIs are awesome, but they aren’t necessarily the answer for everyone. Sadly, only 11% of NIH funding goes to women’s health projects and about 3% of digital health funding goes to women’s health companies. So the outlook feels bleak. But with Jill Biden’s announcement of $100M in federal funding to support women’s health research, and even private efforts popping up, like supplement company Perelel’s Fund Women’s Health initiative, I have hope that the next decade might look a little better for women and our health. 

 ✅ You should also know…

🌀 Zeera: Founder Ariela Safira launched Zeera to be an on-demand mental health copilot that fits into your everyday life. Check out this “Spotify for your mental health” here. 

🤰 Seven Starling: As women experience different reproductive life events, we require different approaches to our mental healthcare. Seven Starling specifically focuses on mental health for each stage of motherhood, starting with trying to conceive. 

👚 Swag to Support Women’s Health: Supplement company Perelel recently announced they’re donating $10M to fund women’s health research. Grab a “Fund Women’s Health” t-shirt here - 100% of the proceeds go to the initiative. 

💃 The girls have spoken

Last week, we took a look at the words, phrases, and linguistic norms in our everyday language that are surprisingly (or maybe not surprisingly) gendered. Roughly 35% of you said that you feel masculine qualifiers or phrases that present men before women are pervasive throughout many different forms of communication and subconsciously shape the way we think. An additional 43% of you said it’s something that you sometimes notice in a particular facet of your life, such as in politics, professional settings, or relationships. One traditional linguistic construct that stood out to many of you was the continued (and oftentimes recommended) use of the man’s full name on formal correspondence like wedding invitations with only a “Mrs.” in reference to his partner. As one reader very thoughtfully noted, while this kind of overly masculine language can reinforce the implication that women are inferior to their male counterparts, it’s also the symptom of a larger societal gender imbalance. Shifting our language might help us break out of the cycle, but it may not necessarily address the crux of the problem.

💌 Up Next

That’s all for today! If you liked this edition of Not That Personal, we think one of your friends probably will too – refer one (or two or three) below. ;)

Have something to say? We’d love to hear it – reply to this email or leave an anonymous comment here :) 

Up next: So…are women’s sports the new men’s sports? 

💖 S & J