Do women who screen positive for mental disorders in primary care have lower mammography rates?

doi:10.1016/S0163-8343(03)00014-8

General Hospital Psychiatry

Volume 25, Issue 3, May–June 2003, Pages 214-216

https://doi.org/10.1016/S0163-8343(03)00014-8 Get rights and content

Abstract

Disparities in mammography rates have been documented for underserved populations, yet no data are available for women with mental illness in primary care settings. We analyzed data on mammography rates for 526 women age 40–70 who were new patients and completed the Primary Care Evaluation of Mental Disorders (PRIME-MD). There were no significant differences in mammography rates among women who screened negative and positive for any mental illness (56% and 53%, respectively). Screening for mental disorders in primary care does not appear to identify women at risk for nonreceipt of mammography.

Introduction

Breast cancer is a significant cause of morbidity and mortality in the United States, with an estimated 193,700 new cases and 40,600 deaths in 2001 [1]. Recent studies have focused on the disproportionate burden of disease in minority and medically underserved communities. Likewise, a number of studies have found significant disparities in screening for breast cancer between ethnic minority and white women in the United States [2]. We believe women with mental illness may represent another group with barriers to obtaining breast cancer screening.

This study investigated whether women who screen positive for mental illness in a primary care setting would have lower rates of mammography screening than women who screen negative for mental illness. Previous studies have found that psychiatric patients [3] and women who have taken certain antidepressant medications [4] may be at increased risk for developing breast cancer, and that women with a history of major depression have an increased likelihood of late-stage diagnosis of breast cancer [5]. It is unclear whether this increased risk is due to delayed detection associated with decreased use of preventive services, decreased access to treatment, or to a combination of these and other factors. Prior studies have shown high mammography rates among psychiatric patients [6], [7], [8] but have been limited by the absence of a comparison group [6], [8] or the use of ICD codes to define mental illness [7]. No study has examined the effect of mental illness on mammography screening rates in a low-income, culturally diverse group of patients who receive primary care in a community health center setting.

Section snippets

Study setting and sample

The Cambridge Health Alliance (CHA) consists of 13 primary care centers that serve a multi-cultural, low-income, medically underserved population in Cambridge and Somerville, MA, USA. Eleven of the thirteen health centers participated in a mental disorders screening program from 1998 to the present, using a modified version of the patient questionnaire portion of the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument [9]. We modified this instrument by adding questions pertaining

Results

Fifty-two percent of the sample was identified as white, 15% as black, 12% as Hispanic, 13% as other race, and in 9% race was not identified. The majority of patients were non-English speaking (52%) and uninsured (64%). Forty-four percent of women screened positive for a mental disorder on the PRIME-MD. Women who screened positive for a mental disorder were more likely to speak English (χ² P<.05) and to be high utilizers of medical care (χ² P<.05) than were women who screened negative.

Discussion

Women who screened positive for mental disorders in a primary care setting did not have lower rates of mammography screening when compared to women who screened negative for mental disorders in this sample. It is possible that some of the potential risk for lower utilization of mammography among the mentally ill may be offset by frequent contact with mental health clinicians. While we did not have data on patients’ contacts with the mental health system, we hypothesize that clarification and

Acknowledgements

Maxim D. Shrayer, PhD, commented on earlier drafts of the manuscript.

Drs. Lasser, Miller, and Becker’s work was supported by a grant from Harvard Medical School’s Center of Excellence in Women’s Health fund for women’s health.

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The cancer prevention model must take into account the phenotype of accelerated aging associated with health disparities as well as the important interplay of biological and sociocultural factors that lead to disparate health outcomes. The building blocks of this prevention model will include interdisciplinary prevention modalities that encourage partnerships across medical and nonmedical entities, community-based participatory research, development of ethnically and racially diverse research cohorts, and full actualization of the prevention benefits outlined in the 2010 Patient Protection and Affordable Care Act. However, the most essential facet should be a thoughtful integration of cancer prevention and screening into prevention, screening, and disease management activities for hypertension and diabetes mellitus because these chronic medical illnesses have a substantial prevalence in populations at risk for cancer disparities and cause considerable comorbidity and likely complicate effective treatment and contribute to disproportionate cancer death rates.
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Brief reportDo women who screen positive for mental disorders in primary care have lower mammography rates?☆

Abstract

Introduction

Section snippets

Study setting and sample

Results

Discussion

Acknowledgements

Gen Hosp Psychiatry

Demographic predictors of mammography and Pap smear screening in US women

Am J Public Health

Are chronic psychiatric patients at increased risk for developing breast cancer?

Am J Psychiatry

Antidepressant medication use and breast cancer risk

Am J Epidemiol

The effects of major depression and phobia on stage at diagnosis of breast cancer

Int J Psychiatry Med

Brief report
Do women who screen positive for mental disorders in primary care have lower mammography rates?☆