Serious psychological distress as a barrier to cancer screening among women

Abstract

Background: The purposes of the study were to examine the association of serious psychological distress (SPD) and cancer-screening utilization in a nationally representative sample of women aged 40 to 74 years and to identify barriers and facilitating factors to breast and cervical cancer screening among women with SPD.

Methods: Women aged 40 to 74 (n = 17,770) were selected from the Household Component of Medical Expenditure Panel Survey series of 2007, 2009, and 2011. SPD was defined as a score of 13 of higher on the Kessler Psychological Distress Scale-6 items (K6 scale) of nonspecific psychological distress. Logistic regression was conducted to examine the association between SPD and up-to-date cancer screening.

Findings: Women with SPD had significantly lower rates of up-to-date clinical breast examination (67.56% vs. 81.93%), mammography (59.94% vs. 75.56%), and Pap smear (72.27% vs. 85.37%). In multivariate logistic regression analyses adjusting for sociodemographics, insurance, health behaviors, comorbidity, and service utilization, SPD was associated with nearly 40% decreased odds of being up to date with all three screening tests. Having a usual place of care, being physically active, and a greater number of past-year medical visits were strongly associated with higher odds of screening utilization among women with SPD.

Conclusions: Women with mental health problems have substantial risk for low use of routine breast and cervical cancer screenings. The K6 may be a useful tool to screen this risk factor. Frequent contact with the health care system among women with mental health problems opens up opportunities to reduce the mental illness-related disparities in utilization of cancer screening.