INDIANAPOLIS -- Women with mental disorders are less likely to have screening mammograms than women without mental illness, although the nature of the mental illness does play a role, according to a large study published by Indiana University School of Medicine and Richard Roudebush VA Health Services Center for Excellence researchers in the October issue of Journal of General Internal Medicine. Prior to this study, little was known about whether the type or severity of mental illness influences receipt of preventive services such as mammograms.
"Although women with mental disorders are less likely to receive mammography than women who do not have mental disorders, we found that both the type and severity of mental illness does influence the receipt of mammograms. Women with psychotic disorders such as schizophrenia are significantly less likely to receive mammograms than women in the general population. However, women with mild depression do not differ markedly. But, as depression severity increases, so does the likelihood that women will not receive needed screening," said senior author Caroline Carney Doebbeling, M.D., M.Sc., associate professor of psychiatry and medicine at the I.U. School of Medicine. She is also a Regenstrief Institute, Inc. research scientist and director of the IU Cancer Center's CompleteLife program.
Severity contributed to lower receipt of mammography among women with mood and anxiety disorders, however women with psychotic, alcohol, and substance abuse disorders had decreased odds for receipt of mammography regardless of severity, the authors reported.
A comparison of insurance claims data for 59,673 women with a mental illness diagnosis and 131,683 women without this type of diagnosis indicated that the presence, type, and severity of the mental illness significantly influenced receipt of mammography throughout a five-year period. All the women in the study were between the ages of 40 and 64 and were privately insured.
Mammography has been shown to reduce death from breast cancer in women. The U.S. Preventive Services Task Force and the American Cancer Society recommend that all women undergo mammography a minimum of every 1 to 2 years beginning at age 40 years and annual screening beginning at age 50 years. According to the Centers for Disease Control, in 2002, 75.9 percent of women 40 years and older had a mammography screening in the past two years.
"Women with severe mental illness or psychotic and substance abuse disorders should be targeted to ensure delivery of mammography," said Dr. Carney Doebbeling, who is both a psychiatrist and an internist.
Laura E. Jones, M.Sc., is co-author of the study which was supported by the National Institute of Mental Health.
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