Mammography Rates 'Abysmal' for Mentally Ill


NEW ORLEANS — Women being treated for a mental health disorder may be getting shortchanged when it comes to preventive medical care, said Caroline C. Carney-Doebbeling, M.D.

A comparison of insurance claims data for 59,673 women with a mental illness diagnosis and 131,683 without one showed that the presence, type, and severity of the mental illness significantly influenced receipt of mammography during the 5-year period being considered, Dr. Carney-Doebbeling said at the annual meeting of the Society of General Internal Medicine.

The mammography rates for women diagnosed with severe anxiety and mood disorders “were abysmal,” she noted.

Compared with women with no mental illness diagnosis, women who were classified as having moderately severe or highly severe symptoms of mental illness had odds ratios of 62% and 38%, respectively, for receiving a mammogram. Women with “low-severity” mental health symptoms were as likely as their peers without mental illness to undergo mammography, said Dr. Carney-Doebbeling of the University of Iowa.

The type of diagnosis also influenced mammography rates. “Women with any psychotic disorder, regardless of the severity, received fewer than half the number of mammograms as women in the control group,” Dr. Carney-Doebbeling said.

The women who fared the worst were those with highly severe mental illness and a diagnosis of a somatoform disorder. “The likelihood of receiving a mammography in these women was only 17%,” she said.

Data for the study came from an analysis of all Wellmark Blue Cross Blue Shield claims records during 1996–2001 for women aged 40–65 years who had filed at least one medical claim and who did not have a diagnosis of breast cancer. Women were classified as having a mental health disorder if this diagnosis was reflected in at least one claim during the eligibility period.

The criterion for low-severity mental health disorder was the absence of a dual mental health diagnosis or related hospitalization. A moderately severe classification was noted for those who had a dual diagnosis or hospitalization; a high-severity classification required the presence of both.

The investigators used multivariate logistic regression to compare mammography rates among women who had any mental illness diagnosis with those who had none, and to determine if there were associations between specific type and severity of mental health disorders. The analyses were adjusted for age, number of months of eligibility, rural residence, and number of non-mental health visits to primary care physicians and ob.gyns.

“With few exceptions, mental illness was a significant barrier to mammography receipt among women in this study,” Dr. Carney-Doebbeling said. “There is no clear indication of why this should be, considering all of the women were insured and should have had similar access to mammography facilities.”

It is possible the fragmentation of the current mental health care system serves as a barrier, she said, “as prior studies have noted that women with chronic mental health disorders often have difficulty with care disparities.”

“These data have significant implications for the overall health of women,” particularly in light of the high incidence and prevalence of mood and anxiety disorders in women, Dr. Carney-Doebbeling said. More research is needed to understand the relationship between the underuse of mammography and mental illness/mental health care to develop effective interventions for increasing screening rates in this population, she concluded.

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