(Jan. 3, 2018) Women with serious mental illness are significantly less likely to have had a mammography test than those without mental illness, according to new research published this week in Psychiatric Services.
With prevalence rates of breast cancer nearing 20% of women in the United States, preventative mammography screens are becoming ever more important. However, women with serious mental illness are significantly less likely to receive these life-saving tests.
Melanie Thomas and colleagues from the Weill Institute for Neurosciences at University of California San Francisco analyzed administrative records from 14,651 women aged 48 to 67 with a serious mental illness enrolled in California Medicaid in 2011. Mammography results were stratified based on mental illness diagnosis, demographics, history of comorbid substance use disorder and county of residence, among others.
Study results
The findings were striking. Only 26.3% of the entire cohort of women with serious mental illness had received breast cancer screening in the past year, more than 17 points less than the national average of 43% for women in the same age group.
In addition, those with the most severe of mental illnesses were even less likely to receive this preventative care. Less than 23% of women with schizophrenia spectrum disorder received a mammogram during the study period, compared to 32% of those with anxiety and 30% with depressive disorders.
Women with a history of comorbid drug or alcohol use were also significantly less likely to have received breast cancer screens than for those without substance use disorders. Interestingly, woman with severe mental illness in rural counties were more likely to have received a mammogram than for those living in urban areas, according to the results.
Implications for the future
Nearly 40,000 women in the United States die from breast cancer every year, a number that is climbing due to the aging population. It is well documented that individuals with serious mental illness die up to 25 years earlier than those in the general population, mostly due to comorbid chronic physical conditions and lack of physical health care. In addition, women with serious mental illness are disproportionately affected by this trend as we have previously reported in our paper 10 ways women with serious mental illness are overlooked and undercounted.
Mammograms and other preventative health screens significantly reduce mortality due to chronic health conditions, according to preventive health experts. Women who had received non-psychiatric health care during the study period had higher breast cancer screening rates than those who received no such care, according to the results. An integrated approach is needed to improve screening rates and improve the health outcomes of women with serious mental illnesses.
"Effectively closing this disparity gap will require individual, clinical, and systemic changes," according to the authors, "including both increased outreach to women with severe mental illness and increased communication between mental health and primary care providers."
Elizabeth Sinclair
Research Associate
References:
- Thomas, M. et al. (January 2018). Mammography among women with serious mental illness: Exploring disparities through a large retrospective cohort study. Psychiatric Services.