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Mental Health Disorders Associated with Mammography Receipt Among Women Veterans
Thad E Abrams1,2, Amy Gravely3, Elisheva Danan3,4
1Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA. Thad-Abrams@uiowa.edu.
Background:
Women experiencing mental health disorders (MHD) have shown lower preventive mammography screening rates. Studies in veterans have shown inconsistent results and been limited to single facilities, failed to separate substance use and MHD into individual categories, and have had limited analyses on systems level covariates.
Objective:
The study examined the individual associations between MHD in univariate and multivariate analyses and included adjustments for factors previously shown to impact on the rate of receipt of recommended preventive breast cancer screening.
Participants:
Women veterans ages 50 through 54 receiving primary care in the Veterans Health Administration (VHA) in 2021 and 2022.
Study Design:
The design was an observational cohort study using health data including patient level factors and system factors. Women veterans were studied over a 2-year period and generalized liner mixed regression models examined for the association between MHD (e.g., depression, PTSD, anxiety, opioid, cannabis) on mammography.
Results:
A total of 36,720 eligible women veterans were identified in the 2-year evaluation period, of which 79.2% received preventive breast cancer screening. Depression was the most common MHD (17,798; 48.5%). In univariate analyses, depression, PTSD, and anxiety disorders were not associated with mammography receipt. For individual substance use disorders, univariate analyses revealed opioid, cocaine, cannabis, and alcohol were all significantly associated with lower mammogram rates. In multivariate models including any significant univariate person or system factors, decreased rates of mammography were associated with bipolar (OR 0.76, p < .001), schizophrenia (OR 0.62, p < .001), opioid use (OR 0.50, p < .001), and cannabis use (OR 0.77, p < .001).
Conclusions:
Multivariate regression revealed that bipolar disorder, schizophrenia, opioid and cannabis use disorders are significantly associated with lower mammography rates while depression, anxiety, PTSD and alcohol use disorder are not.
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