Exploring Cancer Screening in the Context of Unmet Mental Health Needs: A Participatory Pilot Study

Williams, Abigail; Erb-Downward, Jennifer; Bruzelius, Emilie; O'Hara-Cicero, Ellen; Maling, Alison; Machin, Lauren; Viera-Delgado, Meiling; Valera, Pamela; Maysonet, Nicole; Weiss, Elisa S.

doi:10.1353/cpr.2013.0027

Cited by 18 publications

(11 citation statements)

References 38 publications

(25 reference statements)

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“…11,26 At the system-level, there is also evidence of the prioritisation of more immediate health concerns in these individuals by primary care providers to the detriment of recommendations for preventative healthcare. 27,28 This is especially apposite given the highly influential role of primary care providers in encouraging participation in breast screening. 27,29 Furthermore, evidence from qualitative studies indicates that some individuals have reported feeling mistreated as a result of the stigma surrounding mental illness, and this lack of staff education and compassion negatively impacts a woman's likelihood of subsequent attendance.…”

Section: Discussionmentioning

confidence: 99%

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study

Ross¹,

Maguire²,

Donnelly³

et al. 2019

European Journal of Public Health

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Background Research from the USA indicates disparities in breast cancer screening uptake for women with poor mental health. However, no attempt has been made to examine the contribution of poor mental health to socio-demographic variations in breast screening uptake. The current study aims to examine the impact of self-reported chronic poor mental health on attendance at breast screening in the UK, and to what extent this explains socio-demographic inequalities in screening uptake. Methods Breast screening records were linked to 2011 Census records within the Northern Ireland Longitudinal Study. This identified a cohort of 57 328 women who were followed through one 3-year screening cycle of the National Health Service Breast Screening Programme. Information on mental health status, in addition to other individual and household-level attributes, was derived from the 2011 Census. Logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of attendance at screening. Results 10.7% of women in the cohort reported poor mental health, and in fully adjusted analyses, these individuals were 23% less likely to attend breast screening (OR 0.77; 95% CI 0.73–0.82). Although poor mental health was a strong predictor of screening uptake, it did not explain the observed inequalities in uptake by socio-economic status, marital status, or area of residence. Conclusions This study provides novel evidence of inequalities in breast screening uptake for women with chronic poor mental health in the UK. Targeted interventions are necessary to ensure equitable screening access and to enhance overall mortality benefit.

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Section: Discussionmentioning

confidence: 99%

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study

Ross¹,

Maguire²,

Donnelly³

et al. 2019

European Journal of Public Health

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“…The observed disparities in both cancer screening and mental health care among low-income and racial/ethnic women have resulted in an alarming public health situation. There is growing evidence that women who experience untreated mental health problems (e.g., depression) are less likely to participate in cancer screenings (22, 23). Lower participation in cancer screening results in cancer diagnoses at later stages of tumor growth and metastasis, contributing to higher morbidity and mortality rates (6).…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Lower participation in cancer screening results in cancer diagnoses at later stages of tumor growth and metastasis, contributing to higher morbidity and mortality rates (6). Because this disparity widens among women from racial or ethnic minority groups (23), it is imperative to examine the intersectionality of sociodemographic factors on screening behaviors and depression treatment. That is, women who are both low-income and from racial/ethnic minorities may experience greater challenges related to cancer screening and depression treatment in additive and multiplicative ways, making them especially vulnerable to poor outcomes.…”

Section: Background and Objectivesmentioning

confidence: 99%

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression among Low-Income Women

Cassells

Lin

et al. 2020

Preprint

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Background: Women from low-income, racial/ethnic minority backgrounds receive fewer cancer screenings than other women and have higher rates of depression, which can interfere with cancer screening participation. Objective: Assess the comparative effectiveness of two interventions to improve breast, cervical, and colorectal cancer screening and reduce depression among underserved women with depressive symptoms. Design: Randomized comparative effectiveness trial Setting: Six Federally Qualified Health Centers Participants: N=757, 50-64 years with depression symptoms and overdue for cancer screening. Interventions: Participants were randomized to collaborative depression care plus cancer screening intervention (Collaborative Care Intervention, CCI) or cancer screening intervention alone (Prevention Care Management, PCM). Both of these evidence-based, telephone interventions were delivered in English or Spanish, for up to 12 months, by care managers. Measurements: Electronic Health Records provided cancer screening data (primary outcome). PHQ-9 measured depression at study entry (T0), 6- and 12-months post-baseline (T1 and T2, respectively; secondary outcome). Results: Analyses revealed statistically significant increases in up-to-date status for all cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the two interventions in improving cancer screening rates or reducing depression. Limitations: Depressive symptom improvement may be explained by typical symptom remission. The study duration (12-months) was insufficient to evaluate intervention effects on long-term cancer screening behavior and depression. This study was not powered for site-level analysis. Conclusions: CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities, however neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.

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“…Given the observation that women who experience mental health problems such as depression are less likely to participate in preventive behaviors, including cancer screenings (Lin et al, 2019; Mitchell et al, 2014; Ross et al, 2020; Williams et al, 2013), a recognized need exists to address the cancer screening status among depressed women from lower-income backgrounds. A recent meta-analysis found that screening occurred significantly less frequently among individuals with mental illness compared with the general population (Solmi et al, 2020).…”

mentioning

confidence: 99%

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women

Weiss

Cassells

Lin

et al. 2022

Journal of Prevention and Health Promotion

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Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.

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Exploring Cancer Screening in the Context of Unmet Mental Health Needs: A Participatory Pilot Study

Cited by 18 publications

References 38 publications

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study

Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression among Low-Income Women

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women

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