Receipt of Cervical Cancer Screening in Female Veterans: Impact of Posttraumatic Stress Disorder and Depression

• Published in: Women's health issues Vol. 23; no. 3; pp. e153 - e159
• Main Authors: Weitlauf, Julie C., PhD, Jones, Surai, MS, Xu, Xiangyan, MS, Finney, John W., PhD, Moos, Rudolf H., PhD, Sawaya, George F., MD, Frayne, Susan M., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2013
• Subjects: Adult; Cervical cancer; Comorbidity; Cross-Sectional Studies; Depression; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Early Detection of Cancer - statistics & numerical data; Female; Humans; Logistic Models; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Middle Aged; Obstetrics and Gynecology; Posttraumatic stress disorder; Primary health care; Primary Health Care - statistics & numerical data; Screening; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; United States; United States Department of Veterans Affairs; Uterine Cervical Neoplasms - diagnosis; Veterans - psychology; Women; United States
• ISSN: 1049-3867; 1878-4321
• DOI: 10.1016/j.whi.2013.03.002

Abstract Purpose We evaluated receipt of cervical cancer screening in a national sample of 34,213 women veterans using Veteran Health Administration facilities between 2003 and 2007 and diagnosed with 1) posttraumatic stress disorder (PTSD), or 2) depression, or 3) no psychiatric illness. Methods Our study featured a cross-sectional design in which logistic regression analyses compared receipt of recommended cervical cancer screening for all three diagnostic groups. Results Cervical cancer screening rates varied minimally by diagnostic group: 77% of women with PTSD versus 75% with depression versus 75% without psychiatric illness were screened during the study observation period ( p  < .001). However, primary care use was associated with differential odds of screening in women with versus without psychiatric illness (PTSD or depression), even after adjustment for age, income and physical comorbidities (Wald Chi-square (2): 126.59; p  < .0001). Specifically, among low users of primary care services, women with PTSD or depression were more likely than those with no psychiatric diagnoses to receive screening. Among high users of primary care services, they were less likely to receive screening. Conclusion Psychiatric illness (PTSD or depression) had little to no effect on receipt of cervical cancer screening. Our finding that high use of primary care services was not associated with comparable odds of screening in women with versus without psychiatric illness suggests that providers caring for women with PTSD or depression and high use of primary care services should be especially attentive to their preventive healthcare needs.