Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA.
Med Care. 2010 Oct;48(10):934-9. doi: 10.1097/MLR.0b013e3181e57901.
Research regarding the association between mental health and colorectal cancer (CRC) screening has produced mixed results. Variations may be explained by methodology, including whether potential confounders such as frequency of healthcare visits are considered.
We examined the association between mental health and CRC screening, before and after controlling for demographics, comorbidities, and outpatient visit frequency.
Observational study based on a retrospective cohort.
A total of 855 veterans receiving care at a Veterans Affairs Medical Center.
Medical record data were used to assess CRC screening rates and mental health status (number of diagnoses and the presence of depression, anxiety, posttraumatic stress disorder, substance, or psychotic disorders). Logistic regression was used to estimate the association between mental health diagnoses and CRC screening, before and after controlling for covariates.
Bivariate analyses suggested that CRC screening rates were higher for patients with a history of one or more mental health diagnoses (57% vs. 47%, P < 0.01). However, adjusting for timing of mental health diagnosis and outpatient visit frequency resulted in significant negative associations between CRC screening and all measures of mental health except posttraumatic stress disorder.
Estimates of the association between mental health and CRC screening that do not adjust for outpatient visit frequency may be misleading. Veterans with mental health diagnoses were significantly less likely to be screened for CRC than their counterparts with no mental health diagnoses and an equal number of outpatient visits.
关于心理健康与结直肠癌（CRC）筛查之间的关联的研究结果喜忧参半。这种差异可能可以通过方法学来解释，包括是否考虑了潜在的混杂因素，如就诊频率。
我们在控制人口统计学因素、合并症和门诊就诊频率后，检查了心理健康与 CRC 筛查之间的关联。
基于回顾性队列的观察性研究。
在退伍军人事务医疗中心接受治疗的 855 名退伍军人。
使用病历数据评估 CRC 筛查率和心理健康状况（诊断次数以及是否存在抑郁、焦虑、创伤后应激障碍、物质或精神病障碍）。使用逻辑回归来估计心理健康诊断与 CRC 筛查之间的关联，在控制协变量之前和之后。
双变量分析表明，有一个或多个心理健康诊断史的患者 CRC 筛查率更高（57% vs. 47%，P < 0.01）。然而，调整心理健康诊断时间和门诊就诊频率后，CRC 筛查与除创伤后应激障碍以外的所有心理健康测量指标之间均呈显著负相关。
如果不调整门诊就诊频率，估计心理健康与 CRC 筛查之间的关联可能会产生误导。与没有心理健康诊断且门诊就诊次数相同的患者相比，有心理健康诊断的退伍军人接受 CRC 筛查的可能性明显降低。
