Women's Health Unit, Section of General Internal Medicine, Department of Medicine, and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA 02118, USA.
J Gen Intern Med. 2012 Apr;27(4):452-7. doi: 10.1007/s11606-011-1920-5. Epub 2011 Nov 15.
Delays in care after abnormal cancer screening contribute to disparities in cancer outcomes. Women with psychiatric disorders are less likely to receive cancer screening and may also have delays in diagnostic resolution after an abnormal screening test.
To determine if depression and anxiety are associated with delays in resolution after abnormal mammograms and Pap tests in a vulnerable population of urban women.
We conducted retrospective chart reviews of electronic medical records to identify women who had a diagnosis of depression or anxiety in the year prior to the abnormal mammogram or Pap test. We used time-to-event analysis to analyze the outcome of time to resolution after abnormal cancer screening, and Cox proportional hazards regression modeling to control for confounding.
Women receiving care in six Boston-area community health centers 2004-2005: 523 with abnormal mammograms, 474 with abnormal Pap tests.
Of the women with abnormal mammogram and pap tests, 19% and 16%, respectively, had co-morbid depression. There was no difference in time to diagnostic resolution between depressed and not-depressed women for those with abnormal mammograms (aHR = 0.9, 95 CI 0.7,1.1) or Pap tests (aHR = 0.9, 95 CI 0.7,1.3).
An active diagnosis of depression and/or anxiety in the year prior to an abnormal mammogram or Pap test was not associated with a prolonged time to diagnostic resolution. Our findings imply that documented mood disorders do not identify an additional barrier to resolution after abnormal cancer screening in a vulnerable population of women.
癌症筛查异常后护理的延误导致癌症结局存在差异。患有精神疾病的女性接受癌症筛查的可能性较低，并且在异常筛查测试后，其诊断的明确时间也可能会延长。
确定在一个城市中处于弱势地位的女性群体中，抑郁和焦虑是否与异常乳房 X 光片和巴氏涂片检查后诊断明确时间的延迟有关。
我们对电子病历进行了回顾性图表审查，以确定在异常乳房 X 光片或巴氏涂片检查前一年患有抑郁或焦虑症的女性。我们使用时间事件分析来分析异常癌症筛查后明确时间的结果，并使用 Cox 比例风险回归模型进行混杂因素控制。
2004-2005 年在波士顿地区六个社区卫生中心接受治疗的女性：523 例乳房 X 光片异常，474 例巴氏涂片异常。
在乳房 X 光片和巴氏涂片检查异常的女性中，分别有 19%和 16%患有共病性抑郁。对于乳房 X 光片异常的女性（aHR=0.9，95%CI 0.7，1.1）或巴氏涂片异常的女性（aHR=0.9，95%CI 0.7，1.3），抑郁和不抑郁的女性在诊断明确时间上没有差异。
在异常乳房 X 光片或巴氏涂片检查前一年被确诊为抑郁和/或焦虑症与诊断明确时间的延长无关。我们的研究结果表明，在一个处于弱势地位的女性群体中，记录的情绪障碍并不能识别异常癌症筛查后明确诊断的额外障碍。
