From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway.
From the Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
Am J Prev Med. 2023 Jan;64(1):76-85. doi: 10.1016/j.amepre.2022.08.011. Epub 2022 Oct 8.
The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation.
Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships.
Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests.
These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.
结直肠癌筛查计划的有效性取决于参与率。本研究旨在探讨精神疾病的类型和严重程度与结直肠癌筛查参与之间的关系。
2012 年至 2017 年间，共有 46919 人受邀接受乙状结肠镜筛查，70019 人受邀接受粪便免疫化学检测。2022 年，我们使用逻辑回归评估了在筛查邀请前一年使用抗精神病药、抗焦虑药、催眠药和抗抑郁药与筛查参与之间的关系，并根据人口统计学和社会经济因素进行了调整。我们使用个体药物的定义日剂量来评估剂量-反应关系。
总体而言，所有受邀者中有 19.2%（女性为 24.8%，男性为 13.4%）至少使用了一种精神药物。在两种筛查方式中都未参与的人更有可能使用抗焦虑药（使用者中为 60.7%，非使用者中为 43.2%；OR=1.53；95%CI=1.45，1.62）和抗精神病药（使用者中为 64.3%，非使用者中为 43.8%；OR=1.41；95%CI=1.30，1.53），且这两种药物的剂量越高，与未参与筛查的关联越强。催眠药和抗抑郁药与较高剂量的药物之间只有较弱的关联。在分别被开 0、1、2 和 3-4 类精神药物的人群中，筛查参与率分别为 57.3%、52.3%、42.9%和 35.4%。在这两种筛查测试中，使用精神药物与未参与筛查之间的关系相似。
这些发现表明，患有精神疾病的个体参与结直肠癌筛查的比例存在显著差异，且与筛查方法无关。此外，筛查参与情况还取决于精神疾病的类型和严重程度。需要采取有针对性的干预措施，以确保精神疾病患者能够获得结直肠癌筛查的益处。
