title: Depressive symptom burden as a barrier to screening for breast and cervical cancers.
abstract: BACKGROUND
  Depression has been associated with lower cancer screening rates in some studies. We examined whether a higher depressive symptom burden presented a barrier to subsequent mammography and Papanicolaou (Pap) smear testing.
  
  
  METHODS
  Study of Women's Health Across the Nation (SWAN) is a cohort study of 3302 community-dwelling women. At baseline, participants were 42-52 years old, had no surgical removal of the uterus or both ovaries, no current use of hormones that affect the ovaries, and at least one menses in the previous 3 months. SWAN data spanned 4 years. Repeated measures logistic models determined odds of mammography and of Pap screening in the year following depressive symptom burden, as determined by Center for Epidemiological Studies Depression score (CES-D). The models controlled for age, race/ethnicity, health insurance, medical history and use, smoking, obesity, and socioeconomic status.
  
  
  RESULTS
  At baseline, 75.6% (2493 of 3297) had a low depressive symptom burden (CES-D score < 16, referent), 9.5% (312 of 3297) had a moderate burden (CES-D 16-20), and 14.9% (492/3297) had a high burden (CES-D > or = 21). Women with a high depressive symptom burden had, in the subsequent year, significantly lower odds of mammography (OR 0.84, 95% CI 0.73-0.97) but not Pap smear (OR 0.88, 95% CI 0.76-1.03). There was not a significant dose-response relationship between depressive symptom burden and screening.
  
  
  CONCLUSIONS
  The presence of a high depressive symptom burden is a modest independent risk factor for lack of subsequent mammography. Ensuring that depressed patients receive regular cancer screening services is important.
authors.affiliation: Division of General Internal Medicine, Rhode Island Hospital, Providence, RI, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pirraglia
authors.forename: Pallabi
authors.initials: P
authors.lastname: Sanyal
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology; D015331:Cohort Studies; D016001:Confidence Intervals; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000523:psychology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health