title: Depression and anxiety diagnoses are not associated with delayed resolution of abnormal mammograms and pap tests among vulnerable women.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Women receiving care in six Boston-area community health centers 2004-2005: 523 with abnormal mammograms, 474 with abnormal Pap tests.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. andrea.kronman@bmc.org
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Kronman
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
authors.forename: Tim
authors.initials: T
authors.lastname: Heeren
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Beaver
authors.forename: Mary
authors.initials: M
authors.lastname: Flynn
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D001900:Boston; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D016001:Confidence Intervals; D057210:Delayed Diagnosis / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D008913:Minority Groups; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013223:Statistics as Topic; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000523:psychology*; D014626:Vaginal Smears / Q000523:psychology; D016387:Women's Health; D055815:Young Adult
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