title: Serious psychological distress as a barrier to cancer screening among women.
abstract: BACKGROUND
  The purposes of the study were to examine the association of serious psychological distress (SPD) and cancer-screening utilization in a nationally representative sample of women aged 40 to 74 years and to identify barriers and facilitating factors to breast and cervical cancer screening among women with SPD.
  
  
  METHODS
  Women aged 40 to 74 (n = 17,770) were selected from the Household Component of Medical Expenditure Panel Survey series of 2007, 2009, and 2011. SPD was defined as a score of 13 of higher on the Kessler Psychological Distress Scale-6 items (K6 scale) of nonspecific psychological distress. Logistic regression was conducted to examine the association between SPD and up-to-date cancer screening.
  
  
  RESULTS
  Women with SPD had significantly lower rates of up-to-date clinical breast examination (67.56% vs. 81.93%), mammography (59.94% vs. 75.56%), and Pap smear (72.27% vs. 85.37%). In multivariate logistic regression analyses adjusting for sociodemographics, insurance, health behaviors, comorbidity, and service utilization, SPD was associated with nearly 40% decreased odds of being up to date with all three screening tests. Having a usual place of care, being physically active, and a greater number of past-year medical visits were strongly associated with higher odds of screening utilization among women with SPD.
  
  
  CONCLUSIONS
  Women with mental health problems have substantial risk for low use of routine breast and cervical cancer screenings. The K6 may be a useful tool to screen this risk factor. Frequent contact with the health care system among women with mental health problems opens up opportunities to reduce the mental illness-related disparities in utilization of cancer screening.
authors.affiliation: School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois. Electronic address: xxiang3@illinois.edu.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Xiang
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data