title: Psychiatric morbidity and non-participation in breast cancer screening.
abstract: BACKGROUND
  Organised breast cancer screening is currently one of the best strategies for early-stage breast cancer detection. However, early detection has proven challenging for women with psychiatric disease. This study aims to investigate psychiatric morbidity and non-participation in breast cancer screening.
  
  
  METHODS
  We conducted an observational cohort study including women invited to the first organised screening round in the Central Denmark Region. Data on psychiatric diagnosis, psychoactive prescription medicine and consultation with private psychiatrists were obtained from Danish registries and assessed for a period of up to 10 years before the screening date.
  
  
  RESULTS
  The cohort comprised 144,264 women whereof 33.0% were registered with an indication of psychiatric morbidity. We found elevated non-participation propensity among women with a psychiatric diagnosis especially for women with schizophrenia and substance abuse. Also milder psychiatric morbidity was associated with higher non-participation likelihood as women who had redeemed psychoactive prescription medicine or have had minimum one consultation with a private psychiatrist were more likely not to participate. Finally, we found that the chronicity of psychiatric morbidity was associated with non-participation and that woman who had a psychiatric morbidity defined as 'persistent' had higher likelihood of non-participation than women with recently active morbidity or inactive psychiatric morbidity.
  
  
  CONCLUSIONS
  This study showed a strong association between psychiatric morbidity and an increased likelihood of non-participation in breast cancer screening in a health care system with universal and tax-funded health services. This knowledge may inform interventions targeting women with psychiatric morbidity as they have poorer breast cancer prognosis.
authors.affiliation: The Research Centre for Cancer Diagnosis in Primary Care (CaP), the Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; Department for Public Health Programs, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Central Denmark Region, Denmark. Electronic address: line.jensen@ph.au.dk.
authors.forename: Line Flytkjær
authors.initials: LF
authors.lastname: Jensen
authors.affiliation: The Research Centre for Cancer Diagnosis in Primary Care (CaP), the Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
authors.forename: Anette Fischer
authors.initials: AF
authors.lastname: Pedersen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
authors.affiliation: Department for Public Health Programs, Regional Hospital of Randers, Skovlyvej 1, 8930 Randers, Central Denmark Region, Denmark.
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
authors.affiliation: The Research Centre for Cancer Diagnosis in Primary Care (CaP), the Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D015331:Cohort Studies; D003718:Denmark; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D012042:Registries
keywords: Breast cancer; Denmark; Psychiatric diseases; Psychoactive medicine; Screening participation