Depression, Anxiety, and Compliant Breast Cancer Screening: Results from the Health Information National Trends Survey 5, Cycle 2

Background and purpose:  As the second leading cause of cancer death among women, breast cancer directly affects lives of the over 331,000 women expected to receive a diagnosis in 2019.  Furthermore, over 41,000 women are expected to die from breast cancer in the same year; and women from racial/ethnic groups and lower socioeconomic environments are disproportionately affected. As a result, secondary prevention to detect breast cancer as early as possible remains a primary goal of health care policy.  Healthy People 2020 aims for 81% of women aged 50-74, the prime years for breast cancer diagnoses, to receive regular mammogram screening.  Recommendations define complaint screening as receiving at least one mammogram every two years between the ages of 50-74 for women with an average risk of breast cancer.  While many studies exist examining ways to increase screening especially among priority populations, few have examined mental health status in relation to screening outcomes.  Therefore, this study examines the relationship between diagnoses of depression and anxiety and compliant mammogram screening among a nationally representative sample.

Methods:  This study analyzes data from the most recent cycle of the Health Information National Trends Survey (HINTS 5, Cycle 2) conducted by the National Cancer Institute.  Population weighted data of 3,504 respondents, estimating a total of 249,489,772 individuals in the US, provided responses to demographic, self-reported health, cancer prevention beliefs, mental health status, and mammogram screening questions.  The sample included women aged 50-74 (N=1,047), corresponding to the recommendation guidelines.  A series of weighted logistic regression models examined the odds of compliant mammogram screening.

Results:  In the demographic only model, women with lower incomes experienced higher odds of compliant mammogram screening compared to those with higher incomes.  The next model included health status and cancer belief variables and found that women with favorable views of their health status (excellent, very good, or good) experienced lower odds of compliant mammogram screening.  This finding repeated in the final model, where women who reported being diagnosed with depression or anxiety experienced significantly lower odds (OR: 0.56, CI: 0.32-0.99) of having a mammogram within the last two years controlling for demographic, health status, and cancer prevention belief variables.

Conclusions and implications:  The results indicate that depression and anxiety may serve as barriers to compliant breast cancer screening.  The findings from this study also yield valuable information for health social workers involved in comprehensive health and mental health care for individuals.  First, women in treatment for depression or anxiety may represent a key group to assess for selfcare and health seeking behavior related to physical health.  Similarly, health care practitioners aware of patients’ depression or anxiety diagnoses can use these findings to encourage complaint breast cancer screening practices among their patients.  As the data are cross-sectional, future studies should explore causal relationships between mental health status and cancer screening to confirm the results of this study.