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Abstract

Objective:

This study compared rates of cervical cancer screening and acute care (primary or gynecological) visits among women with and without a diagnosis of psychosis, substance use disorder, bipolar disorder or mania, or depression.

Methods:

Using data about women (N=105,681) enrolled in Maryland's Medicaid program in fiscal year 2005, the authors constructed logistic models with cancer screening and acute care visits as dependent variables and serious mental illness flags as independent variables. Covariates were age, race, geography, Medicaid eligibility category, and sexually transmitted diseases. The logistic model of cervical cancer screening outcomes was repeated with acute care visits as a covariate.

Results:

Women with psychosis (N=4,747), bipolar disorder or mania (N=3,319), or depression (N=5,014) were significantly (p<.05) more likely than women in a control group without such disorders (N=85,375) to receive cancer screening (adjusted odds ratio (AOR) range=1.46–1.78) and to have associated acute care visits (AOR range=1.45–2.15). Compared with those in the control group, women with a substance use disorder, with (N=1,104) or without (N=6,122) psychosis, demonstrated reduced odds of cancer screening (AOR=.80) but similar odds of acute care visits (AOR=1.04). Acute care visits were strongly correlated with cancer screens. Genital cancer prevalence did not significantly differ among diagnostic groups.

Conclusions:

In Maryland Medicaid, the odds of cancer screening and related acute care visits were greater for women with major mental disorders compared with women in the control group. For women with substance use disorders, however, screening was reduced and acute care visits were similar compared with women in the control group. Providers should encourage and support their patients with substance use disorders to increase use of preventive care services by primary care physicians and gynecologists. (Psychiatric Services 63:815–822, 2012; doi: 10.1176/appi.ps.201100301)

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Figures and Tables

Table 1 Eligibility categories for Maryland Medicaid
Table 2 Characteristics of all nonpregnant women (N=105,681) enrolled continuously in Maryland Medicaid between July 2004 and June 2005, by diagnosis
Table 3 Logistic regression results for cervical cancer screening and acute care visits among women continuously enrolled in Maryland Medicaid between July 2004 and June 2005
Table 4 Cervical cancer screening rates among Medicaid enrollees (N=104,157) with or without a primary care or gynecological visit, by type of visit

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Cover: Girl With Ball, by Roy Lichtenstein, 1961. Oil on canvas. Gift of Philip Johnson. The Museum of Modern Art, New York. Digital image © The Museum of Modern Art/Licensed by SCALA/Art Resource, New York.
Psychiatric Services
Pages: 815 - 822
PubMed: 22660581

History

Published online: 1 August 2012
Published in print: August 2012

Authors

Details

Michael T. Abrams, M.P.H.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Carol S. Myers, Ph.D.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Stephanie M. Feldman, M.S.W., L.C.S.W.-C.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Cynthia Boddie-Willis, M.D., M.P.H.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Junyong Park, Ph.D.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Robert P. McMahon, Ph.D.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.
Deanna L. Kelly, Pharm.D.
Mr. Abrams and Dr. Boddie-Willis are affiliated with The Hilltop Institute, University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Sondheim Bldg., Third Floor, Baltimore, MD 21250 (e-mail: [email protected]). Dr. Myers is with the National Institute on Drug Abuse, Baltimore. Ms. Feldman, Dr. McMahon, and Dr. Kelly are with the Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore. Dr. Park is with the Department of Math and Statistics, UMBC.

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