Women enrolled in California’s Medicaid program (Medi-Cal) who have been diagnosed with severe mental illness have been screened for cervical cancer at much lower rates than other women, according to a new study by researchers at UC San Francisco.
In an examination of California Medicaid administrative records for 31,308 women from 2010 and 2011, the UCSF scientists found that only 20.2 percent of women with severe mental illness were screened for cervical cancer during the one-year study period. Over the same period, the screening rate for the general population of women in California was calculated to be 42.3 percent.
Although women with severe mental health problems are less likely to be screened for cervical cancer, they are at greater risk for developing the disease, according to the senior author of the study, Christina Mangurian, MD, associate professor of clinical psychiatry at UCSF. She directed the study with Dean Schillinger, MD, a UCSF professor of medicine and member of the UCSF Helen Diller Family Comprehensive Cancer Center.
“The women were receiving services in a public health setting, but were not receiving preventive services as often as women in the general population,” Mangurian said. “The results of this very large study indicate that we need to better prioritize cervical cancer screening for these high-risk women with severe mental illnesses.”
In their analysis of the data, published online April 17, 2017, in the journal Psychiatric Services, the researchers considered possible predictors of screening rates, including age, race or ethnicity, rural versus urban residence, severe mental illness diagnosis, drug or alcohol use, and evidence for use of health care services.
They discovered that factors significantly associated with cervical cancer screening in the study population included age, race or ethnicity, specific mental health diagnosis — and most of all, utilization of primary care services, not just specialty mental health services.
Among the women with severe mental illness included in the study, 42 percent had some form of schizophrenia, 29 percent had major depression, 18 percent had bipolar disorder, and the remainder had a diagnosis of anxiety or another psychiatric diagnosis.