Serious Psychological Distress as a Barrier to Cancer Screening Among Women

  • Xiaoling Xiang
    Correspondence to: Ms. Xiaoling Xiang, MPhil, School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada, Urbana, IL 61801. Phone: 217-419-6693; Fax: 217-244-5220.
    School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Published:October 29, 2014DOI:



      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.


      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.


      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.


      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.
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      Xiaoling Xiang, MPhil, is affiliated with the School of Social Work, University of Illinois at Urbana-Champaign. Her areas of research expertise and interests include the connection between mental health and physical health, health promotion and health behaviors, health services research, and social determinants of health.