The influence of type and severity of mental illness on receipt of screening mammography

BACKGROUND: Women with mental illness may be at risk for failure to receive recommended preventive services such as mammography. Little is known about whether the type or severity of mental illness influences receipt of preventive services. OBJECTIVES: To measure the influence of type and severity of mental illness on receipt of mammography. DESIGN: Retrospective study of administrative claims data, 1996 to 2001. SUBJECTS: Privately insured women age 40 to 64 years, with and without claims for mental illness, and who were eligible for mammography between 1996 and 2001. MEASUREMENTS: Odds ratios (OR) for receipt of screening mammography, any mammography, and follow-up mammography, adjusted for age, rural location, utilization of nonmental health services, and severity and type of the mental disorder. Severity measures were based on utilization of outpatient and inpatient mental health services and presence of comorbid substance use disorder. RESULTS: Women with any mental disorder were significantly less likely to receive mammography than controls. This was strongly influenced by severity of mental illness (any mammography: moderate severity OR 0.62; confidence interval [CI] 0.59 to 0.66: high severity OR 0.38; CI 0.33 to 0.43). Whereas severity contributed to lower receipt of mammography among women with mood and anxiety disorders, women with psychotic, alcohol, and substance abuse disorders had decreased odds for receipt of mammography regardless of severity. CONCLUSIONS: Women with mental disorders are at risk for failure to receive mammography, a recommended preventive service. Women with severe mental illness or psychotic and substance abuse disorders should be targeted to ensure delivery of mammography.