University of California San Francisco (USCF) researchers evaluated cervical cancer screening rates in the severely mentally ill enrolled in California’s Medicaid program (Medi-Cal) and noted lower than average rates in this population as compared to the general California population.
In a study published in Psychiatric Services, researchers evaluated the records of 31,308 Medi-Cal female recipients from 2010 and 2011, and they found that only 20.2% of the severely mentally ill underwent annual cervical cancer screening compared to 42.3% of California’s general population.
Of these women, white women were less likely to have undergone cervical cancer screening, with Asian women rating the highest. Additionally, they found that severely mentally ill women ages 18 to 27 were 30% less likely to be screened than similarly afflicted women ages 28 to 47.
Most of the women from the study were diagnosed with schizophrenia, followed by major depression, bipolar disorder, anxiety, and other psychiatric diagnoses. Interestingly, researchers did note that those with schizophrenia were the least likely to have undergone screening.
“The women were receiving services in a public health setting, but were not receiving preventive services as often as women in the general population,” said study author Christina Mangurian, MD, associate professor of clinical psychiatry at UCSF. “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.”
Seventy-four percent of patients with evidence of primary care visits were three times more likely to have been screened than those for whom there was no evidence of such health care use.
While the lack of use of healthcare services is one factor likely leading to low screening rates, severely mentally ill women are at a greater risk for developing cervical cancer due to risk factors like smoking and increased numbers of lifetime sexual partners.
Considering strategies are apparently needed to help remove barriers to primary healthcare, researchers suggest using specialty mental health clinics as the “medical home” for women with severe mental illness. Providing “women’s mini-clinics” on site could help alleviate screening disparities.