Background Evidence from the United States (US) suggests that uptake of breast cancer screening is lower for women with severe mental illness, but it is unclear whether this applies to the United Kingdom (UK) where services are free at the point of access. Furthermore, no attempt has been made to investigate whether this finding extends to the more prevalent mental disorders. The aim of this study was to conduct the first population-wide record linkage study of the influence of poor mental health and different types of mental disorder (as assessed by use of psychotropic medications) on routine breast screening uptake in the UK.
Methods Breast screening records were obtained from the National Breast Screening System (NBSS) and were subsequently linked to 2011 Census data within the Northern Ireland Longitudinal Study (NILS). This resulted in a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service (NHS) breast screening programme. Psychotropic medication receipt was derived from a centralised prescribing database and classified according to prescriptions in the three months preceding screening invite. Other individual and household-level cohort attributes known to be associated with breast screening uptake were derived from Census records. Logistic regression was employed to calculate age-only and fully-adjusted odds ratios (ORs) and 95% confidence intervals of attendance at breast screening.
Results Over a third of women received at least one prescription for psychotropic medication in the three months prior to screening invite and these women were 15% less likely to attend screening (OR 0.85: 0.81–0.88). Although significantly reduced uptake was observed for individuals in receipt of all types of psychotropic medication, attendance was particularly low for women prescribed antipsychotics (OR 0.63: 0.56–0.70), anxiolytics (OR 0.61: 0.57–0.66), or hypnotics (OR 0.68: 0.63–0.72). Additionally, there was evidence that this association was further influenced by severity of mental illness (as assessed by duration of medication usage).
Conclusion This study advances our current understanding of the factors contributing to suboptimal breast screening uptake rates, confirming the existence of disparities in breast screening uptake for individuals with poor mental health in the United Kingdom (U.K), and for the first time, demonstrating that the observed disparities vary according to the type and severity of mental disorder examined. The extension of this association to common mental disorders is of particular concern given the high prevalence of these disorders worldwide.
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