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Patel R, Akahara PC, Musa MRO, Okereke OP, Puri C, Abera S, Okoronkwo OU, Iroro J, Dan-Eleberi AO, Okobi OE, Nwachukwu O. Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study. Cureus 2023; 15:e42659. [PMID: 37644921 PMCID: PMC10462395 DOI: 10.7759/cureus.42659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting. OBJECTIVE This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized. METHODS We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05). CONCLUSION Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.
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Affiliation(s)
- Radhey Patel
- Psychiatry and Behavioral Sciences, Avalon University School of Medicine, Willemstad, CUW
| | | | | | | | - Chander Puri
- Medical School, Gian Sagar Medical College and Hospital, Patiala, IND
| | - Saare Abera
- Internal Medicine, American University of Integrated Sciences, St. Michael, BRB
| | - Obiaku U Okoronkwo
- School of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, GHA
| | - Joy Iroro
- Internal Medicine, All Saints University School of Medicine, Dominica, DMA
| | | | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Ogechukwu Nwachukwu
- Internal Medicine, St. Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, GBR
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Tsai MH, Bevel MS, Andrzejak SE. Racial/Ethnic Disparity in the Relationship of Mental and Physical Health With Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors. JCO Oncol Pract 2023; 19:e714-e724. [PMID: 36800561 DOI: 10.1200/op.22.00718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE We examined colorectal cancer (CRC) screening utilization among non-Hispanic White, non-Hispanic Black (NHB), non-Hispanic other (NHO)/Hispanic cancer survivors. We also determined whether experiencing poor physical and/or mental health affects CRC screening utilization in breast and prostate cancers across different racial/ethnic groups. METHODS Data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3,023 eligible treatment-utilizing cancer survivors with complete treatment were used. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS Among 3,023 eligible survivors, 67.7% of NHO/Hispanic survivors demonstrated lower CRC screening use compared with non-Hispanic White (82%) and NHB (89%) survivors (P < .001). In multivariable analysis, having frequent (14-30 days) poor mental health was associated with lower odds of receiving CRC screening among NHB (odds ratio [OR], 0.32; 95% CI, 0.11 to 0.95) and NHO/Hispanic (OR, 0.39; 95% CI, 0.18 to 0.81) survivors. Similar results in physical health were also found in NHB (OR, 0.34; 95% CI, 0.13 to 0.91) and NHO/Hispanic (OR, 0.22; 95% CI, 0.05 to 0.91) groups. Among those experienced both frequent poor mental and physical health, NHB/NHO/Hispanic were less likely to be screened for CRC (OR, 0.05; 95% CI, 0.02 to 0.10). CONCLUSION NHO/Hispanic survivors demonstrated lower CRC screening use. Frequent poor mental and/or physical health was strongly associated with lower CRC screening use among NHB and NHO/Hispanic survivors. Our study suggests that cancer survivorship care considering mental and physical health status may improve adherence to CRC screening recommendation (for secondary cancer prevention) for NHB, NHO, and Hispanic survivors.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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Jørgensen MD, Mikkelsen EM, Erichsen R, Thomsen MK. Mental illness and participation in colorectal cancer screening: a scoping review. Scand J Gastroenterol 2022; 57:1216-1226. [PMID: 35639472 DOI: 10.1080/00365521.2022.2073185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Compared with the background population, persons with mental illness have increased colorectal cancer (CRC) mortality. Screening has the potential to alleviate the increased cancer mortality due to mental illness, but the extent to which persons with mental illness participate in CRC screening programs is uncertain. This scoping review aims to summarize the literature on CRC screening participation among persons with mental illness. MATERIALS AND METHODS We searched four databases (PubMed, PsychInfo, Embase, and the Cochrane Library) to identify published literature on mental illness and participation in CRC screening programs. We included full-text papers available in English, published before February 2021, and excluded papers on dementia, intellectual disabilities, and developmental disabilities. RESULTS In total, we included 17 studies and categorized the findings according to severity of mental illness. Across varying study designs, the studies found that persons with severe mental illness, e.g. schizophrenia, participate less in CRC screening compared with the background population. The results were ambiguous for common mental illness, such as depression and anxiety. In general, studies were small or lacked comparison groups and the estimates were imprecise. CONCLUSION This is the first scoping review to evaluate participation in CRC screening programs among persons with mental illness. Overall, the existing literature lacks high quality evidence from large population-based studies and comparison groups based on organized screening programs.
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Affiliation(s)
- Marie D Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.,Department of Surgery, Randers Regional Hospital, Randers NØ, Denmark
| | - Mette K Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
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Wang S, Tian H, Xue R. Using psychological interventions in the nursing care of rectal cancer patients. Am J Transl Res 2021; 13:7282-7287. [PMID: 34306494 PMCID: PMC8290720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To explore the significance of psychological interventions in the nursing care of rectal cancer patients undergoing ostomy surgery. METHODS We recruited 120 rectal cancer patients undergoing ostomy surgery in our hospital from March 2017 to March 2018 as the study cohort, and they were equally and randomly divided into a control group and an observation group. The control group was administered routine nursing, and the observation group was administered routine nursing combined with psychological nursing. The patients' conditions were evaluated using the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the MOS item short form health survey (SF-36), and their defecation. The two groups' satisfaction levels with the nursing were also compared. RESULTS The SAS, SDS, HAMA, and HAMD scores in the two groups after the treatment were lower than they were before the treatment, and the observation group was much lower. The SF-36 scores, the patients' defecation, the nursing satisfaction levels, and the sleep durations in the observation group were higher than they were in the control group, and there were fewer incidences of postoperative complications in the observation group than there were in the control group (P < 0.05). CONCLUSION The effects of psychological interventions in the nursing of rectal cancer patients undergoing ostomy surgery are significant. The interventions can relieve the patients' bad moods, stabilize the patients' conditions, and improve the patients' defecation, so it is superior to routine nursing.
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Affiliation(s)
- Sumin Wang
- Disinfection Supply Room, Xingtai People’s HospitalXing Tai 054001, Heibei Province, China
| | - Huiqian Tian
- Pediatrics, Xingtai People’s HospitalXing Tai 054001, Heibei Province, China
| | - Rongrong Xue
- Pediatrics, Xingtai People’s HospitalXing Tai 054001, Heibei Province, China
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Abuelo C, Ashburner JM, Atlas SJ, Knudsen A, Morrill J, Corona P, Shtasel D, Percac-Lima S. Colorectal Cancer Screening Patient Navigation for Patients with Mental Illness and/or Substance Use Disorder: Pilot Randomized Control Trial. J Dual Diagn 2020; 16:438-446. [PMID: 32762637 DOI: 10.1080/15504263.2020.1802542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD. METHODS A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50-74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention (n = 126) or usual care (n = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups. RESULTS Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% (p = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, p = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group (p = .05). CONCLUSIONS A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population. TRIALS REGISTRATION NUMBER 2016P001322.
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Affiliation(s)
- Carolina Abuelo
- Massachusetts General Hospital, Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey M Ashburner
- Massachusetts General Hospital, Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven J Atlas
- Massachusetts General Hospital, Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Knudsen
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
| | - James Morrill
- Massachusetts General Hospital, Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Derri Shtasel
- Massachusetts General Hospital, Division of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital, Division of General Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Yarborough BJH, Perrin NA, Stumbo SP, Muench J, Green CA. Preventive Service Use Among People With and Without Serious Mental Illnesses. Am J Prev Med 2018; 54:1-9. [PMID: 29056371 PMCID: PMC5736432 DOI: 10.1016/j.amepre.2017.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes. METHODS In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015. RESULTS Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group. CONCLUSIONS In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
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Affiliation(s)
| | - Nancy A Perrin
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - John Muench
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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