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Mental Health, Frequency of Healthcare Visits, and Colorectal Cancer Screening

Kodl, Molly M. PhD*; Powell, Adam A. PhD, MBA†; Noorbaloochi, Siamak PhD†; Grill, Joseph P. MSA†; Bangerter, Ann K. BS†; Partin, Melissa R. PhD†

doi: 10.1097/MLR.0b013e3181e57901
Brief Report

Background: Research regarding the association between mental health and colorectal cancer (CRC) screening has produced mixed results. Variations may be explained by methodology, including whether potential confounders such as frequency of healthcare visits are considered.

Objective: We examined the association between mental health and CRC screening, before and after controlling for demographics, comorbidities, and outpatient visit frequency.

Design: Observational study based on a retrospective cohort.

Subjects: A total of 855 veterans receiving care at a Veterans Affairs Medical Center.

Measures: Medical record data were used to assess CRC screening rates and mental health status (number of diagnoses and the presence of depression, anxiety, posttraumatic stress disorder, substance, or psychotic disorders). Logistic regression was used to estimate the association between mental health diagnoses and CRC screening, before and after controlling for covariates.

Results: Bivariate analyses suggested that CRC screening rates were higher for patients with a history of one or more mental health diagnoses (57% vs. 47%, P < 0.01). However, adjusting for timing of mental health diagnosis and outpatient visit frequency resulted in significant negative associations between CRC screening and all measures of mental health except posttraumatic stress disorder.

Conclusions: Estimates of the association between mental health and CRC screening that do not adjust for outpatient visit frequency may be misleading. Veterans with mental health diagnoses were significantly less likely to be screened for CRC than their counterparts with no mental health diagnoses and an equal number of outpatient visits.

From the *Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN; and †Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN.

Supported by VA Health Services Research & Development grant IIR 04–042–2 awarded (to M.R.P.), the Minneapolis VA Health Services Research and Development Center for Chronic Disease Outcomes Research (HFP 98–001), and a VHA Health Services Research and Development fellowship.

The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Reprints: Molly M. Kodl, PhD, Minneapolis VA Medical Center, One Veterans Drive (116 A6), Minneapolis, MN 55417. E-mail: molly.kodl@va.gov.

© 2010 Lippincott Williams & Wilkins, Inc.