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The Influence of Stress, Depression, and Anxiety on PSA Screening Rates in a Nationally Representative Sample

Kotwal, Ashwin A. BA*; Schumm, Phil MA; Mohile, Supriya G. MD, MS; Dale, William MD, PhD*,§

doi: 10.1097/MLR.0b013e318269e096
Original Articles

Background: Prostate-specific antigen (PSA) testing for prostate cancer is controversial, with concerning rates of both overscreening and underscreening. The reasons for the observed rates of screening are unknown, and few studies have examined the relationship of psychological health to PSA screening rates. Understanding this relationship can help guide interventions to improve informed decision-making for screening.

Methods: A nationally representative sample of men 57–85 years old without prostate cancer (N=1169) from the National Social life, Health and Aging Project was analyzed. The independent relationship of validated psychological health scales measuring stress, anxiety, and depression to PSA testing rates was assessed using multivariable logistic regression analyses.

Results: PSA screening rates were significantly lower for men with higher perceived stress [odds ratio (OR)=0.76, P=0.006], but not for higher depressive symptoms (OR=0.89, P=0.22) when accounting for stress. Anxiety influences PSA screening through an interaction with number of doctor visits (P=0.02). Among the men who visited the doctor once those with higher anxiety were less likely to be screened (OR=0.65, P=0.04). Conversely, those who visited the doctor 10+ times with higher anxiety were more likely to be screened (OR=1.71, P=0.04).

Conclusions: Perceived stress significantly lowers PSA screening likelihood, and it seems to partly mediate the negative relationship of depression with screening likelihood. Anxiety affects PSA screening rates differently for men with different numbers of doctor visits. Interventions to influence PSA screening rates should recognize the role of the patients’ psychological state to improve their likelihood of making informed decisions and improve screening appropriateness.

*Department of Medicine, Section of Geriatrics & Palliative Medicine

Department of Health Studies, University of Chicago, Chicago, IL

Department of Medicine, James Wilmot Cancer Center, University of Rochester, Rochester, NY

§Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL

National Social Life Health and Aging Project (NSHAP) (NIH—5R01 AG021487).

The authors declare no conflict of interest.

Reprints: William Dale, MD, PhD, Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago, MC6098, 5841S. Maryland Avenue, Chicago, IL 60637. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.