Evaluation of integrated psychological services in a university-based primary care clinic.

Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.

Disparities in breast and cervical cancer screening in women with mental illness: a systematic literature review.

CONTEXT: Breast and cervical cancer screening rates have improved substantially in the U.S. during the past decade. Cancer screening and other health outcomes in patients with mental illnesses, such as major depression and schizophrenia, remain suboptimal. Understanding the prevalence and root causes of these disparities is an essential first step toward developing effective interventions. This paper presents a systematic literature review of current evidence on breast and cervical cancer screening disparities in women with mental illness. EVIDENCE ACQUISITION: A systematic PubMed/MEDLINE and PsycINFO search completed in May 2012 retrieved articles pertaining to cancer screening and mentally ill patients using pertinent search terms. Articles that met the inclusion criteria were appraised critically for evidence quality related to screening disparities using defined criteria. Articles that reported cancer screening rates in patients with mental illness were reviewed to determine whether any barriers to screening or factors that promote screening were identified. EVIDENCE SYNTHESIS: Nineteen studies met the inclusion criteria. Many articles contributed to more than one of the identified areas of interest (i.e., screening utilization, barriers to screening, and factors that encourage screening). CONCLUSIONS: Substantial evidence in the current literature confirms disparities in breast and cervical cancer screening rates among women with mental illness. However, the mentally ill population is more complex and diverse than many studies imply. Using a global functional indicator that measures the overall impact of mental illness may yield a more useful categorization of influences on cancer screening.

Are depressive symptoms associated with cancer screening and cancer stage at diagnosis among postmenopausal women? The Women's Health Initiative observational cohort.

BACKGROUND: Women with depressive symptoms may use preventive services less frequently and experience poorer health outcomes. We investigated the association of depressive symptoms with breast and colorectal cancer screening rates and stage of cancer among a cohort of postmenopausal women. METHODS: In The Women's Health Initiative Observational Study, 93,676 women were followed on average for 7.6 years. Depressive symptoms were measured at baseline and at 3 years using the 6-item scale from the Center for Epidemiological Studies Depression scale (CES-D). We calculated a cancer screening rate expressed as a proportion of the years that women were current with recommended cancer screening over the number of follow-up visits in the study. Breast and colorectal cancers were staged based on Surveillance, Epidemiology and End Results (SEER) classification. RESULTS: At baseline, 15.8% (12,621) women were positive for depressive symptoms, and 6.9% (4,777) were positive at both baseline screening and at 3 years. The overall average screening rate was 71% for breast cancer and 53% for colorectal cancer. The breast cancer screening rate was 1.5% (CI 0.9%-2.0%) lower among women who reported depressive symptoms at baseline than among those who did not. Depressive symptoms were not a predictor for colorectal cancer screening. Stage of breast and colorectal cancer was not found to be associated with depressive symptoms after adjusting for covariates. CONCLUSIONS: Among a healthy and self-motivated cohort of women, self-reported depressive symptoms were associated with lower rates of screening mammography but not with colorectal cancer screening.

The role of numeracy on cancer screening among urban women.

OBJECTIVES: To determine the role of numeracy on cancer screening knowledge and practices among an ethnically diverse population. METHODS: Women aged 40+ presenting for primary care at an urban academic medical center were surveyed. Numeracy was measured as a dichotomous outcome (numerate: yes/no) using 3 criteria adapted from a validated instrument. Self-report was used to determine if women were upto-date with breast and colorectal cancer screening. RESULTS: Adequate numeracy was associated with increasing age, white race, higher education, and knowledge of breast cancer screening guidelines. No association was found between numeracy and cancer screening practices. CONCLUSIONS: Adequate numeracy was not a key determinant of cancer screening.