Moderate psychological distress as a barrier to breast cancer screening among women

Objective: To examine the relationship between Breast Cancer Screening (BCS) and Moderate Psychological Distress (MPD). Also, to assess the effect of aggregating women with No Psychological Distress (NPD) and MPD into one group, as done in prior studies when evaluating the relationship between BCS and Psychological Distress (PD). Methods: The study population comprised of 34,565 women aged 50-74 years who participated in the National Health Interview Survey from 2013 to 2017. The Kessler-6 PD index score (0-24) was dichotomized (0-12: NPD; > 13: Severe Psychological Distress SPD) and trichotomized (0-5: NPD; 5-12: MPD; > 13 SPD). Two multivariate logistic regressions were conducted for the dichotomous and trichotomous PD categories. Andersen’s Behavioral Model of Health Services Use guided the choice of covariates. Data analysis was conducted using SAS version 9.4. Results: Our study showed 4.6% had SPD, and 17.9% had MPD. The latter group (MPD) was included in the NPD group in the dichotomous analysis. In the dichotomous analysis, women with SPD (adjusted Odds Ratio (aOR) = 0.71, 95% CI = 0.63, 0.81, p < .00001) were less likely to have received a mammogram than those with NPD. In the trichotomous model, women with SPD (aOR = 0.76, 95% CI = 0.67, 0.87, p = .0001) and MPD (aOR = 0.84, 95% CI = 0.78, 0.91, p <.00001) were both less likely to have had a mammogram than those with NPD. Conclusions: Prior studies that included individuals with MPD among those with NPD overestimated the effect of SPD on mammography and minimized the importance of targeting women with MPD along with those that have SPD to enhance the uptake of mammography.