Archives of Women's Mental Health

, Volume 14, Issue 2, pp 159–168 | Cite as

Depressive symptoms as a determinant of breast and cervical cancer screening in women: a population-based study in Ontario, Canada

  • Simone N. Vigod
  • Paul A. Kurdyak
  • Donna E. Stewart
  • William H. Gnam
  • Paula N. Goering
Original Article


The objective of this study was to investigate the relationship between depression and screening for breast and cervical cancer. The study sample included Ontario female respondents to the Canadian Community Health Survey Cycle 1.2, Mental Health and Well Being component (2002). Women with Major Depressive Disorder (MDD) were identified based on the World Mental Health Composite International Diagnostic Interview and women with clinically significant depressive symptoms were identified using the Kessler 6-item Distress Scale (K6 ≥ 8). Respondents eligible for screening (N = 4,042 for cervical cancer and N = 1,403 for breast cancer) were linked to Ontario administrative data to prospectively ascertain screening outcomes. Both women with MDD and K6 ≥ 8 were less likely to receive breast cancer screening than their non-depressed counterparts (46.1% vs. 61.5% for MDD, Χ2 = 5.47, p = 0.02; 49.9% vs. 61.9% for K6, Χ2 = 6.61, p = 0.01). Adjusted analyses revealed persistence of the association between K6 ≥ 8 and breast cancer screening (adjusted odds ratio (AOR) 0.63, 95% CI 0.40–0.97). Neither MDD nor K6 ≥ 8 were found to be associated with cervical cancer screening in the full sample. A sub-group analysis by age revealed that women over age 40 years with K6 ≥ 8 were less likely to receive cervical cancer screening than their non-depressed counterparts (49.9% vs. 64.5%, X2 = 6.47, p = 0.01). This association approached statistical significance in adjusted analysis (AOR = 0.65, 95% CI 0.41–1.04). This study’s findings suggest that attention to the uptake of preventive services in women with depressive symptoms is warranted.


Depression Health service use Mammography screening Pap test screening 


  1. Aggarwal A, Freund K, Sato A, Adams-Campbell LL, Lopez AM, Lessin LS, Bonds DE (2008) Are depressive symptoms associated with cancer screening and cancer stage at diagnosis among postmenopausal women? The Women's Health Initiative Observational Cohort. J Women's Health 17(8):1353–1361CrossRefGoogle Scholar
  2. Ayuso-Mateos JL, Nuevo R, Verdes E, Naidoo N, Chatterji S (2010) From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry 196(5):365–371PubMedCrossRefGoogle Scholar
  3. Blackwell D, Martinez M, Gentleman J (2008) Women's compliance with public health guidelines for mammograms and pap tests in Canada and the United States. Women's Health Issues 18:85–99PubMedGoogle Scholar
  4. Cairney J, Veldhuizen S, Wade TJ, Kurdyak P, Streiner DL (2007) Evaluation of 2 measures of psychological distress as screeners for depression in the general population. Can J Psychiatry 52(2):111–120PubMedGoogle Scholar
  5. Fagiolini A, Goracci A (2009) The effects of undertreated chronic medical illnesses in patients with severe mental disorders. J Clin Psychiatry 70(Suppl 3):22–29PubMedCrossRefGoogle Scholar
  6. Fehringer G, Howlett R, Cotterchio M, Klar N, Majpruz-Moat V, Mai V (2005) Comparison of Papanicolou rates across Ontario and factors associated with cervical screening. Can J Public Health 96(2):140–144PubMedGoogle Scholar
  7. Gentleman J, Lee J (1997) Who doesn't get a mammogram? Statistics Canada Health Reports 9(1):20–28Google Scholar
  8. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Meth Psychiatr Res 15(4):167–180CrossRefGoogle Scholar
  9. Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New YorkGoogle Scholar
  10. Hemminki K, Li X, Mutanen P (2001) Age-incidence relationships and time trends in cervical cancer in Sweden. Eur J Epidemiol 17(4):323–328PubMedCrossRefGoogle Scholar
  11. Kaida A, Colman I, Janssen PA (2008) Recent Pap tests among Canadian women: is depression a barrier to cervical cancer screening? J Women's Health 17(7):1175–1181CrossRefGoogle Scholar
  12. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Zaslavsky AM (2003a) Screening for serious mental illness in the general population. Arch Gen Psychiatry 60(2):184–189PubMedCrossRefGoogle Scholar
  13. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Wang PS (2003b) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289(23):3095–3105PubMedCrossRefGoogle Scholar
  14. Lipscombe L, Hux J, Booth G (2005) Reduced screening mammography among women with diabetes. Arch Intern Med 165:290–295CrossRefGoogle Scholar
  15. McLachlin CM, Mai V, Murphy J, Fung Kee Fung M, Chambers A, members of the Cervical Screening Guidelines Development Committee of the Ontario Cervical Screening Program and the Gynecology Cancer Disease Site Group of Cancer Care Ontario (2005) Cervical screening: a clinical practice guidelineGoogle Scholar
  16. Nicholson A, Kuper H, Hemingway H (2006) Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 27(23):2763–2774PubMedCrossRefGoogle Scholar
  17. Ontario Breast Screening Program (2010) Breast Screening. Accessed January 28, 2010
  18. Patten SB, Williams JVA, Lavorato DH, Eliasziw M (2009) The effect of major depression on participation in preventive health care activities. BMC Public Health 9:87PubMedCrossRefGoogle Scholar
  19. Pirraglia PA, Sanyal P, Singer DE, Ferris TG (2004) Depressive symptom burden as a barrier to screening for breast and cervical cancers. J Women's Health 13(6):731–738CrossRefGoogle Scholar
  20. Ringash J, Canadian Task Force on Preventative Health Care (2001) Preventative health care 2001 update. Can Med Assoc J 164(4):469–476Google Scholar
  21. Statistics Canada. (2002). Canadian community health survey, mental health and well-being cycle 1.2 master file documentation. Accessed January 28, 2010
  22. Stecker T, Fortney JC, Prajapati S (2007) How depression influences the receipt of primary care services among women: a propensity score analysis. J Women's Health 16(2):198–205CrossRefGoogle Scholar
  23. Upshur R, Wang L, Maaten S, Leong A (2006) Ch. 5: patterns of primary care and prevention. In: ICES Atlas: Primary Care in Ontario, pp 79–90Google Scholar
  24. Vigod SN, Stewart DE (2006) Major depression in female urinary incontinence. Psychosomatics 47(2):147–151PubMedCrossRefGoogle Scholar
  25. World Health Organization (2010) Depression. Accessed October 22, 2010

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Simone N. Vigod
    • 1
    • 2
    • 5
  • Paul A. Kurdyak
    • 2
    • 3
    • 6
  • Donna E. Stewart
    • 2
    • 4
  • William H. Gnam
    • 2
    • 3
    • 6
  • Paula N. Goering
    • 2
    • 3
  1. 1.Women’s College Hospital and Women’s College Research InstituteTorontoCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.Centre for Addiction and Mental HealthTorontoCanada
  4. 4.University Health NetworkTorontoCanada
  5. 5.Women’s Mental Health ProgramWomen’s College HospitalTorontoCanada
  6. 6.Institute for Clinical Evaluative SciencesTorontoCanada

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