Preventive Service Uptake in Women With Mental Illness: Results From the 2011 Medical Expenditure Panel Survey 公开

Gittleman, Dorian Laura (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/ff365617r?locale=zh
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Abstract

Objective: This study uses the 2011 Medical Expenditure Panel Survey (MEPS), a nationally representative subsample of the National Health Interview Survey, to examine women's preventive health service use in women with mental illness and mental distress. The study seeks to determine if women with mental illness are at additional risk for lower uptake of clinical breast exams (CBE), Pap smears, and mammograms, and if their health insurance status mediates that relationship.

Methods: The sample was restricted to 13,498 women aged 18 or older. Mental illness was determined by ICD-9 insurance code, score on the SAQ-42 symptom screening measure, and report of overall mental wellness. Receipt of service was measured by self- report and dichotomized to receipt within the recommended period. Final analyses of the relationship between mental health and service receipt were a series of logistic regressions with service type as the dependent variable.

Results: After controlling for demographic variables and entering care access variables and insurance categories into the regression, mental wellness perception was significantly predictive of each kind of service uptake. Women with low perceived mental wellness were 39% less likely to receive mammograms, 27% less likely to have CBEs, and 21% less likely to have Pap smears. Diagnosis of mental illness was not statistically significant with service use. Insurance category was statistically significant with service uptake and a partial mediator for breast-related screening but not for Pap smear.

Conclusions: There is an independent relationship between mental health and service use, even after controlling for other factors such as income, education, and race. After examining the relationship between mental health, insurance category, and service use, it appears that while insurance might be partially mediating for breast-related screening services, it is not so for Pap smears. The results show that women without insurance are significantly less likely to use services, and women with public insurance are significantly less likely to receive CBEs or mammograms. Women with low perceived mental health are much more likely to have public insurance than private, although they do not significantly differ from women with stronger mental health in percentage of women without insurance.

Table of Contents

Introduction ......................................................................................................................... 1

Background ..................................................................................................................................1

Theoretical Framework ................................................................................................................6

Hypotheses ....................................................................................................................................7

Background.......................................................................................................................... 8

Section I ........................................................................................................................................9

Section II.....................................................................................................................................10

Section III ...................................................................................................................................13

Section IV ...................................................................................................................................15

Section V.....................................................................................................................................16

Methods ............................................................................................................................. 19

Survey Description......................................................................................................................19

Participants.................................................................................................................................20

Procedures ..................................................................................................................................20

Measures.....................................................................................................................................20

Results................................................................................................................................ 26

Analysis.......................................................................................................................................26

Results ........................................................................................................................................26

Hypothesis 1........................................................................................................................................ 29

Hypothesis 2........................................................................................................................................ 29

Hypothesis 3........................................................................................................................................ 30

Discussion........................................................................................................................... 38

Limitations..................................................................................................................................42

Conclusions.................................................................................................................................43

Appendices......................................................................................................................... 56

Figures ........................................................................................................................................56

Figure 1 Aggarwal et al. Model .......................................................................................................... 56

Figure 2 & 3 Anderson Model ................................................................................................................... 58

Figure 4. Gittleman model .................................................................................................................. 59

Tables .........................................................................................................................................60

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