PAP screening and gynecologic visit rates for Medicaid enrollees with mental and substance use disorders

Persons with severe mental illness (SMI) frequently experience other morbidity that is far in excess of that encountered by the general population. Such co-morbidities are intensified for women as they are especially vulnerable to abuse and diseases such as genital cancers and osteoporosis. Preventive somatic care is one obvious way to reduce morbidity in women with SMI. This study used Maryland Medicaid data from 2005 to assess PAP screening and gynecological visit rates experienced by women with non-affective psychosis versus other women with substance use disorder (SUD), bipolar or unipolar depression, or the absence of any of these illnesses (controls). Logistic regression adjusted for age, race, Medicaid eligibility (a proxy for illness severity and Medicaid coverage), HPV, HIV, and other sexually transmitted diseases. Excluding those with hysterectomies or HPV (1% of sample), this modeling found that women with psychosis (n=4,643) or depression (n=2,332) were more likely to receive PAP screening versus controls (n=89,952) (Odds Ratios=1.33, 1.44; 95% Confidence Intervals=1.24-1.44, 1.30-1.58; respectively). Women with SUD with (n=1,066) or without (n=5,905) psychosis demonstrated reduced screening rates (ORs=0.71, 0.77; 95% CIs=0.67-0.76, 0.66-0.90; respectively). Findings were generally weaker for gynecologic visits. Women with psychosis or depression were again more likely to receive such services, while women with SUD were only marginally less likely to receive such services (OR=0.94, 95% CI=0.89-1.00), and those with SUD and psychosis were indistinguishable from controls (OR=1.07, 95% CI=0.95-1.22). These findings suggest adequate gynecologic care utilization for women with psychosis or depression, but sub-standard utilization for persons with SUD.