Table 2.

Cervical Cancer Screening Among Individuals with Mental Health vs. Substance Use.

Study	Mental Health and Cervical Cancer Screening			Substance Use and Cervical Cancer Screening
	Sample Size by Mental Health Condition	Prevalence of Cervical Cancer Screening	Model Results of Receiving Screening Compared to Control Group	Sample Size by Substance Use	Cervical Cancer Screening Prevalence	Model Results of Screening Compared to Control Group
Examined Cervical Cancer Screening and Mental Health and Substance Use
Abrams, 2012	•Psychosis (n = 4,747) •Bipolar or Mania (n = 3,319) •Depression (n = 5,014)  •Control group(n=85,375)	•Psychosis= 25% •Bipolar or Mania=29% •Depression= 32% •Control group = 18%	•Psychosis, (AOR=1.46 ; 95% CI = 1.36,1.57) •Bipolar disorder or mania, (AOR= 1.59 ; 95% CI = 1.43, 1.76); •Depression, (AOR=1.78; 95% CI = 1.61, 1.96)	•Substance Use - (n=1,104) •Control group - (n = 6,122)	•Substance Use (excluding tobacco)= 27% •Control group=18%	Substance use = (AOR=.80; 95% CI = 75, .85)
Asgary, 2017	•History of mental illness (n = 122) •Control group (n = 40)	NR	No statistical association between mental health and screening. Did not report effect.	•Substance Use - (n=56) •Control group - (n = 106)	NR	No statistical association between mental health and screening. Did not report effect.
Byrne, 2010	Mental Health Days not good daily N/A •Daily – 2454 •Less than daily – 36,052 27	NR	Daily not good mental health days compered to none (AOR 0.90; 95% CI= 0.78, 1.03)	•Smokers - (n = 8,179) •Control group - (n =30884)	4,710 had a pap test < 3 years)	Smokers =(AORs 0.60; 95% CI= 0.55, 0.66)
Crawford, 2016	•Depression – (n=15,950) •Control – (n=50,452)	•Screened on time- 22% vs. Control group 48%	p < .05	•Current Smoker (n=8,969) •Former smoker –(n=16,176) •Control – (n=40,992)	Screened on time •Current Smoker =12.8% •Former smoker =23.3% •Control= 63.9%	p< .05
Fletcher, 2014	•Anxiety-(n=18) •Depression –(n= 94)	NR	NR	•Illicit drug use - (n=48) •Hazardous drinking -(n=33)	•NR	Non-Adherence •Hazardous drinking (OR=5.30; 95% CI=1.92, 14.67)Cigarettes smoked per day (OR=1.07; 95% CI=1.03, 1.12)
James, 2017	•Schizophrenia Spectrum Disorders (n=13,149, 42%) •Major Depressive Disorder (n=9,079, 29%)	•Schizophrenia & Major Depressive Disorder = 20.2% •Comparison =42.3%	Compared Anxiety (ARR =1.28; 95% CI = 1.14-1.45), Bipolar (ARR =1.17; 95% CI = 1.10, 1.25) and Major Depressive disorder (ARR =1.21; 95% CI = 1.13, 1.30)) to Schizophrenia.	History of drug use	NR	History of drug use (ARR =1.01; 95% CI =.96, 1.07)
Cervical Cancer Screening and Substance Use Only
Maclaughlan, 2011	N/A	N/A	N/A	Total n= 890586.37% current smokers 52.8% never smokers 40.8% former smokers	•Never smokers = 83.7% •Current smokers = 81.7%	Current smokers (OR=0.53, (0.47-0.59)) compared to never smokersFormer smokers (OR: 1.10; 95% CI: 1.02-1.18) compared to never smokers
Nelson, 2009	N/A	NR	NR	•Current smokers (n = 398) Never smokers (n = 1,185)Former smoker (n=487)	•Current smoker- 74.01%  Never smoker- 86.38%Former smoker 88.07	p=0.0008
Cervical Cancer Screening and Mental Health Conditions Only
Massetti, 2017	•Mental Health problems = (n=20,344, 22.4%)	•Adherence •With mental health- 84.7% •Control- 85.6%	•p=0.273	N/A	N/A	N/A
Pirraglia, 2004	•Low depressive symptom burden- (n=2493) •Moderate burden -(n=312) •High burden - (n=492)	NR	•High Symptom Burden compared to low symptom burden= (OR 0.88; 95% CI= 0.76,1.03) •Moderate Symptom Burden compared to low symptom burden= (OR 1.00; 95% CI= 0.85, 1.17).	N/A	N/A	N/A
Weitlauf, 2013	•PTSD-(n = 5,668) •Depression- (n = 11,627)	•PTSD= 77% •Depression= 75% •Control =75%	•PTSD=(OR: 1.14; 95% CI= 1.06, 1.22) •Depression = (OR: 1.05; 95% CI= .99 ,1.12)	N/A	N/A	N/A
Xiang, 2015	•Serious Psychological Distress (SPD) – (n=1,340) •Control =(n=16,430)	•SPD =72.27%  •Control =85.37%	•SPD = (OR: 0.59; 95% CI= 0.45, 0.77)	N/A	N/A	NA
Yee, 2011	•Mental health diagnosis (MHD) =(n=321, 53% ) •Control =(n=285, 47%)	•MHD= 84% •Without MHD= 80%	•MHD compared to control: (OR:1.71; 95% CI= 0.91, 3.21)	N/A	N/A	N/A
Zhang, 2019	•Anxiety - (n=299) •Depression-(n =307)	NR	Missing screening •Anxiety (OR=1.430; 95% CI =1.009, 2.026) •Depression (OR=1.689; 95% CI=1.208, 2.362)	N/A	N/A	N/A

*NR – Not Reported *NA –Not applicable, Adherence = adherence to cervical cancer screening guidelines. ARR Adjusted Risk Ratio.