DESCRIPTION (provided by applicant): This study will examine an issue not yet addressed in the extant literature whether posttraumatic stress disorder (PTSD) is a risk factor for decreased cervical cancer surveillance care among women. Further analyses will assess the additional contributions of comorbid psychiatric and substance use disorders while controlling for the potential confounding effects of demographic factors including age, race/ethnicity, and other medical comorbidities to the likelihood of receiving guideline-concordant screening. To achieve these objectives, we will capitalize on existing data sources that include VA's National Patient Care Database, a rich national database that includes health care utilization data on all women receiving care in VA. This work will lay the foundation for subsequent studies that will include primary data collection to better understand the relationships between PTSD and receipt of guideline-concordant cervical cancer surveillance (CCS). Our long-term goals include the implementation of intervention studies, based upon the findings of this study that will target specific cohorts of women with PTSD for improved adherence to CCS guidelines. PTSD may be an important source of variability in CCS, as a result of patient-level or provider-level factors. Behavioral factors such as avoidance are common in PTSD and may increase the likelihood that some women will postpone or avoid preventive GYN care. Such avoidance may be particularly pronounced among women whose PTSD was caused by the leading precipitant in women, i.e., sexual trauma, as invasive exams may trigger traumatic memories of a prior assault. Moreover, the interpersonal features of PTSD (i.e., poor communication skills, anger, and hostility) and commonly comorbid psychiatric symptoms (i.e., anxiety) may interfere with doctor-patient interactions and adversely impact women's quality of care. Prior work has determined that patients perceived as "difficult" tend to receive lower quality care from busy clinicians. Therefore, it is highly likely that women with PTSD receive less consistent CCS. However, to our knowledge this issue has not yet been examined.
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