The Effect of False-positive Mammograms on Antidepressant and Anxiolytic Initiation

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Abstract

Background:

Despite reported increases in anxiety following a false-positive mammogram, there is little evidence the effect rises to the clinical level of initiating medication.

Objective:

To analyze the effect of a false-positive mammogram on antidepressant or anxiolytic initiation and identify subpopulations most at risk.

Subjects:

MarketScan commercial and Medicaid claims databases used to identify women ages 40–64 undergoing screening mammography with no prior antidepressant or anxiolytic claims.

Research Design:

Using a retrospective cohort design, we estimated the effects of a false-positive relative to a negative mammogram on the likelihood of initiating antidepressants or anxiolytics using multivariate logistic models estimated separately by insurance type.

Results:

At 3 months after a false-positive mammogram, the relative risk (RR) for antidepressant or anxiolytic initiation was 1.19 [95% confidence interval (CI), 1.06–1.31] for the commercially insured and 1.13 (95% CI, 0.96–1.29) in the Medicaid population. In addition, 4 subgroups were at particularly elevated risk: commercially insured women ages 40–49 (RR=1.33; 95% CI, 1.13–1.54) or whose false-positive required multiple tests to resolve (RR=1.37; 95% CI, 1.17–1.57), included a biopsy (RR=1.68; 95% CI, 1.18–2.17), or whose resolution took >1 week (RR=1.21; 95% CI, 1.07–1.34).

Conclusions:

False-positive mammograms were associated with significant increases in antidepressant or anxiolytic imitation among the commercially insured. Follow-up resources may be particularly beneficial for cases taking longer to resolve and involving biopsies or multiple tests. The results highlight the need to resolve false-positives quickly and effectively and to monitor depressive symptoms following a positive result.

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