An article titled, “The association between a history of anxiety or depression and utilization of diagnostic imaging” has been published by PLOS ONE. The study was jointly conducted by authors affiliated with HealthHelp, Humana, The Kennedy Forum, and Thomas Jefferson University. HealthHelp and Humana have an ongoing outcomes research alliance, and pursued this study to foster scientific understanding of how mental illness may impact diagnostic imaging utilization.

Prior research shows that mental illness is associated with lower utilization of screening imaging. For instance, anxiety and depression have been shown to be associated with lower utilization of mammography. Likewise, mental illness has been shown to be a barrier receiving to lung cancer screening using low-dose computed tomography. While screening imaging is performed on people with no suspicion of a disease, and is somewhat elective in nature, diagnostic imaging is performed in response to clinical suspicion of a disease and is less elective. Little is known about how mental illness impacts use of diagnostic imaging. This study explores the association between a history of anxiety or depression in the prior year and utilization of diagnostic imaging.

Commercial and Medicare Advantage health plan claims from 2017 and 2018 from patients with plans from one national organization were extracted from a claims database. Exclusions were made for patients without continuous plan enrollment. History of anxiety or depression was determined using 2017 claims, and downstream diagnostic imaging was determined using 2018 claims. Univariate associations were assessed with Chi-square tests. A matched sample was created using Coarsened Exact Matching, with history of mental illness serving as the treatment variable. Logistic regressions were used to calculate adjusted odds ratios, before and after matching, controlling for age, sex, urbanicity, local income, comorbidities, claims history, region, and health plan characteristics. Associations between mental illness and chest imaging, neuroimaging, and emergency department imaging were also evaluated.

The sample analyzed included 2,381,851 patients before matching. Imaging was significantly more likely for patients with a history of anxiety (71.1% vs. 55.7%, P<.001) and depression (73.2% vs. 55.3%, P<.001). The adjusted odds of any imaging were 1.24 (95% confidence interval [CI]: 1.22-1.26) for patients with a history of anxiety, and 1.43 (CI: 1.41-1.45) for patients with a history of depression before matching, and 1.18 (CI: 1.16-1.20) for a history of anxiety and 1.33 (CI: 1.32-1.35) for a history of depression after matching. Adjusted analyses found significant, positive associations between mental illness and chest imaging, neuroimaging, and emergency department imaging both before and after matching. In contrast to prior findings on screening, anxiety and depression were associated with greater likelihood of diagnostic imaging within the population studied.

In response to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., commented, “Using data pertaining to millions of people both with and without a history of mental illness, we examined whether there was an association between a history of anxiety or depression and subsequent diagnostic imaging utilization. Exploring this question through multiple methods, we consistently found that there was a positive association. This finding stands in contrast to the literature on the association between mental illness and screening imaging, which shows that people with a history of mental illness are less likely to receive screening. Future researchers should work to validate whether a history of mental illness is associated with a different impact on the use of screening versus diagnostic imaging, as these findings suggest that the relationship may be different.”

To read the article, visit: The association between a history of anxiety or depression and utilization of diagnostic imaging