Prevalence and predictors of anxiety and worry in women after colposcopy: a longitudinal study

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Publication date: 
November, 2013
Presentation type: 
Poster presentation
Cancers: 
Related staff: 
Dr Mairead O'Connor (former staff)
Prof Linda Sharp (former staff)
Abstract: 

Prevalence And Predictors Of Anxiety And Worry In Women After Colposcopy: A Longitudinal Study

Background: Organised screening is effective in reducing cervical cancer incidence. Women with abnormal cytology require follow-up and many are referred for a colposcopy examination. Studies have reported raised anxiety levels prior to and during the examination. Less is known about the psychological after-effects, and the issues that concern women. This study aimed to estimate prevalence of anxiety and specific worries at 4, 8 and 12-months post-colposcopy and identify women most at risk of suffering psychological after-effects.

Methods: Women referred for colposcopy following an abnormal smear result completed questionnaires 4-, 8- and 12-months following their initial colposcopy at two hospitals in Ireland. Anxiety was assessed by the Hospital Anxiety and Depression Scale (HADS). Worries about future fertility and cervical cancer were assessed by the Process Outcome Specific Measure (POSM). Prevalence of significant anxiety (HADS anxiety subscale score ≥11) and each worry was estimated at each time-point. Multiple logistic regression models were developed to identify predictors of risk of anxiety and each worry.

Results: 584 women were recruited (response rate=73%, 59%, 52% at 4, 8, and 12-months). Over 12-months, prevalence of significant anxiety remained steady (21%, 23% and 20% at 4, 8 and 12-months). Worry about future fertility was the most common worry; 56% were worried at 4-months, declining to 47% at 8-months and 39% at 12-months. Cervical cancer worries fell from 36% at 4-months to 23% at 12-months. In multivariate models, being younger and having ever had depression, a lower satisfaction with life/healthcare, no private health insurance, and less social support were significantly associated with increased risks of anxiety and worries post-colposcopy.  

Conclusion: High proportions of women attending colposcopy report anxiety or worries afterwards. While worries declined over time, the proportions affected remain high at 12-months.Various socio-demographic and other factors are associated with an increased risk of psychological distress post-colposcopy.

Research implications: This study highlights that colposcopy and related procedures can place a significant psychological burden on women. Research into appropriate interventions that target ‘vulnerable’ women and reduce this burden is urgently required. Research is also needed into whether this burden impacts on compliance with follow-up or future cervical screening intentions.

Clinical implications: Clinicians and other medical professionals involved in the follow-up of women with abnormal cytology should be aware of the psychological after-effects experienced by women following colposcopy and related procedures. They also need to be aware that certain groups of women are at higher risk of suffering adverse psychological after-effects and may benefit from support.

Acknowledgement of funding: This research was funded by the Health Research Board, Ireland.

Published abstract: 
Yes
Authors: 
O'Connor M, White C, Ruttle C, Flannelly G, von Bunau G, O'Leary J, Pilkington L, Turner M, Farah N, Cleary S, Darcy T, Prendiville W, Murphy J, Sharp L
Conference/meeting title: 
15th International Psycho-Oncology Society World Congress
Event date: 
4 Nov 2013 to 8 Nov 2013
Venue: 
Rotterdam
Journal: 
Psychooncology
Volume: 
22
Issue: 
Supplement S3
Page numbers: 
363-374

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