Psychological After-Effects of Colposcopy: Prevalence of Worries, Anxiety, and Depression at 4 Months
Colposcopy can be a distressing experience for women, leading to raised anxiety levels. This study aims to investigate worries about health, cervical cancer, future fertility, and sex at 4 months post-colposcopy. It also assesses levels of anxiety and depression among women, aiming to identify those at highest risk of negative psychological effects. Participants were recruited from Dublin hospitals, and questionnaires were mailed to assess various factors related to psychological well-being.
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Psychological after-effects of colposcopy: prevalence of worries, anxiety and depression at 4 months M O Connor, C White, C Ruttle, C Martin, G Flannelly, G von Bunau, J O Leary, L Pilkington, M Anglim, M Turner, N Farah, S Cleary, T Darcy, W Prendiville J Murphy, L Sharp on behalf of the Irish Cervical Screening Research Consortium (CERVIVA)
Background It is widely known that colposcopy can be a distressing experience for women Studies have reported raised anxiety levels & distress both prior to and during the examination less is known about the psychological after-effects of colposcopy & associated procedures Need for better understanding of psychological after- effects of colposcopy; to identify those women at highest risk of adverse effects and to identify issues that concern women the most
Aims 1. To investigate worries about health, cervical cancer, future fertility and having sex 4 months following colposcopy 2. To assess levels of anxiety and depression among women 4 months post-colposcopy 3. To identify women mostly likely to experience negative psychological effects following colposcopy
Methods Women were recruited from 2 large Dublin hospitals Questionnaires were mailed to 393 women 4 months following their initial colpscopic management Worries about general health, cervical cancer, future fertility and having sex were assessed using the Process Outcome Specific Measure (POSM) (Gray et al., 2005) Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS; clinically significant anxiety, HADS subscale score 11; clinically significant depression, HADS subscale score 8)
Situation in Ireland Mixed public/private health care system Time of rapid change in cervical cancer prevention in Ireland Cervical screening oCervicalCheck, the national programme was launched on the 1st September 2008 HPV vaccine - Protect now, for the Future
Participants Age <30 years 67 (27%) 30-49 years 164 (66%) 50 years 17 (7%) 250 surveys were returned (response rate=64%) Education <third level 152 (61%) third level 93 (37%) 43% had private health insurance Relationship status single 60 (24%) married/cohabiting 126 (50%) In a relationship 74 (30%) divorced/separated 19 (8%) widowed 1 (0.4%) Over one third (34%) were smokers Children yes 139 (56%) no 108 (43%) Missing values not reported
Participants Previous abnormal smear Over half (55%) had an another abnormal smear before the one that resulted in referral for colposcopy Previous colposcopy Almost one-quarter (23%) had previously had another colposcopy Women who have had another colposcopy have different levels of worries, anxiety and depression?
Overall prevalence of worries Agree Disagree I have been worried about my general health 53% 47% I have been worried that my next smear will show changes 68% 32% I have been worried that I may have cervical cancer 37% 63% I have been worried about my ability to have children 41% 59% I have been worried about having sex 32% 68%
Which women were more likely to be worried? General Health Women that were cohabiting (living with partner) (63%) and those that reported having or had depression in the past (73%) more likely to be concerned about their general health Cervical Cancer Prevalence of worries did not vary socio-demographic characteristics or having had another colposcopy Fertility Worries about having sex did not vary by socio-demographic characteristics or prior colposcopy Sex Worries about having sex did not vary by socio-demographic characteristics or prior colposcopy
Prevalence of clinically significant anxiety and depression 25% 21% 20% 15% 11% 10% 5% 0% Anxiety Depression
Anxiety Prevalence of anxiety did not vary by women s age, education level, martial status, having had another abnormal smear or another colposcopy Current or ex-smokers were more likely to be anxious (80%) Women that reported having depression or depression in the past were more likely to be anxious (41%) Women with anxiety were more worried about their general health, their next smear being abnormal, having cervical cancer, future fertility and having sex
Depression Significant depression among the women did not vary by age or martial status Women classified as depressed more likely to have concerns over otheir general health onext smear being abnormal oability to have children ohaving cervical cancer ohaving sex Women with depression omore likely to have < third level education omore likely to smoke or report having/had depression
Conclusions High proportions of women report anxiety, depression and worries following colposcopy These results highlight some of the specific issues that concern women after having a colposcopy Colposcopy and other related procedures incur a significant psychological burden on women Interventions that reduce this burden and focus on women s concerns over their general health, having cervical cancer, future fertility and having sex are urgently required
Future plans Ongoing collection of questionnaires at 3 time points (apx 4, 8 & 12 months post colposcopy) Analysis of questionnaires at each time-point independently Tracking the trajectory of each psychological outcome over time (adjusting for confounders) Collection of hospital record data (to assign women to groups according to management received/results)
Acknowledgements All the women who participated in the study to date Coombe Women & Infants University Hospital, Dublin and National Maternity Hospital, Dublin The clinicians and research nurses who helped recruit women to the study www.cerviva.ie This study is funded by the Health Research Board in Ireland
