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Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.

The outbreak of the novel SARS CoV-2-virus (COVID-19) is pushing national and international healthcare systems to their limits. The aspect of mental health issues, which has been neglected (so far) in times of social isolation and governmental restrictions, now demands innovative and situation-based approaches to support psychological burdened people. The developed e-mental health intervention ‘CoPE It’ offers manualized, evidence-based psychotherapeutic/psychological support to overcome psychological distress in times of COVID-19. E-mental health approaches offer great possibilities to support burdened people during the SARS-CoV-2 pandemic effectively.

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IntroductionThe SARS-CoV-2 (COVID-19) pandemic poses immense challenges for national and international healthcare systems. Especially in times of social isolation and governmental restrictions, mental health should not be neglected. Innovative approaches are required to support psychologically burdened people. The e-mental health intervention ‘CoPE It’ has been developed to offer manualised and evidence-based psychotherapeutic support adapted to COVID-19-related issues in order to overcome psychological distress. In our study, we aim to assess the efficacy of the e-mental health intervention ‘CoPE It’ in terms of reducing distress (primary outcome), depression and anxiety symptoms as well as improving self-efficacy, quality of life and mindfulness (secondary outcomes). Furthermore, we want to evaluate the programme’s usability, feasibility and participants’ satisfaction with ‘CoPE It’ (tertiary outcome).Methods and analysisThe e-mental health intervention ‘CoPE It’ consists of four 30 min modules, conducted every other day, involving psychotherapeutic techniques of mindfulness-based stress reduction and cognitive–behavioural therapy. The widely applied and previously established content has been adapted to the context of the COVID-19 pandemic by experts in psychosomatic medicine and stress prevention. In our longitudinal study, adult participants—with adequate German language and computer skills, and who have provided informed consent—will be recruited via emergency support hotlines in Germany. Flyers will be distributed, and online channels will be used. Participants will complete a baseline assessment (T0), a postintervention assessment (T1) and assessments 1 and 3 months later (T2 and T3, respectively). We will perform repeated measures analysis of covariance, mixed linear models, standard analyses of variance and regression, and correlation coefficients. In case of binary outcome variables, either mixed logistic regression or χ² tests will be used.Ethics and disseminationThe Ethics Committees of the University of Duisburg-Essen (20-9243-BO) and University of Tübingen (469/2020BO) approved the study. Results will be published in peer-reviewed journals and conference presentations.Trial registration numberDRKS00021301.

Recommended instruments for distress assessment in psychooncology measure different areas of distress. They do not sufficiently agree in indicating a patient's need for psychooncological treatment. Hence, one should neither compare results of studies using different assessment instruments nor implement a screening without reflecting the used instrument's characteristics compared to the others. The subjective need seems to provide additional information to the assessment. At present, the combination of an assessment instrument and patients' subjective need is seen as a best practice for identifying patients in need of psychooncological treatment.

Zusammenfassung Hintergrund Auswirkungen der COVID-19-Pandemie auf die psychische Gesundheit zeigten sich bereits früh. Das Ausmaß der Auswirkungen, insbesondere kumulativ über die lang anhaltende Zeit der Pandemie, ist für Deutschland noch nicht umfassend untersucht worden. Ziel der Arbeit Ziel der Studie war es, psychische Belastungen sowie COVID-19-bezogene Erlebens- und Verhaltensweisen zu erheben und deren Veränderung über die verschiedenen Phasen der Pandemie in Deutschland darzustellen. Material und Methoden In die deutschlandweite onlinebasierte Querschnittsstudie (10.03.–27.07.2020) konnten 22.961 Menschen eingeschlossen werden (Convenience Sample). Erhoben wurden: generalisierte Angst (GAD-7), Depression (PHQ-2), psychischer Distress (DT) sowie COVID-19-bezogene Erlebens- und Verhaltensweisen wie COVID-19-bezogene Angst, Vertrauen in staatliche Maßnahmen, subjektives Informiertheitslevel, adhärentes Sicherheitsverhalten und persönliche Risikoeinschätzung für Ansteckung/Erkrankungsschwere. Die Pandemie wurde retrospektiv in 5 Phasen (Anfangs‑, Krisen‑, Lockdown‑, Neuorientierungsphase und „neue Normalität“) eingeteilt. Ergebnisse Es zeigten sich im Vergleich zu Prä-COVID-19-Referenzwerten anhaltend erhöhte Werte in GAD‑7, PHQ‑2 und DT. COVID-19-bezogene Angst, Informiertheitslevel, Vertrauen, Sicherheitsverhalten und die Einschätzung, an COVID-19 zu erkranken, zeigten, nach initial starkem Anstieg, einen Abfall bis z. T. unter den Ausgangswert. Ausnahme waren konstante Einschätzungen, einen schweren Verlauf von COVID-19 zu haben bzw. daran zu versterben. Diskussion Die durch alle Pandemiephasen anhaltend erhöhten Werte psychischer Belastung verdeutlichen die Notwendigkeit nachhaltiger Unterstützungsangebote. Sinkende Werte in Bezug auf Vertrauen in staatliche Maßnahmen und das subjektive Informiertheitslevel unterstreichen das Gebot gezielter Aufklärung.

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