Anxiety and distress following receipt of results from routine HPV primary testing in cervical screening: The psychological impact of primary screening (PIPS) study

Abstract

We used a cross‐sectional survey to examine short‐term anxiety and distress in women receiving different results following routine human papillomavirus (HPV) primary testing at cervical screening. Participants were women aged 24–65 (n = 1,127) who had attended screening at one of five sites piloting HPV primary screening in England, including a control group with normal cytology who were not tested for HPV. Women completed a postal questionnaire ~2 weeks after receiving their screening result. Unadjusted mean anxiety scores ranged from 32.9 (standard deviation [SD] = 12.2) in HPV‐negative women to 42.1 (SD = 14.9) in women who were HPV‐positive with abnormal cytology. In adjusted analyses, anxiety was significantly higher in women testing HPV‐positive with either normal cytology (mean difference [MD] = 3.5, CI: 0.6–6.4) or abnormal cytology (MD = 7.2, CI: 3.7–10.6), than the control group. Distress was slightly higher in women who tested HPV‐positive with abnormal cytology (MD = 0.9, CI: 0.02–1.8), than the control group. We also found increased odds of very high anxiety in women who tested HPV‐positive with normal or abnormal cytology compared to the control group. This pattern of results was only observed among women receiving their first HPV‐positive result, not among women found to have persistent HPV at 12‐month follow‐up. Testing HPV‐positive with normal cytology for the first time, is associated with elevated anxiety despite carrying very low immediate cervical cancer risk. However, receiving the same test result at 12‐month early recall does not appear to be associated with higher anxiety, suggesting anxiety may normalise with repeated exposure and/or over time.

Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey

“…These findings complement an English study investigating the psychosocial impact of HPV testing on women during piloting of primary HPV testing 26. Anxiety (53.03) and distress (3.94) levels for women who reported testing HPV+ in this study are much higher compared with the English study (women HPV+ with abnormal cytology anxiety 42.9; distress 3.3).…”

Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis

“…Consistently, another study found no differences over a 12-month period (Nagele et al, 2019). General psychological distress (Golderberg & Williams, 1988) was found to be slightly higher (worse) in women testing HPV-positive with abnormal cytology 4-weeks after their result in two studies (Maissi et al, 2004;McBride et al, 2020). However, no differences were found 6-months later in a follow-up study (Maissi et al, 2005) or up to 12 or 24 months later in two other studies (Andreassen et al, 2019;Nagele et al, 2019).…”

“…Seventeen papers were quantitative studies (Alay et al, 2019;Andreassen et al, 2019;Ferenidou et al, 2012;Garces-Palacio et al, 2019;Hsu et al, 2018;Kitchener et al, 2008;Kwan et al, 2011;Maggino et al, 2007;Maissi et al, 2004Maissi et al, , 2005McBride et al, 2020;McCaffery et al, 2004;Nagele et al, 2019;Ngu et al, 2018;Rodriguez et al, 2019;Wang et al, 2010;Wang et al, 2011), 15 were qualitative (Barrera-Clavijo et al, 2015;Barreto et al, 2016;Bertram & Magnussen, 2008;Head et al, 2017;Kosenko et al, 2012;Lin et al, 2011;Linde et al, 2019;McCaffery & Irwig, 2005;McCaffery et al, 2006;McCurdy et al, 2011;O'Connor et al, 2014;Perrin et al, 2006;Tiro et al (2019); Waller, McCaffery, et al, 2007;Wyndham-West et al, 2018) and one was mixed-methods (Daley et al, 2010). A total of 12,789 women aged between 18 and 65 participated in twenty studies (n=12,244 quantitative; n=545 qualitative), of whom 4,305 were reported as having tested positive for HPV (n=3,874 quantitative; n=431 qualitative).…”

“…Ten quantitative studies measured anxiety at different time points (Alay et al, 2019;Garces-Palacio et al, 2019;Kitchener et al, 2008;Kwan et al, 2011;Maggino et al, 2007;Maissi et al, 2004Maissi et al, , 2005McBride et al, 2020;McCaffery et al, 2004;Ngu et al, 2018) mostly using the state subscale from the state-trait anxiety inventory (Marteau & Bekker, 1992;Spielberger, 1983).…”

“…Sixteen quantitative studies included a measure of psychological distress: ten included test-specific distress (Ferenidou et al, 2012;Garces-Palacio et al, 2019;Kwan et al, 2011;Maissi et al, 2004Maissi et al, , 2005McBride et al, 2020;McCaffery et al, 2004;Ngu et al, 2018;Wang et al, 2010Wang et al, , 2011, eleven sexual distress (Alay et al, 2019;Ferenidou et al, 2012;Hsu et al, 2018;Kitchener et al, 2008;Kwan et al, 2011;Maggino et al, 2007;Maissi et al, 2005;McCaffery et al, 2004;Nagele et al, 2019;Wang et al, 2010Wang et al, , 2011 and six general distress (Andreassen et al, 2019;Hsu et al, 2018;Kitchener et al, 2008;Maissi et al, 2004Maissi et al, , 2005McBride et al, 2020). Test-specific distress was consistently higher (worse) for women testing HPV-positive with any cytology result compared to normal results up to 6-months post-result (Maissi et al, 2005), but not at 12-months post-result (Garces-Palacio et al, 2019).…”