Swedish women’s awareness of human papillomavirus, and health-related quality of life, anxiety, and depression after a notification of an abnormal Pap smear result: a cross-sectional study

Psychosocial Burden of Women Who Are to Undergo Additional Diagnostic Procedures Due to Positive Screening for Cervical Cancer

Background/Objectives: This study aimed to evaluate psychosocial burden and its associated factors in women who were referred for additional diagnostic procedures following receipt of a positive cervical-cancer-screening smear result. Methods: A cross-sectional study was performed in a consecutive cohort of only women who received an abnormal Papanicolaou screening result and therefore presented to a gynecologist for additional diagnostic examinations (colposcopy/biopsy/endocervical curettage) at the Clinic for Gynecology and Obstetrics of the Clinical Center. Multivariate linear regression was used for data analysis, with Bonferroni correction applied for multiple comparisons. Results: Significant independent predictors for the occurrence of psychosocial burden-worry in women with a positive Papanicolaou screening test before diagnostic procedures were the use of oral contraceptives (β = -0.174, p < 0.001), alcohol consumption (β = 0.188, p < 0.001), anxiety (β = -0.189, p = 0.001), high burden of depressive symptoms (β = 0.191, p = 0.001) and insufficient knowledge of the meaning of the term dysplasia/precancerous (β = -0.187, p < 0.001), according to the multivariate linear regression. The significant independent predictor for the occurrence of psychosocial burden-satisfaction with information/support in women with a positive Papanicolaou screening test before diagnostic procedures was psychological distress (β = -0.210, p = 0.001). Conclusions: Providing information in order to improve understanding of the term dysplasia/precancerous, as well as identifying which women are at risk of psychosocial burden, may help protect against this potential harm among women who receive a positive cervical-cancer-screening result and may facilitate their intention to undergo further diagnostic procedures.

An Artificial Neural Network Prediction Model of Depressive Symptoms among Women with Abnormal Papanicolaou Smear Results before and after Diagnostic Procedures

(1) Background: Cervical screening and additional diagnostic procedures often lead to depression. This research aimed to develop a prediction model for depression in women who received an abnormal Papanicolaou screening test, prior to and following the diagnostic procedures. (2) Methods: The study included women who had a positive Papanicolaou screening test (N = 172) and attended the Clinical Center of Kragujevac in Serbia for additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). Women filled out a sociodemographic survey and the Center for Epidemiologic Studies Depression questionnaire (CES-D scale) before and after diagnostic procedures. A prediction model was built with multilayer perceptron neural networks. (3) Results: A correlation-based filter method of feature selection indicated four variables that correlated with depression both prior to and following the diagnostic procedures-anxiety, depression, worry, and concern about health consequences. In addition, the use of sedatives and a history of both induced and spontaneous abortion correlated with pre-diagnostic depression. Important attributes for predicting post-diagnostic depression were scores for the domains 'Tension/discomfort' and 'Embarrassment' and depression in personal medical history. The accuracy of the pre-diagnostic procedures model was 70.6%, and the area under the receiver operating characteristic curve (AUROC) was 0.668. The model for post-diagnostic depression prediction showed an accuracy of 70.6%, and an AUROC = 0.836. (4) Conclusions: This study helps provide means to predict the occurrence of depression in women with an abnormal Papanicolaou screening result prior to and following diagnostic procedures, which can aid healthcare professionals in successfully providing timely psychological support to those women who are referred to further diagnostics.

The effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results: A time-series quasi-experimental study

Background

Due to the cervical cancer screening campaign, there is a gradual increase in the number of women diagnosed with abnormal cervical cytology results. Most women experience high anxiety upon learning about these results, leading to adverse psychological effects. Therefore, nurses play a vital role in counseling these women to alleviate their concerns.

Objective

This study aimed to examine the effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results.

Methods

The study employed a time-series quasi-experimental design with a comparison group. It was conducted at the colposcopy clinic of a university hospital in Bangkok, Thailand, from August 2022 to April 2023. A total of 68 women with abnormal cervical cytology results were purposively recruited based on inclusion criteria. The comparison group (n = 34) received only usual care, while the experimental group (n = 34) received colposcopy counseling and usual care. Colposcopy counseling was provided after collecting baseline data. Anxiety was assessed at baseline, immediate post-test, and 12th week post-test. Data were analyzed using descriptive statistics, Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA).

Results

There was no statistically significant difference in anxiety across the three-time points between the two groups (F1, 66 = 0.062, p = 0.804). However, anxiety in the experimental group significantly decreased over time (p <0.05). In contrast, anxiety in the comparison group at baseline was not significantly different from that at the immediate post-test (p = 0.480).

Conclusion

Colposcopy counseling was effective in reducing anxiety in Thai women with abnormal cervical cytology results, especially during the initial period after receiving the results. Nonetheless, anxiety could gradually decrease regardless of the intervention. Therefore, colposcopy counseling by nurses and healthcare providers is helpful for women in relieving anxiety during their first colposcopy attendance.

The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review

The impact of HPV diagnosis and subsequent treatment with the electrosurgical excision procedure (LEEP) on anxiety, depression, psychosocial quality of life, and sexual functioning has not been thoroughly investigated. The aim of this review was to systematically summarize the available knowledge on this topic, according to PRISMA guidelines. Data from observational and intervention studies were analyzed. A total of 60 records were included, of which 50 papers addressed the impact of HPV diagnosis on patients' psychosocial status, while 10 studies addressed the impact of the implemented LEEP procedure on patients' mental health and sexual functioning. The results indicated a negative impact of HPV diagnosis on the occurrence of depressive and anxiety symptoms, poorer quality of life, as well as on the sexual functioning of the affected women. The results of the studies to date have not confirmed the negative impact of the LEEP procedure on mental health and sexual life, although more research is needed in this area. It is necessary to implement additional procedures to minimize anxiety and distress in patients receiving a diagnosis of HPV or abnormal cytology and to improve awareness of sexually transmitted pathogens.

The Impact of HPV Diagnosis and Abnormal Cervical Cytology Results on Sexual Dysfunction and Anxiety

BACKGROUND

The objective of this study is to evaluate the effect of HPV diagnosis on the sexual function and anxiety levels of Turkish women.

METHODS

A total of 274 female patients who tested positive with HPV were included in the study and categorized into four groups: Group 1 (HPV 16/18 with normal cytology), Group 2 (HPV 16/18 with abnormal cytology), Group 3 (other high-strain HPV with normal cytology), and Group 4 (other high-strain HPV with abnormal cytology). All patients filled out the Beck Anxiety Inventory (BAI) and Female Sexual Function Index (FSFI) at the time when they tested positive for HPV and during the two-month and six-month follow-ups.

RESULTS

Significant increases were observed in BAI scores in all four groups, whereas significant decreases were observed in total FSFI scores in Groups 1 and 2 only(p < 0.05). BAI scores of Groups 1 and 2 were significantly higher than those of Groups 3 and 4 (p < 0.05). FSFI scores of Groups 1 and 2 measured during the sixth-month follow-up were significantly decreased (p = 0.004 and p < 0.001, respectively).

CONCLUSIONS

Our findings suggest that patients with HPV 16 and 18 positivity and abnormal cytological findings are more likely to have high anxiety and sexual dysfunction.

Development and psychometric properties of the human papillomavirus-quality of life (HPV-QoL) questionnaire to assess the impact of HPV on women health-related-quality-of-life

Purpose

The HPV-Quality-of-Life (HPV-QoL) questionnaire was developed to determine the impact of Human-Papillomavirus (HPV) infection and related interventions on women health-related quality-of-life. This study provides the development and preliminary psychometric properties of a novel HPV-QoL questionnaire for adult women with HPV.

Methods

After reviewing literature and cognitive debriefing interviews in women who had experienced HPV-related conditions, instrument items and domains were developed. A draft questionnaire was pilot tested for comprehension and ease of completion. Psychometric evaluation of the final HPV-QoL scale was conducted in a psychometric study including 252 adult women derived to our centre by a positive HPV test in the cervical cancer screening program and/or presenting genital warts.

Results

The present study reveals that the HPV-QoL questionnaire, structured in four domains: general well-being [including psychological well-being and social well-being subdomains], health, contagiousness and sexuality, showed good metric properties of feasibility irrespective of age or educational level, and time to administer was less than 5 min. Internal consistency and temporal stability (reliability) showed values above the acceptable standards. The instrument showed its concurrent validity by means of a significant correlation with mental and sexual existing instruments; GHQ-12 and FSFI questionnaires, respectively, and also known groups validity showing significant differences among the subgroups regarding either sexual dysfunction or mental deterioration.

Conclusion

This study provides an HPV-QoL questionnaire with an innovative patient-reported outcomes specific measurement tool to assess HRQoL in women with HPV infection. The present study suggests this questionnaire has satisfactory psychometric properties, including validity and reliability. Results support the use of the HPV-QoL questionnaire as a HRQoL measurement instrument for daily medical practice and clinical research.

Depression before and after diagnostic procedures among women with abnormal finding of Papanicolaou screening test

Background

Some studies did find significant differences in the level of depression of women while undergoing diagnostic evaluation of an abnormal Papanicolaou screening smear, but findings were not consistent. This study aimed to assess prevalence and correlates of depression in women with abnormal cervical screening results before and after diagnostic procedures.

Methods

A cross‐sectional study was carried out during 2017 in a cohort of women with positive Papanicolaou screening test before and after diagnostic procedures (colposcopy/biopsy/endocervical curettage) at the university Clinical Centre Kragujevac, Serbia. Women completed a questionnaire about demographics, lifestyle, and other factors of interest. Also, questionnaire “Hospital Anxiety and Depression Scale” (HADS) was used immediately before and 2–4 weeks after the diagnostic procedures: a score of ≥8 on HADS‐D and HADS‐A subscales indicated depression and anxiety, respectively. Multivariate logistic regression was applied in the data analysis.

Results

The study comprised 172 women, giving a response rate of 72.3%. The mean age of the participants was 47.8 ± 11.1 years (range 23–65). The frequency of depressive symptoms was significantly higher after diagnostic procedures (48.3%) than before diagnostic procedures (37.2%) (p = 0.038). Before diagnostic procedures, older age (OR = 1.60; 95% CI = 1.09–2.34; p = 0.017), and level of anxiety according to the HADS‐A subscale (OR = 1.61; 95% CI = 1.38–1.88; p < 0.001) were significant independent predictors of depression. After diagnostic procedures, significant independent predictors of depression were urban place of residence (OR = 0.12; 95% CI = 0.03–0.47; p = 0.002) and level of anxiety according to the HADS‐A subscale (OR = 1.85; 95% CI = 1.54–2.21; p < 0.001).

Conclusion

Our study showed that older age, rural residence, and anxiety play a role in shaping the risk of depression among women undergoing additional diagnostic procedures after receiving an abnormal Papanicolaou screening result.

Psychological factors among Appalachian women with abnormal Pap results

PURPOSE

Women who receive an abnormal Pap result may experience negative psychological factors. The purpose of this study is to assess the baseline occurrence of negative psychological factors and evaluate the relationships between psychological factors and demographic characteristics among Appalachian women who received abnormal Pap results.

METHODS

We conducted a secondary analysis of data collected from Appalachia Kentucky women (N = 521) ages ≥18 enrolled in an intervention. Data included sociodemographics, Beck depression and anxiety inventories, fatalism, and personal control measures. Multiple variable logistic regression was used to investigate the association between demographics and psychological factors.

FINDINGS

Participants were predominantly White (96.2%), with mean age 28.93 ± 11.03 years, and the majority (77%) had yearly income below $20,000. Depression was reported by 34.6% (n = 173); 10% (n = 50) experienced moderate or severe anxiety; 20.6% (n = 107) had fatalistic beliefs; and 55.1% (n = 289) believed they lacked personal control over cancer. Women with lower income had higher occurrence of depression (P = .003). Women with moderate to severe anxiety were significantly older than those with low to moderate depression (34.44 vs 28.34, P < .001). Controlling for other variables, as age increased, the odds of fatalistic beliefs increased, OR (95%) = 1.042 (1.022, 1.062). When education level increased, the odds of fatalistic beliefs decreased, OR (95%) = 0.873 (0.800, 0.952).

CONCLUSIONS

Given the high occurrence of depression, anxiety, and fatalistic beliefs among this population, health care providers should assess for underlying mental health diagnoses and psychological distress during each patient encounter and provide recommendations to address them.

Do different treatment strategies influence women's level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions

OBJECTIVE

To examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions.

STUDY DESIGN

Observational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups.

RESULTS

209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well.

CONCLUSIONS

Fear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.

Anxiety and Depression in Thai Women with Abnormal Cervical Cytology who Attended Colposcopic Unit in Thammasat University Hospital

Background: Colposcopy is the standard investigation for women with abnormal cervical cytology. Waiting time to colposcopy could impact to psychological distress. Data about anxiety and depression in eastern countries patients were limited. Aim of this investigation was to evaluate anxiety and depression status in Thai women who were waiting for colposcopy compared to women who attended gynecology clinic for cervical cancer screening. Materials and methods: This study was conducted at the outpatient gynecology clinic of Thammasat University Hospital between January 2017 to March 2018. A Total of 200 women were recruited into the study. The cases were divided into the study and control group. Study group consisted of one hundred women with abnormal cervical cytology referred to colposcopy. One hundred of women who attended gynecology clinic for cervical cancer screening was classified as control group. The Hospital Anxiety and Depression Scale (HADS) was used to determine anxiety in the participants. Results: Total of 200 women who met criteria of the study were recruited. The mean ages of both groups were 40 years old. Both groups were significantly different when it came to their education, 30 and 59 percent of study and control group had education level more than bachelor (p=0.003). The prevalence of anxiety was statistically significantly higher in study group than the control group (15% and 6%, respectively). There was only one case of depression in study. Waiting time and abnormal cervical cytology severity did not affected to anxiety level. Conclusions: Colposcopy and appointment caused anxiety. However anxiety was not associated with waiting time to colposcopy or Pap result’s severity.