title: Effect of stress and depression on the frequency of squamous intraepithelial lesions.
abstract: OBJECTIVE
  To explore the previously reported associations between cervical squamous lesions and psychologic measures of stress and depression.
  
  
  METHODS
  In a multicenter cohort study, women with HIV and HIV-seronegative women had Pap tests and completed self-report questionnaires including the Perceived Stress Scale-10 (PSS), which measures perceived stress, the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), which measures symptoms of PTSD, and the Center for Epidemiologic Studies Depression (CES-D) scale, which measures depressive symptoms.
  
  
  RESULTS
  Median scores were 13 (range = 0-38) for the PSS, 24 (range = 17-85) for the PCL-C, and 8 (range = 0-57) for the CES-D, indicating moderate stress and minimal depression. For PSS, compared with women in the lowest tertile of reported stress, the odds ratios (ORs) for squamous intraepithelial lesions (SIL) were 0.88 (95% confidence interval [CI] = 0.50-1.54) for women in the middle tertile and 0.96 (95% CI = 0.54-1.68) for women in the highest tertile. For PCL-C, compared with women in the lowest tertile of PTSD symptoms, ORs for SIL were 0.79 (95% CI = 0.43-1.41) for women in the middle tertile and 1.17 (95% CI = 0.68-2.01) for women in the highest tertile. Rates of SIL were similar for CES-D scores 16 or higher (compared with women with lower scores; OR = 1.41, 95% CI = 0.88-2.26) and 23 or higher (OR = 1.39, 95% CI = 0.81-2.40). In the multivariable analysis including the number of sexual partners, age, income, ethnicity, and serostatus, stress as measured by PSS and PCL-C and depressive symptoms as measured by CES-D remained unassociated with SIL.
  
  
  CONCLUSIONS
  We found no evidence that stress and depression affect the prevalence of cervical squamous lesions.
authors.affiliation: Washington University School of Medicine, St Louis, MO, USA. massadl@wudosis.wustl.edu
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Denis
authors.initials: D
authors.lastname: Agniel
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: Anthony
authors.initials: A
authors.lastname: Cajigas
authors.forename: Kathleen
authors.initials: K
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology*; D015995:Prevalence; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears