title: The psychosocial impact of an abnormal cervical smear result.
abstract: BACKGROUND
  Data on the impact of abnormal cervical smear results on health-related quality of life (HrQoL) are scarce. We aimed to (i) prospectively assess the HrQoL of women who were informed of an abnormal smear result; (ii) identify predictors of greater negative psychosocial impact of an abnormal result; and (iii) prospectively estimate the quality-adjusted life-years (QALYs) lost following an abnormal result.
  
  
  METHODS
  Between 08/2006 and 08/2008, 492 women with an abnormal result and 460 women with a normal result, frequency matched for age and clinic, were recruited across Canada. HrQoL was measured at recruitment and 4 and 12 weeks later with the EuroQol, Short Form-12, short Spielberg State-Trait Anxiety Inventory (STAI) and HPV Impact Profile. Three blocks of potential predictors of higher psychosocial impact were tested by hierarchical modeling: (i) socio-demographics; (ii) sexual activity; and (iii) smear result severity, communication, and understanding.
  
  
  RESULTS
  Receiving an abnormal result significantly increased anxiety (STAI mean difference between both groups = 8.3). Initial anxiety decreased over time for the majority of women. However, 35% of women had clinically meaningful anxiety at 12 weeks (i.e. STAI scores ≥0.5 standard deviation of the controls). These women reported a lower socio-economic level, did not completely understand the information about their result and perceived themselves at higher risk of cancer. QALY lost following an abnormal result were between 0.007 and 0.009.
  
  
  CONCLUSIONS
  Receiving an abnormal smear has a statistically significant and clinically meaningful negative impact on mental health. However, this negative impact subsides after 12 weeks for the majority of women.
authors.affiliation: URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Quebec City, Quebec, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.forename: Marc
authors.initials: M
authors.lastname: Brisson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maunsell
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.forename: William
authors.initials: W
authors.lastname: Fisher
authors.forename: James A
authors.initials: JA
authors.lastname: Mansi
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D002170:Canada; D016022:Case-Control Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000523:psychology*; D014626:Vaginal Smears / Q000523:psychology*