title: Long-term psychological morbidity, sexual functioning, and relationship outcomes in women with gestational trophoblastic disease.
abstract: OBJECTIVE
  Clinical observation suggests a protracted psychosocial recovery after gestational trophoblastic disease (GTD), although this has not been well studied. We describe long-term psychological morbidity, sexual functioning, and relationship outcomes after GTD.
  
  
  METHODS
  Cross-sectional analysis was made of 176 Australian women previously diagnosed with GTD recruited from a statewide registry. Participants comprised 149 women (85%) who did not require chemotherapy and 27 women (15%) who required chemotherapy for malignant or persistent GTD/molar disease (gestational trophoblastic tumor [GTT]). Data were collected from medical records and via validated self-report questionnaires.
  
  
  RESULTS
  The participants were 94 women (53%) with partial mole, 75 women (43%) with complete mole, 4 women (2%) with choriocarcinoma, and 3 women (2%) with hydatidiform mole not otherwise specified. The mean (SD) age at diagnosis and time since diagnosis were 32.1 (6.3) and 4.7 (3.3) years, respectively. Elevated levels of depression and anxiety were reported by 22% and 26% of the women, respectively. One fifth to half of the women experienced some GTD-related avoidant and intrusive phenomena, the latter being more prominent among women who had not had chemotherapy. Sexual dysfunction was reported by 52% of the women. Most women (81%) felt well supported by their partners during the illness, 19% thought the relationship had changed, and 26% perceived that GTD had negatively affected sex life. This perception was stronger in those who received chemotherapy, although objective measures of sexual morbidity showed no group differences. Socially disadvantaged women and those who did not conceive subsequent to the diagnosis had poorer psychosocial outcomes.
  
  
  CONCLUSIONS
  Notwithstanding limitations, this study is the largest of its type to date. Psychological morbidity rates exceeded community norms, but sexual dysfunction rates, although high, are likely consistent with local norms. These findings highlight the long-term burden of GTD and the importance of a supportive care component in management, even among those who do not require chemotherapy. Socially disadvantaged women and those who do not conceive subsequent to GTD diagnosis require greater psychosocial support.
authors.affiliation: Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia. lesley@lesleystafford.com
authors.forename: Lesley
authors.initials: L
authors.lastname: Stafford
authors.forename: Orla M
authors.initials: OM
authors.lastname: McNally
authors.forename: Penelope
authors.initials: P
authors.lastname: Gibson
authors.forename: Fiona
authors.initials: F
authors.lastname: Judd
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D011247:Pregnancy; D012042:Registries; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology / Q000209:etiology*; D014594:Uterine Neoplasms / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult