title: Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA).
abstract: BACKGROUND
  Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.
  
  
  METHODS
  Nine hundred and eighty-nine women aged 20-59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression.
  
  
  RESULTS
  The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer.
  
  
  CONCLUSIONS
  Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required.
authors.affiliation: National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland. linda.sharp@ncri.ie
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Seonaidh
authors.initials: S
authors.lastname: Cotton
authors.forename: Anne-Elie
authors.initials: AE
authors.lastname: Carsin
authors.forename: Nicola
authors.initials: N
authors.lastname: Gray
authors.forename: Alison
authors.initials: A
authors.lastname: Thornton
authors.forename: Margaret
authors.initials: M
authors.lastname: Cruickshank
authors.forename: Julian
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000523:psychology; D003127:Colposcopy / Q000523:psychology; D003863:Depression / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D016015:Logistic Models; D008875:Middle Aged; D000075384:Neuroticism; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000523:psychology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000523:psychology*