title: Psychological impact of lifestyle-related disease disclosure at general checkup: a prospective cohort study.
abstract: BACKGROUND
  Little is known about psychological impact of disclosing lifestyle-related diseases. Previous studies discussed the long-term psychological impact of disease disclosure, and a significant psychological impact was not observed. This study clarified the psychological impact on anxiety state of patients when lifestyle-related diseases are disclosed at general checkups for local residents. In particular, this study evaluated the short-term impact on patients, and how the notification of abnormal values and the disclosure of disease at general checkups affect patients' subsequent behavioral changes.
  
  
  METHODS
  The study design was a prospective cohort study. We compared the anxiety state of participants using a self-administered anxiety assessment scale, State-Trait Anxiety Inventory (STAI), before and after Physician's explanation of abnormal values in markers of lifestyle-related diseases. The participants were those between the age of 40 and 75 years who underwent general checkups at two primary care facilities. In addition, we assessed the effects on lifestyle habits and the psychological impact caused by general checkup using STAI and a survey on behavioral changes one month after the checkup.
  
  
  RESULTS
  The valid response rate at the survey of the general checkup was 92% (534/578). Of those who showed abnormal levels in markers of lifestyle-related diseases, anxiety was augmented significantly among those who responded that the physician had told them of their diagnosis compared to those who responded that the physician had not told them of their diagnosis (Wilcoxon rank-sum test, P < 0.007). The percentage of patients whose state anxiety scale of STAI increased ≥5 points was 30% in the disease disclosed group (33/111) and 17% in the disease undisclosed group (27/159), respectively. The risk ratio was 1.5 (95% CI: 1.1-2.0). One month after the general checkup, overall anxiety diminished regardless of whether diagnosis of lifestyle-related diseases was disclosed to patients notified of abnormal values. In addition, improvements in daily life behaviors as a result of notification of abnormalities or disclosure of diagnosis at general checkup were not observed.
  
  
  CONCLUSIONS
  Even in a general checkup for the general population, disclosing non-critical diseases such as lifestyle-related diseases exacerbated anxiety as a short-term psychological impact.
authors.affiliation: Musashi-Koganei Clinic, Japanese Health and Welfare Co-operative Federation, 1-15-9 Honcho koganeishi, 181-0004, Tokyo, Japan. littlemuffinbaby@gmail.com.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Tominaga
authors.affiliation: Division of Clinical Epidemiology, Jikei University School of Medicine, 3-25-8 Nishishimbachi, 105-8461, Minato-ku, Tokyo, Japan. masato@jikei.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Division of Clinical Epidemiology, Jikei University School of Medicine, 3-25-8 Nishishimbachi, 105-8461, Minato-ku, Tokyo, Japan. taku8nagata@gmail.com.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Division of Clinical Epidemiology, Jikei University School of Medicine, 3-25-8 Nishishimbachi, 105-8461, Minato-ku, Tokyo, Japan. moriya.akinari@gmail.com.
authors.forename: Akinari
authors.initials: A
authors.lastname: Moriya
authors.affiliation: Kita-Adachi Seikyo Clinic, Tokyo Hokuto Health Co-operative, 3-1-5 Iriya, 121-0836, Adachi-ku, Tokyo, Japan. watanabetakamasa@gmail.com.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Japan Small Animal Cancer Center, 2-27-4 Nakatomiminami, 359-0003, Tokorozawa, Saitama, Japan. yuko-n@momo.so-net.ne.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Oji Seikyo Hospital, Tokyo Hokuto Health Co-operative, 3-4-15 Toshima, 114-0003, Kita-ku, Tokyo, Japan. yokohira7@gmail.com.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hirayama
authors.affiliation: Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, 3-22-1 Ukima, 115-0051, Kita-ku, Tokyo, Japan. yasukifujinuma@gmail.com.|Interprofessional Education Research Center (IPERC), Graduate School of Nursing, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670, Chiba City, Chiba, Japan. yasukifujinuma@gmail.com.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Fujinuma
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D001294:Attitude to Health; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000523:psychology; D050171:Dyslipidemias / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000523:psychology; D007564:Japan; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D011580:Psychological Techniques; D014342:Truth Disclosure