Sims Rebecca, Michaleff Zoe A, Glasziou Paul, Jones Mark, Thomas Rae
Institute for Evidence-Based Healthcare, Bond University, Australia.
Research Office, Northern New South Wales Local Health District, Australia.
BJPsych Open. 2023 Apr 19;9(3):e73. doi: 10.1192/bjo.2023.49.
Screening for asymptomatic health conditions is perceived as mostly beneficial, with possible harms receiving little attention.
To quantify proximal and longer-term consequences for individuals receiving a diagnostic label following screening for an asymptomatic, non-cancer health condition.
Five electronic databases were searched (inception to November 2022) for studies that recruited asymptomatic screened individuals who received or did not receive a diagnostic label. Eligible studies reported psychological, psychosocial and/or behavioural outcomes before and after screening results. Independent reviewers screened titles and abstracts, extracted data from included studies, and assessed risk of bias (Risk of Bias in Non-Randomised Studies of Interventions). Results were meta-analysed or descriptively reported.
Sixteen studies were included. Twelve studies addressed psychological outcomes, four studies examined behavioural outcomes and none reported psychosocial outcomes. Risk of bias was judged as low ( = 8), moderate ( = 5) or serious ( = 3). Immediately after receiving results, anxiety was significantly higher for individuals receiving versus not receiving a diagnostic label (mean difference -7.28, 95% CI -12.85 to -1.71). On average, anxiety increased from the non-clinical to clinical range, but returned to the non-clinical range in the longer term. No significant immediate or longer-term differences were found for depression or general mental health. Absenteeism did not significantly differ from the year before to the year after screening.
The impacts of screening asymptomatic, non-cancer health conditions are not universally positive. Limited research exists regarding longer-term impacts. Well-designed, high-quality studies further investigating these impacts are required to assist development of protocols that minimise psychological distress following diagnosis.
对无症状健康状况进行筛查被认为大多是有益的，而可能存在的危害却很少受到关注。
量化对无症状非癌症健康状况进行筛查后被赋予诊断标签的个体的近期和长期后果。
检索了五个电子数据库（从建库至2022年11月），以查找招募了接受或未接受诊断标签的无症状筛查个体的研究。符合条件的研究报告了筛查结果前后的心理、心理社会和/或行为结果。独立评审员筛选标题和摘要，从纳入研究中提取数据，并评估偏倚风险（干预非随机研究中的偏倚风险）。对结果进行荟萃分析或描述性报告。
纳入了16项研究。12项研究涉及心理结果，4项研究考察了行为结果，没有研究报告心理社会结果。偏倚风险被判定为低（=8）、中度（=5）或严重（=3）。在收到结果后立即进行比较，接受诊断标签的个体的焦虑水平显著高于未接受诊断标签的个体（平均差异-7.28，95%可信区间-12.85至-1.71）。平均而言，焦虑从非临床范围升至临床范围，但从长期来看又回到了非临床范围。在抑郁或总体心理健康方面未发现显著的即时或长期差异。筛查前后一年的缺勤率没有显著差异。
对无症状非癌症健康状况进行筛查的影响并非普遍积极。关于长期影响的研究有限。需要开展设计良好、高质量的研究来进一步调查这些影响，以协助制定方案，尽量减少诊断后的心理困扰。
