Pennisi Flavia, Ricciardi Giovanni Emanuele, von Wagner Christian, Smith Lauren, Kaushal Aradhna, Lyratzopoulos Georgios, Merriel Samuel William David, Hamilton Willie, Abel Gary, Valderas Jose Maria, Renzi Cristina
PhD National Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
School of Medicine, Università Vita-Salute San Raffaele, Milano, Italy.
Cancer Med. 2024 Dec;13(23):e70426. doi: 10.1002/cam4.70426.
To investigate if pre-existing mental health morbidity (MHM) might influence help-seeking and willingness to undergo diagnostic investigations for potential colorectal cancer (CRC) symptoms.
An online vignette survey was completed by 1307 adults aged > 50 years recruited through Prolific, a UK panel provider. Participants self-reported any chronic physical or MHM. After having been presented with vignettes describing new onset symptoms (rectal bleeding or change in bowel habit), participants answered questions on symptom attribution and attitudes to investigations. Using multivariable logistic regression we examined the association between MHM and symptom attribution, intended help-seeking, and willingness to undergo investigations, controlling for socio-demographic factors and physical morbidities.
Self-reported MHM (reported by 14% of participants) was not associated with cancer symptom attribution (29% of participants with or without MHM mentioned cancer as a possible reason for rectal bleeding and 14% for change in bowel habit). Individuals with self-reported MHM were less likely to contact a GP if experiencing a change in bowel habit (19% vs. 39%; adjusted (a)OR = 0.34, 95% CI 0.19-0.60) and to mention rectal bleeding to their GP (83% vs. 89%, aOR = 0.49, 95% CI 0.26-0.94). Although most participants would be willing to undergo a colonoscopy for these high-risk symptoms, those with depression/anxiety were less willing (90% vs. 96%; aOR: 0.37, 95% CI 0.16-0.87).
Individuals with self-reported MHM are less likely to seek help and less willing to undergo investigations for high-risk symptoms. Targeted support, for example, through additional mental health nurses, might facilitate prompt cancer diagnosis for the large group of people with MHM.
探讨既往存在的心理健康问题（MHM）是否会影响对潜在结直肠癌（CRC）症状的求助行为及接受诊断性检查的意愿。
通过英国的一个专门小组Prolific招募了1307名年龄大于50岁的成年人，他们完成了一项在线案例调查。参与者自行报告任何慢性身体疾病或心理健康问题。在向参与者展示描述新出现症状（直肠出血或排便习惯改变）的案例后，他们回答了关于症状归因以及对检查态度的问题。我们使用多变量逻辑回归分析，在控制社会人口学因素和身体疾病的情况下，研究心理健康问题与症状归因、预期求助行为以及接受检查意愿之间的关联。
自我报告存在心理健康问题的参与者（占参与者的14%）与癌症症状归因无关（有或没有心理健康问题的参与者中，29%提到癌症可能是直肠出血的原因，14%提到是排便习惯改变的原因）。自我报告存在心理健康问题的个体在出现排便习惯改变时联系全科医生的可能性较小（19%对39%；调整后的优势比（a）OR = 0.34，95%置信区间0.19 - 0.60），向全科医生提及直肠出血的可能性也较小（83%对89%，aOR = 0.49，95%置信区间0.26 - 0.94）。尽管大多数参与者愿意因这些高危症状接受结肠镜检查，但患有抑郁症/焦虑症的参与者意愿较低（90%对96%；aOR：0.37，95%置信区间0.16 - 0.87）。
自我报告存在心理健康问题的个体寻求帮助的可能性较小，且对高危症状接受检查的意愿较低。例如，通过增加心理健康护士提供有针对性的支持，可能有助于为大量存在心理健康问题的人群实现癌症的早期诊断。
