Mental Health in Familial Adenomatous Polyposis: A Systematic Review.

OBJECTIVE

Familial adenomatous polyposis (FAP) is a hereditary disposition causing a nearly 100% risk of developing colorectal cancer without treatment. Therefore lifelong endoscopic surveillance and prophylactic colectomy, generally before the age of 30, are offered. Children of genetically confirmed FAP-patients have a 50% risk of inheriting the disease. It is a challenge to cope with the burden of FAP. The aim of this systematic review was to study the literature on the presence of mental issues, including anxiety, depression, distress, intellectual disability, and symptoms in the autism spectrum in FAP-patients.

METHODS

A search was performed in PubMed, EMBASE and Cochrane Library to retrieve English studies on mental health and FAP from inception to May 2024.

RESULTS

Of the 2045 identified papers, 35 met our criteria. Most papers did not show increased levels in mean scores of distress, anxiety or depression. However, subgroups with high levels of distress, anxiety and depression were identified, specifically around the time of genetic testing and bowel surgery. Associations between FAP and co-occurrent psychiatric disorders and lower cognitive function were suggested.

CONCLUSIONS

In conclusion, there is some evidence that co-occurrent psychiatric disorders and intellectual deficits are more prevalent in FAP-patients compared to the general population. During genetic testing and bowel surgery, distress, anxiety and depressive symptoms in subgroups of FAP-patients might be increased. As FAP is a rare disease and sample sizes were small, firm conclusions cannot be drawn. Large prospective studies on mental health issues over time are needed.