Bell S, Porter M, Kitchener H, Fraser C, Fisher P, Mann E
Department of Mental Health, University of Aberdeen, United Kingdom.
Prev Med. 1995 Nov;24(6):610-6. doi: 10.1006/pmed.1995.1096.
Few studies have examined the psychological costs of cervical screening, despite expressed concern over possible negative sequelae.
Seventy-five women with mild or moderately dyskaryotic smears, under cytological surveillance, 75 women referred for colposcopy after a first-ever abnormal smear showing severe dyskaryosis, and 75 controls with recent negative cytology were interviewed at home, and their psychological adjustment was assessed.
Levels of distress were higher among women with an abnormal smear than among controls with a recent negative smear. Anxiety (Hospital Anxiety and Depression Scale range 0-21, "normal" range 0-7) was highest among those referred for colposcopy (mean 8.12, controls 5.88, P < 0.001); afterward, distress fell (mean 6.61, P < 0.001) but more problems of social adjustment were evident (surveillance vs controls, P < 0.01). High anxiety was associated with social maladjustment (colposcopy, P < 0.001; surveillance, P < 0.01) and negative feelings about the self (P < 0.05). Current anxiety was unrelated to knowledge about abnormal smears, but in the surveillance group was related to satisfaction with the explanation provided (P < 0.05).
A positive cervical smear may by psychologically traumatic for a significant minority of women, irrespective of management strategy.
尽管有人对宫颈筛查可能产生的负面后果表示担忧，但很少有研究探讨过宫颈筛查带来的心理代价。
对75名接受细胞学监测的轻度或中度核异质涂片女性、75名首次涂片异常显示重度核异质后被转诊接受阴道镜检查的女性以及75名近期细胞学检查呈阴性的对照者进行了家访，并评估了她们的心理调适情况。
涂片异常的女性的痛苦程度高于近期涂片阴性的对照者。焦虑（医院焦虑抑郁量表范围为0 - 21，“正常”范围为0 - 7）在被转诊接受阴道镜检查的女性中最高（平均8.12，对照者为5.88，P < 0.001）；之后，痛苦程度下降（平均6.61，P < 0.001），但社会调适方面的问题更加明显（监测组与对照者相比，P < 0.01）。高度焦虑与社会适应不良（阴道镜检查，P < 0.001；监测组，P < 0.01）以及对自我的负面感受（P < 0.05）相关。当前的焦虑与对异常涂片的了解无关，但在监测组中与对所提供解释的满意度相关（P < 0.05）。
无论采用何种管理策略，宫颈涂片结果呈阳性可能会给相当一部分女性带来心理创伤。
