初级保健中心血管筛查与干预的心理影响：虚假安慰问题？英国家庭心脏研究小组
The psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group.
作者信息
Marteau T M, Kinmonth A L, Thompson S, Pyke S
机构信息
Psychology and Genetics Research Group, United Medical School, University of London.
出版信息
Br J Gen Pract. 1996 Oct;46(411):577-82.
BACKGROUND
There have been many reports of the adverse psychological effects of screening. Here we discuss the results of a randomized controlled study--one of the first to address this issue.
AIM
To determine the extent to which participation in a population-based intervention programme that aims to reduce the risk of cardiovascular diseases raises concerns about health, or undermines a belief in the ability to reduce that risk.
METHOD
A randomized controlled trial involving 13 general practices in England, Wales and Scotland was conducted. Two thousand, nine hundred and eighty-four middle-aged men and women undergoing cardiovascular risk-screening and intervention, and a randomized comparison group of 3,576 men and women from the same practices, who were not offered the intervention, were compared on three outcomes: perception of current health, perceived risk of suffering a heart attack, and perceived ability to reduce the risk of suffering a heart attack.
RESULTS
We found no evidence to suggest that participation in this one-year, population-based intervention programme, to reduce the risk of cardiovascular disease raised concerns about health or risk of a heart attack; indeed, those in the intervention group were slightly more optimistic about their health. Alterations in perceptions of current health and the risk of suffering a heart attack were associated directly with true alterations in risk factors. A more noticeable effect on participants in this intervention programme was a reduction in their perceived ability to further reduce their risks of a heart attack. This was associated with a decrease in weight and with quitting smoking.
CONCLUSION
Contemporary screening and intervention programmes in primary care, aimed at reducing risk of cardiovascular disease, do not necessarily lead to raised anxiety or concern about health. A more subtle effect of screening would appear to be one of reassurance in the face of continuing, albeit reduced, risk.
背景
关于筛查产生不良心理影响的报道众多。在此，我们讨论一项随机对照研究的结果，这是首批针对该问题的研究之一。
目的
确定参与一项旨在降低心血管疾病风险的人群干预计划在多大程度上会引发对健康的担忧，或削弱对降低该风险能力的信念。
方法
在英格兰、威尔士和苏格兰的13家普通诊所开展了一项随机对照试验。对2984名接受心血管风险筛查和干预的中年男性和女性，以及来自相同诊所的3576名未接受干预的随机对照组男性和女性，就三个结果进行比较：对当前健康状况的认知、心脏病发作的感知风险以及降低心脏病发作风险的感知能力。
结果
我们没有发现证据表明参与这项为期一年的旨在降低心血管疾病风险的人群干预计划会引发对健康或心脏病发作风险的担忧；事实上，干预组的人对自己的健康状况更为乐观。对当前健康状况和心脏病发作风险认知的改变与风险因素的实际改变直接相关。该干预计划对参与者更显著的影响是降低了他们认为自己进一步降低心脏病发作风险的能力。这与体重减轻和戒烟有关。
结论
初级保健中旨在降低心血管疾病风险的当代筛查和干预计划不一定会导致焦虑增加或对健康的担忧。筛查更微妙的效果似乎是在面对持续（尽管降低了）的风险时起到一种安抚作用。
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