Hopwood P, Keeling F, Long A, Pool C, Evans G, Howell A
CRC Psychological Medicine Group, Christie Hospital NHS Trust, Manchester, UK.
Psychooncology. 1998 Sep-Oct;7(5):402-12. doi: 10.1002/(SICI)1099-1611(1998090)7:5<402::AID-PON317>3.0.CO;2-X.
The number of women in the UK seeking genetic counselling, testing and preventative treatment is rapidly increasing. In Manchester 600-800 women are now referred annually to the Family History Clinic. As yet there is no formal provision for this service within the NHS, but research is underway to evaluate such clinics and to identify the psychosocial sequelae of genetic risk counselling. To date, findings have been based on questionnaire data from which it is difficult to ascertain support needs accurately. We interviewed 158 women 3 months after genetic risk counselling because of a family history of breast cancer. Using standard assessment and diagnostic criteria, 21 (13%) women were diagnosed with an affective disorder. This compared with a prevalence of 26% using the 28 item General Health Questionnaire (GHQ). We did not find a relationship between GHQ distress levels and women's understanding of their risk before genetic counselling, but women with accurate risk knowledge post-counsel had significantly lower GHQ scores than those who continued to over or under-estimate and this finding warrants further investigation. Of women referred for psychological help, few reported risk of breast cancer as their main concern, but themes of loss, unresolved grief and relationship problems were common. The value of the GHQ as a screening instrument is discussed and we suggest a new threshold value based on our analysis. We conclude that risk counselling does not adversely affect the general mental health of attenders but a minority of women may need help with the impact of breast cancer in the family.
在英国，寻求基因咨询、检测和预防性治疗的女性人数正在迅速增加。在曼彻斯特，现在每年有600 - 800名女性被转诊至家族病史诊所。目前，英国国家医疗服务体系（NHS）尚未正式提供这项服务，但相关研究正在进行，以评估此类诊所，并确定基因风险咨询的心理社会后遗症。迄今为止，研究结果基于问卷调查数据，很难准确确定支持需求。我们对158名因乳腺癌家族病史接受基因风险咨询3个月后的女性进行了访谈。使用标准评估和诊断标准，21名（13%）女性被诊断患有情感障碍。相比之下，使用28项一般健康问卷（GHQ）得出的患病率为26%。我们没有发现GHQ痛苦水平与女性在基因咨询前对自身风险的理解之间存在关联，但咨询后风险知识准确的女性的GHQ得分显著低于那些继续高估或低估风险的女性，这一发现值得进一步研究。在被转介寻求心理帮助的女性中，很少有人将患乳腺癌的风险作为主要担忧，但失落、未解决的悲伤和关系问题等主题很常见。本文讨论了GHQ作为筛查工具的价值，并根据我们的分析提出了一个新的阈值。我们得出结论，风险咨询不会对就诊者的总体心理健康产生不利影响，但少数女性可能需要帮助来应对乳腺癌在家庭中的影响。
