Anxiety and depression among subjects attending genetic counseling for hereditary cancer Cathrine Bjorvatn a,b, * , Geir Egil Eide a,c , Berit R. Hanestad a , Odd E. Havik d a Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway b Center of Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway c Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway d Department of Clinical Psychology, University of Bergen, Bergen, Norway Received 5 September 2007; received in revised form 19 December 2007; accepted 7 January 2008 Abstract Objectives: The main aims of the study were to investigate changes in anxiety and depression over time in subjects attending genetic counseling (GC) for hereditary cancer, and secondly, to identify psychological, social, and medical variables associated with the course and outcome of anxiety and depression. Methods: Of 275 eligible individuals, 221 consented to participate, 214 returned the baseline questionnaire, and were included in a prospective multi-center study. Questionnaires were mailed to the subjects before and after the GC. Results: The mean values for anxiety and depression were quite low at all assessments. Mixed linear analyzes revealed that both anxiety and depression declined over time. Higher age, GC-related self-efficacy, and social support were associated with lower levels of anxiety. More social support, satisfaction with GC, self-rated physical function, and GC-related self-efficacy were associated with lower levels of depression. The effects of social support on both anxiety and depression had a significant interaction with time. Conclusion: The results support the buffer theory, which proposes that social support acts as a buffer, protecting people from the potentially pathogenic influence of stressful life events, such as GC. Practice implications: Subjects with less social support and less GC-related self-efficacy seem to be more vulnerable to anxiety and depression and should be offered extra attention by counselors. # 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Anxiety; Depression; Social support; Genetic counseling; Hereditary cancer 1. Introduction During the last decade, genetic counseling (GC) and genetic testing for hereditary breast and ovarian cancer (HBOC) and hereditary non-polyposis colorectal cancer (HNPCC) have become available in most Western countries. Even though GC and genetic testing are important interventions from a preventive perspective, the process of counseling and testing may have as their outcome, a known increased risk of future cancers for some of those seeking GC or for their relatives. From this perspective, the process of GC and genetic testing for hereditary cancer may represent a combination of threat and uncertainty, which may challenge and possibly alter the psychological and social adjustment of the individual. There- fore, changes in emotional adjustment should be an important indicator of the psychological impact and outcome of the counseling situation. Consistent with this, the goal of GC is ‘‘helping people understand and adapt to the medical, psychological, and familial implications of genetic contribu- tions to disease’’ [1]. In the research literature, emotional distress in persons seeking GC has been studied in relation to several individuals and situational characteristics. Previous research has shown that socio-demographic and cancer-related characteristics are related to emotional distress. Being young, having children under15 years of age, or having a greater number of relatives with breast or ovarian cancer are associated with higher levels of anxiety [2]. Schlich-Bakker showed that younger and single www.elsevier.com/locate/pateducou Patient Education and Counseling 71 (2008) 234–243 * Corresponding author at: Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway. Tel.: +47 55 58 61 03; fax: +47 55 58 61 30. E-mail address: cathrine.bjorvatn@isf.uib.no (C. Bjorvatn). 0738-3991/$ – see front matter # 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2008.01.008