The influence of long-term awareness of hyperlipidemia and of 3 years of dietary counseling on depression, anxiety, and quality of life ☆,☆☆ Gunnar Einvik a,b, ⁎ , Oivind Ekeberg b,c , Jorgen Glatved Lavik b , Ingrid Ellingsen d , Tor Ole Klemsdal d , Elsa M. Hjerkinn e a Division of Medicine, Akershus University Hospital, Lorenskog, Norway b Department of Behavioural Science, University of Oslo, Oslo, Norway c Department of Acute Medicine, Oslo University Hospital Ulleval, Oslo, Norway d Department of Preventive Cardiology, Oslo University Hospital Ulleval Oslo, Norway e Department of Cardiology, Oslo University Hospital Ulleval Oslo, Norway Received 8 October 2008; received in revised form 3 November 2009; accepted 3 November 2009 Abstract Objective: The purpose of this study is to investigate the long- term effects of participation in a cardiovascular screening program and of dietary counseling on self-reported psychosocial outcomes and health concerns. Methods: High-risk subjects (n=563) with hyperlipidemia from the Oslo Diet and Antismoking Study (1972–1977) were reexamined after 25 years and randomly assigned to a new 3-year prospective 2×2 factorial placebo- controlled study in 1997 of n-3 polyunsaturated fatty acids and/or dietary counseling. Hospital Anxiety and Depression Scale (HADS), Life Satisfaction Index (LSI), and a new questionnaire on health concerns and behavior in response to risk information were collected at the 25-year follow-up. Hospital Anxiety and Depression Scale and LSI were evaluated at the end of the 3-year Diet and Omega-3 Intervention Trial on atherosclerosis (DOIT) in 505 subjects. Results: Twenty-five years after the screening program, HADS-anxiety was similar to the Norwegian norms (3.3 vs. 3.5), while HADS-depression was significantly lower (3.6 vs. 4.1, Pb.01). Patients reported that 25 years of awareness of hyperlipidemia had influenced health concerns through a moderate change in diet habits, some restriction in life conduct, but an improvement of the total life situation. After a novel 3-year intervention in DOIT, there was no difference between the dietary counseling and control group with regard to anxiety, depression, or life satisfaction, but HADS-anxiety increased significantly (4.0 vs. 3.3, Pb.001) in both groups. Conclusion: Compared to the general population, screening-positive subjects did not have increased mental distress 25 years after screening, and beneficial health behavior persisted. Dietary counseling did not affect psychosocial outcomes. © 2010 Elsevier Inc. All rights reserved. Keywords: Diet; Depression; Anxiety; Quality of life Primary preventive measures based on the detection of risk factors are recommended for reducing cardiovascular mortality and morbidity [1]. Increased anxiety, distress, and altered health behavior are immediate reactions to an impending threat, and concerns have been raised on whether such reactions occur when risk factors are detected in screening programs [2]. If interventions are offered, the immediate reactions may be attenuated as the subjects have the ability to cope with the risk [2,3]. Studies with a longer follow-up indicate that these reactions do not persist, as there is no difference in anxiety between screening-positive and screening-negative individuals [2,4,5]. However, it is not Journal of Psychosomatic Research 68 (2010) 567 – 572 This article is dedicated to the memory of Ingrid Ellingsen, who passed away after this paper was finished. ☆ The study was conducted at Oslo University Hospital Ulleval, Oslo, Norway. ☆☆ DOIT received financial support from the Norwegian Cardiovas- cular Council and the Norwegian retail company RIMI. n-3 PUFA and placebo capsules were provided by LUBA DK. Mills DA provided vegetable oil and VITA margarine. There are no reported conflicts of interests. ⁎ Corresponding author. Akershus University Hospital, Division of Medicine, Pb 65, 1478 Lorenskog, Norway. Tel.: +47 41 10 45 42; fax: +47 63 87 78 51. E-mail addresses: gunnar.einvik@medisin.uio.no, geinvik@online.no (G. Einvik). 0022-3999/09/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2009.11.004