A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear C Hellsten, K Sjo ¨ stro ¨ m, PG Lindqvist Department of Obstetrics and Gynaecology, Clinical Science, Malmo ¨ University Hospital, Lund University, Malmo ¨, Sweden 1 Correspondence: Dr C Hellsten, Department of Obstetrics and Gynaecology, Malmo ¨ University Hospital, Lund University, S-205 02 Malmo ¨, Sweden. Email charlotte.hellsten@med.lu.se Accepted 26 September 2007. Objectives The aim of this study was to determine if there were any long-lasting elevated anxiety levels in women attending colposcopy after an abnormal cervical smear. Design Prospective study. Setting Department of Clinical Sciences, Obstetrics and Gynaecology, Malmo ¨ University Hospital, Sweden 2 . Population One hundred consecutive women were invited to participate when referred for colposcopy. Methods Women in the study group completed the State–Trait Anxiety Inventory, the Montgomery–A ˚ sberg Depression Rating Scale—self-rate (MADRS-S) and had a psychosocial interview prior to colposcopy at their two follow-up visits. Main outcome measures State anxiety levels and depression scores at first visit, 6 months and 2 years. Results At follow up, levels of state anxiety and the depression scores of the women studied had decreased and were comparable to those of Swedish normative data. Two variables from the MADRS-S, ‘ability to focus on different activities’ and ‘emotional involvement with others and in activities’ were the most prominent for women with moderate to severe depression. At the 2-year visit, 30% of the women still had a fear of cancer. Conclusions Referral for colposcopy after an abnormal cervical smear does not seem to result in long-lasting anxiety and depression. However, a subgroup of women, with the initially highest depression scores, still had at 2-year state anxiety levels and depression scores significantly higher than normal. Almost one-third of the women still had a fear of cancer in spite of lower 2-year state anxiety levels. Keywords Abnormal cervical smear, anxiety, colposcopy, depression, LEEP, MADRS-S, STAI Please cite this paper as: Hellsten C, Sjo ¨stro ¨m K, Lindqvist P. A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear. BJOG 2007; DOI: 10.1111/j.1471-0528.2007.01609.x. Introduction Infection with human papillomavirus (HPV) is our most common sexually transmitted disease and is the causative agent of cervical cancer. 1 More than 50% of all sexually active women become infected with HPV at some point in their lifetime. 2 Women with persistent infections are at risk of developing precancerous lesions and subsequently cervical cancer. In Sweden, women between the ages of 23 and 50 years are routinely invited for cervical screening every third year; for those between 50 and 60 years, the interval is every fifth year. If the cervical smear results are abnormal, the woman is referred for colposcopy evaluation and examination. Women who are summoned to a diagnostic colposcopy have been reported to have high levels of anxiety as well as inadequate knowledge what an abnormal cervical smear means. 3–5 Therapeutical interventions, such as loop electrical excision procedure (LEEP), may also induce anxiety in some women. We reported in a recent study that the most important risk factor in facilitating high levels of anxiety in women referred for colposcopy is high depression scores. 5 Depression is known to influence the ability to evaluate the meaning of information provided and clinical findings rendered after an examination. 6 A common clinical problem was the primary motivation for this study: why do some women seem to have difficulty in understanding the information given them about the risk implied in an abnormal cervical smear. We were led to believe in the importance of following-up such women for a longer period of time in order to examine their anxiety levels and depressive mood. ª 2007 The Authors Journal compilation ª RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 B J O 1 6 0 9 Journal Name Manuscript No. B Dispatch: 5.11.07 Journal: BJO CE: T. Vijayalakshmi Author Received: No. of pages: 7 ME: Senthil Jr. DOI: 10.1111/j.1471-0528.2007.01609.x www.blackwellpublishing.com/bjog