Psychological distress and bowel cancer screening participation

Abstract

Objective To better understand barriers to participation in mail‐out bowel cancer screening programs, two survey studies tested the relationship between psychological distress and self‐reported bowel cancer screening. Methods First, a nationally representative sample of Australians N = 5421 completed measures of bowel cancer screening and psychological distress (using the Kessler Psychological Distress Scale; K10). Second, N = 479 completed a survey measuring participation in the National Bowel Cancer Screening Program (NBCSP) and psychological distress using the Depression, Anxiety and Stress Scale. In both studies, logistic regressions were conducted to test relationships between psychological distress and self‐reported screening participation. Results Study one found that psychological distress had a significant quadratic effect on having ever screened for bowel cancer, where screening rates were similar for those with low, moderate, or high levels of distress, but were lower for those with very high levels of distress. In study two, depression scores had a negative linear relationship with NBCSP participation (higher depression levels were associated with lower screening participation), and anxiety had a quadratic effect whereby NBCSP participation rates were higher with increasing levels of anxiety except in the severe category, where participation was significantly lower. Conclusions Findings indicate that psychological distress has a complex relationship with screening, and those with extreme levels of distress consistently show lower participation rates. Special efforts to encourage screening may be required for those experiencing extreme psychological distress and mental health disorders.

Anticipatory anxiety and participation in cancer screening. A systematic review

“…It is therefore important not to interpret results as a comprehensive review of general anxiety and cancer screening. One recent study not captured in the current review showed that in two large samples, sub‐clinical levels of trait anxiety and psychological distress were positively associated with bowel cancer screening, but those reporting extreme symptoms were less likely to screen 17 . Curvilinear relationships were not tested in any of the studies in the current review, however an inverted U effect might be a plausible model to describe the relationship between anxiety and cancer screening, as originally proposed by Hailey (1991) in relation to breast cancer screening 107 .…”

“…One recent study not captured in the current review showed that in two large samples, sub-clinical levels of trait anxiety and psychological distress were positively associated with bowel cancer screening, but those reporting extreme symptoms were less likely to screen. 17 Curvilinear relationships were not tested in any of the studies in the current review, however an inverted U effect might be a plausible model to describe the relationship between anxiety and cancer screening, as originally proposed by Hailey (1991) in relation to breast cancer screening. 107 This is supported by other recent research showing that people with extreme or pathological psychological distress may be less likely to participate in cancer screening.…”

“…17,19,20 These mixed findings may indicate that the relationship between anxiety and screening behaviours is neither linear, nor straightforward. 17 To date, only one other systematic review has examined associations between psychological distress, including anxiety, and cancer screening. 21 This previous review focussed on anxiety as an outcome of screening rather than a barrier to screening participation.…”

“…For example, fear of mammography has been shown to reduce breast cancer screening participation 16 . Anxiety about a cancer diagnosis, 8 extreme levels of general anxiety, 17 and a fear of and/or attempt to avoid negative outcomes 6 have all been associated with a lower likelihood of participation in bowel cancer screening. Similarly, fear of a positive test result has been identified as a barrier to participation in cervical screening 18 .…”

“…Similarly, fear of a positive test result has been identified as a barrier to participation in cervical screening 18 . Conversely, some research has shown that moderate anxiety levels are associated with increased participation in cancer screening, as screening may alleviate uncertainty regarding latent cancer 17,19,20 . These mixed findings may indicate that the relationship between anxiety and screening behaviours is neither linear, nor straightforward 17 …”