Irena Ilic

Concurrent depression and anxiety in women undergoing additional diagnostic procedures due to positive screening for cervical cancer

Introduction Undergoing additional diagnostic procedures due to a positive cervical cancer screening in women can lead to psychosocial burden. This study investigated the co-occurrence of depression and anxiety in women both before and after additional diagnostic procedures for cervical cancer. Methods This prospective observational study with repeated measures was conducted in a cohort consisting of all consecutive women (N = 172) who received an abnormal Pap screening test result and therefore presented to a gynecologist for additional diagnostic examinations. Multivariate logistic regression was used to identify the independent predictors of the concurrent depression and anxiety occurrence among women while undergoing additional diagnostic procedures due to positive screening for cervical cancer. Results The prevalence of concurrent depression/anxiety among women while undergoing additional diagnostic procedures due to positive screening for cervical cancer was elevated from 34.3% before diagnostics to 46.5% after diagnostics (P < 0.05). Also, the prevalence of more severe concurrent depression/anxiety was higher after diagnostics than before diagnostics. Multivariate logistic regression presented that worry (regarding cervical cancer, general health, the result of the next cytology test, and having sex) was an independent significant predictive factor for concurrent depression/anxiety in women before undergoing additional diagnostic procedures due to positive screening for cervical cancer. Multivariate logistic regression presented that urban place of residence, history of induced abortion, and sedative use were predictive factors for concurrent depression and anxiety in women after undergoing additional diagnostic procedures due to positive screening for cervical cancer. Conclusion Concurrent depression and anxiety occurrence was highly prevalent among women while undergoing additional diagnostic procedures due to positive screening for cervical cancer. This prospective observational study showed a correlation between certain risk factors and concurrent depression/anxiety, although it is difficult to determine causality of this association due to the limitations of the study design. Only evidence that establishes causality can definitively guide the implementation of specific procedures and interventions during cervical cancer screening aimed at reducing concurrent depression/anxiety.

Validity of the process and outcome specific measure in women with abnormal Papanicolaou screening test

Introduction Women receiving abnormal Papanicolaou (Pap) findings often face psychosocial burden. This study aimed to evaluate the validity and reliability of the Process and Outcome Specific Measure (POSM) in women with abnormal Pap screening test in Serbia. Methods A cross-sectional study was conducted with 238 consecutive women attending cervical cancer screening. Exploratory factor analysis was used to determine the structure of the POSM, and Cronbach’s alpha coefficient to assess internal consistency. Results The factor analysis revealed two factors that explained 47.8% of variance: the first – Worry factor (4 items loaded onto the factor represented questions about worries), and the second – Information-Support factor (3 items loaded onto the factor represented questions about feeling informed well enough and being satisfied with support from others). The Cronbach’s alpha coefficients for the Worry factor and the Information-Support factor were 0.572 and 0.428, respectively. Conclusion The Serbian version of the POSM could be a useful tool for assessing worry and information-support in women with abnormal Pap smear results.

Detecting the impact of diagnostic procedures in Pap-positive women on anxiety using artificial neural networks

Introduction Women who receive a result of an abnormal Papanicolaou (Pap) smear can fail to participate in follow up procedures, and this is often due to anxiety. This study aimed to apply artificial neural networks (ANN) in prediction of anxiety in women with an abnormal Pap smear test, prior to and following diagnostic procedures. Methods One hundred-seventy two women who received an abnormal Pap screening result took part in this study, completing a questionnaire about socio-demographic characteristics and Hospital Anxiety and Depression Scale (HADS), right before and two to four weeks after diagnostics (i.e. colposcopy/biopsy/endocervical curettage). A feedforward back-propagation multilayer perceptron model was applied in analysis. Results Prior to diagnostic procedures 50.0% of women experienced anxiety, while after diagnostics anxiety was present in 61.6% of women. The correlation-based feature selection showed that anxiety prior to diagnostic procedures was associated with the use of sedatives, worry score, depression score, and score for concern about health consequences. For anxiety following diagnostics, predictors included rural place of residence, depression score, history of spontaneous abortion, and score for tension and discomfort during colposcopy. The ANN models yielded highly accurate anxiety prediction both prior and after diagnostics, 76.47% and 85.30%, respectively. Conclusion The presented findings can aid in identification of those women with a positive Pap screening test who could develop anxiety and thus represent the target group for psychological support, which would consequently improve adherence to follow-up diagnostics and enable timely treatment, finally reducing complications and fatal outcome.