Screening people with anxiety/depression for suitability for guided self-help

The aim of this study was to test a questionnaire for screening people with anxiety/ depression for their suitability for certain forms of computer-guided self-help. A total of 196 referrals completed the screening questionnaire. Three clinicians each independently judged the referrals' broad problem type and suitability. Referrals were randomized to 1 of 3 clinicians for a screening interview. The results show that inter-clinician agreement was good for questionnaire-based problem type and suitability, and excellent for screening interview-based problem type and suitability. Agreement between the questionnaire and interview was good on problem type but poor on suitability. Compared with the screening interview, the questionnaire detected suitable patients well but unsuitable patients less well. In conclusion, by quickly scanning the completed questionnaire, clinicians were able sensitively to detect patients' problem types that were suitable for certain forms of self-help. Some unsuitability items need refining.     

Screening People With Anxiety/Depression for Suitability for Guided Self‐help

The aim of this study was to test a questionnaire for screening people with anxiety/depression for their suitability for certain forms of computer‐guided self‐help. A total of 196 referrals completed the screening questionnaire. Three clinicians each independently judged the referrals' broad problem type and suitability. Referrals were randomized to 1 of 3 clinicians for a screening interview. The results show that inter‐clinician agreement was good for questionnaire‐based problem type and suitability, and excellent for screening interview‐based problem type and suitability. Agreement between the questionnaire and interview was good on problem type but poor on suitability. Compared with the screening interview, the questionnaire detected suitable patients well but unsuitable patients less well. In conclusion, by quickly scanning the completed questionnaire, clinicians were able sensitively to detect patients' problem types that were suitable for certain forms of self‐help. Some unsuitability items need refining.     

The effect of nondirective questioning on women's decisions whether to undergo bone density screening: an experimental study.

This study investigated the effects of nondirective counseling on health screening decisions. Ninety women (mean age = 51 years) received information about bone density screening and osteoporosis. They were then randomly allocated to 1 of 4 groups and were encouraged to focus on positive issues about bone density screening (positive group), on negative issues (negative group), on both positive and negative issues (all-focusing group), or on issues relating to the common cold (control group). Women were asked to rate how likely they would be to opt for bone density screening if they saw it available. After being informed that they could have bone density screening, actual uptake was assessed. It was found that the issues on which individuals focused significantly influenced their rate likelihood of opting for the scan. Rated likelihood of testing was significantly associated with whether individuals actually did opt for testing when it was subsequently offered to them.     

Busy lifestyles and mammography screening: Time pressure and women’s reattendance likelihood

Time pressure is often cited as a reason for non-attendance at mammography screening, although evidence from other areas of psychology suggests that time pressure can improve performance when barriers such as time pressure provide a challenge. We predicted that time pressure would negatively predict attendance in women whose self-efficacy for overcoming time pressure is low, but positively predict attendance when self-efficacy is high. Time pressure was operationalised as the self-reported number of dependent children and others, and average number of working hours per week. Australian women were surveyed after being invited to attend second or subsequent screenings at a free public screening service, and subsequent attendance monitored until six months after screening was due. The majority (87.5%) attended screening. Women with more dependent children and higher self-efficacy showed greater attendance likelihood, and women with fewer non-child dependants and lower self-efficacy were less likely to attend. Working hours did not predict attendance. Findings provide partial support for the idea that time pressure acts as a challenge for women with high self-efficacy.     

Examination of the PC-PTSD in previously deployed Air Force Medical Service personnel

This study assessed the performance of the PC-PTSD in diagnosing postdeployment posttraumatic stress disorder (PTSD) in a cohort of Air Force Medical Services personnel (N = 18,530). The prevalence of PTSD in the cohort was 5.18% based on medical record data. The area under the receiver operating characteristic curve was 0.69, indicating poor classification accuracy. Sensitivity was 47.55%, specificity was 90.68%, positive predictive value was 21.79%, and negative predictive value was 96.94%. The positive and negative likelihood ratios were 5.10 and 0.58, respectively. Several risk factors were found to be associated with a diagnosis of postdeployment PTSD: being a nurse, being enlisted in the medical service career field, being enlisted in the mental health service career field, those over age 30, being a member of the Active Duty service component, and having one’s first deployment be to Iraq. Being an officer was found to be a protective characteristic. These factors could potentially improve screening for PTSD among Air Force healthcare personnel.     

Psychosocial Barriers to Cervical Cancer Screening: Concerns With Self-presentation and Social Evaluation1

The incidence of cervical cancer has decreased over 70% in the last several decades due in large part to the Papanicolaou (Pap) test. Despite the acknowledged efficacy of this test, however, many women do not receive cervical screening. The present study investigated the contributions of individual differences in concerns with self-presentation and social evaluation to the prediction of intentions and behavior involving cervical screening. Eighty-two Caucasian women completed measures of social anxiety, physique anxiety, public and private self-consciousness, fear of negative evaluation, and self-esteem, in addition to questions assessing their knowledge and behavior regarding cervical screening. Social anxiety significantly predicted intention to receive cervical screening for a medical reason, as well as the frequency with which the women actually received gynecological examinations. Physique anxiety accounted for a significant percentage of the variance in women's likelihood of receiving cervical screening within the next year. Interpersonal aspects of the gynecological exam, as well as implications of the findings for gynecological practice are discussed.     

Observers' reactions to genetic testing: the role of hindsight bias and judgements of responsibility

In 3 studies, we examined the effect of birth outcome on observers' reactions to genetic testing. Participants read a scenario in which a woman declined to take a genetic screening test and subsequently gave birth to a child with a genetic disorder (negative outcome) or a healthy child (positive outcome). Retrospective judgments of the likelihood that the child would have a genetic disorder were higher given negative than positive outcome knowledge under conditions of high genetic risk. Moreover, the more likely a negative outcome was perceived to be, the more responsible the mother was held for not taking the genetic screening test. Consistent with Weiner's (1993) theory, responsibility judgments were linked to displeasure and sympathy, with sympathy in turn being related to help judgments.     

Pregnant Women’s Perspectives on Expanded Carrier Screening

Expanded carrier screening (ECS) is a relatively new carrier screening option that assesses many conditions simultaneously, as opposed to traditional ethnicity-based carrier screening for a limited number of conditions. This study aimed to explore pregnant women’s perspectives on ECS, including reasons for electing or declining and anxiety associated with this decision-making. A total of 80 pregnant women were surveyed from Northwestern Medicine’s Clinical Genetics Division after presenting for aneuploidy screening. Of the 80 participants, 40 elected and 40 declined ECS. Trends regarding reasons for electing or declining ECS include ethnicity, desire for genetic risk information, lack of family history, perceived likelihood of being a carrier, and perceived impact on reproductive decisions. Individuals who declined ECS seemed to prefer ethnicity-based carrier screening and believed that ECS would increase their anxiety, whereas individuals who elected ECS seemed to prefer more screening and tended to believe that ECS would reduce their anxiety. These findings provide insight on decision-making with regard to ECS and can help guide interactions that genetic counselors and other healthcare providers have with patients, including assisting patients in the decision-making process.     

3~5岁儿童母亲抚养压力类型特点及其影响因素

通过对6021名3~5岁儿童母亲抚养压力进行潜在剖面分析,探讨母亲抚养压力的类型特点及其影响因素.结果表明:(1)3~5岁儿童母亲的抚养压力可以分为五类:低压力型(22.31%,指来自儿童发展和自身承担母亲角色的压力均最低)、适度压力型(38.17%,指来自两方面的压力均处于平均水平)、高儿童侧面压力型(26.39%,指来自儿童发展的压力较高)、高家长侧面压力型(8.62%,指来自母亲角色的压力较高)和高综合压力型(4.52%,指来自两方面的压力均最高);(2)生育年龄和家庭收入较低的母亲更可能属于高儿童侧面压力型,对儿童期望较高的母亲更可能属于高家长侧面压力型;学历较低、夫妻关系较差的母亲更可能属于高儿童侧面、高家长侧面和高综合压力型.     

A retrospective survey of community based utilization of Tay Sachs screening in Eight New Jersey counties

The purpose of this study was to determine the rate of utilization of Tay Sachs disease screening by the Ashkenazi Jewish population. Pregnant women who were referred to one of three genetic centers in New Jersey for amniocentesis unrelated to Tay Sachs screening were the study population. 4490 charts were reviewed retrospectively to determine the at risk population for Tay Sachs disease (Ashkenazi Jews) and whether or not patients and their spouses had elected Tay Sachs screening prior to referral. A group of 25 patients who did not elect screening were questioned as to their specific reason for declining Tay Sachs screening. Overall community utilization was 90%. Of the couples who did not elect screening, 64% felt that their risk to have an affected child was too small, 16% could not recall Tay Sachs screening being offered to them, 8% felt that screening was inconvenient. Tay Sachs screening as a voluntary preventive health care program has a high utilization rate in our study group.     

Attitudes toward maternal serum screening in Chinese women with positive results

Maternal serum screening for fetal Down syndrome has been integrated into routine antenatal care in most clinics in Taiwan. We examined the attitudes toward serum screening and the possible implications in women with positive results. From January to July 1995, 276 women were referred to the Genetic Counseling Clinic, Mackay Memorial Hospital for amniocentesis because of positive screening results, and 214 participated in this study. All women opted for amniocentesis after genetic counseling. Over 40% stated that they made decisions independently after being informed of the serum screening. Need for certainty was the most frequently mentioned reason. Two-thirds believed that serum screening could provide a diagnosis. Almost all women would apply for maternal serum screening for future pregnancies. This study demonstrated that Chinese women need more counseling and autonomy regarding maternal serum screening.     

Changing perspectives on the benefits of newborn screening

The likelihood of benefit is fundamental to decision making about newborn screening. But benefit is construed in different ways by different stakeholders. This article begins with a review of benefit as considered historically by various expert panels and organizations. We then show how 78 conditions fared when experts recently rated them on benefit using a scoring system recommended by a task force of the American College of Medical Genetics. Finally, we analyze how benefit is reflected in the public comments submitted in response to the ACMG report. Results show that benefit has been and remains a core consideration for screening decisions. Historically the focus has been on improved physical health as a result of medical treatment; however, in only 4 of the 78 conditions rated does newborn screening prevent all negative consequences. In fact the majority of both core conditions (51.7%) and secondary targets (87.5%) recommended in the ACMG report were rated as having treatments that prevented only some negative consequences. All conditions rated had perceived benefits for family and society, but currently no conditions are screened on the basis of family or societal benefits alone. No agreed-upon threshold exists for what would be considered meaningful benefit, and stakeholder groups differ in their perceptions of benefit. We conclude by suggesting several key research studies needed to further inform public policy.     

Prostate cancer prevention: do the 5-ARIs make the grade?

Although imperfect, PSA testing is here to stay. Men who undergo PSA testing should do so with an understanding of the potential benefits (decreased prostate cancer mortality) and known risks (increased likelihood of being diagnosed with prostate cancer) of screening. The diagnosis of prostate cancer often leads to radical therapy in men who would never have known they had the disease if not for early detection. Although it is possible that 5-ARIs may occasionally cause a high-grade prostate cancer, the magnitude of this potential harm is likely to be tempered by earlier detection. Also balancing this potential harm is the well-established fact that the 5-ARIs decrease the likelihood that a man who desires PSA testing will become a prostate cancer patient. These are admittedly difficult risk–risk calculations. However, to suggest that only “unambiguously safe” drugs should be approved for cancer risk reduction sets a standard that can only be met by homeopathic nostrums. That is not the standard to which we should aspire.     

Parental history of hypertension and screening attendance: effects of wellness appeal versus threat appeal

This study examined whether the orientation of a health appeal differentially influences health beliefs and early-detection practices among young individuals who are potentially at risk. Undergraduates with and without a hypertensive parent were given printed material about hypertension and the importance of early detection framed in either a wellness or illness-threat format. The major dependent measure was attendance at a blood pressure screening during the week following the experimental session. Results showed that parental history (PH) participants were more than twice as likely to attend the screening when given a wellness message in comparison to threat. In the threat condition, PH participants also reported that hypertension was less preventable in comparison to participants without a hypertensive parent. Reported likelihood of developing hypertension was inversely related to subsequent screening attendance among PH participants only. Factors accounting for the efficacy of wellness-oriented appeals among individuals who report a family history are discussed.     

Outpatient Clinic Identification of Trauma Symptoms in Children in Foster Care

As understanding of the impact of trauma on children has grown, there has been increasing interest in the use of screening the medical setting to identify which children at risk may be symptomatic. This study was undertaken to determine whether the use of a trauma assessment tool to screen for trauma symptoms in the setting of a foster care clinic was feasible and more sensitive than non-standardized approaches in the context of outpatient primary care. Using a chart review of trauma symptom identification before and after the implementation of the Trauma Symptom Checklist for Children (TSC-C) and the Trauma Symptom Checklist for Young Children (TSC-YC), validated trauma assessment tools, we looked at the feasibility of use of this tool and likelihood of trauma symptom identification. 73 % (n = 204) of eligible patients had a trauma screening tool in the medical record following the introduction of the use of the TSC. Detection of trauma symptoms was higher in the screening period than in the baseline period for the entire population (78 vs. 46 %, p < 0.0001), and trauma symptoms were identified with more specificity following the introduction of, and likely due to, formal trauma screening. However, there were limitations as to feasibility in the outpatient medical clinic. In conclusion, the use of the TSC-C and TSC-YC in the setting of an outpatient foster care evaluation clinic increased rates and precision of identification of trauma symptoms, but had limitations to its feasibility of use in the outpatient clinic setting.     

Do the “Savage Origins” of Tattoos Cast a Prejudicial Shadow on Contemporary Tattooed Individuals?

We investigated whether increases in tattooing rates and designs have eradicated or altered traditional delinquent tattooing stereotypes. We tested the perceived suitability of tattooed and non‐tattooed individuals for 2 different jobs. Affective evaluations mediated judgments of job suitability, with those displaying traditional tattoos being rated as less suitable for employment than those who were not tattooed and those displaying contemporary tattoos. Those with a contemporary tattoo were judged in the same manner as those who were not tattooed (even by observers who neither had a tattoo nor were considering getting one). These results suggest that the savage associations of tattooing continue for some, but suggest that for other tattoo enthusiasts, a new stereotype has emerged reflecting a shift toward respectability.     

A psychometric evaluation of the Hospital Anxiety and Depression Scale during pregnancy

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression during pregnancy was investigated. A maximum likelihood factor analysis was conducted on the HADS to determine its psychometric properties and utility in 100 women from two culturally diverse populations (UK and Uzbekistan) at 12-weeks and 34-weeks pregnancy. The findings suggest that the HADS lacks the internal reliability requirements of a clinical assessment tool in this population. There was little evidence found to suggest that the HADS measures two dimensions of anxiety and depression consistently and reliably. The findings from this study suggest that the HADS could not be recommended as a clinical screening tool for anxiety and depression in pregnant women. Further research in this area is both desirable and required.     

Suicide risk screening in an urban high school

Qualitative data from an empirical study of adolescent suicide risk were analyzed to examine the screening component built in to a larger protocol. It was determined that a significant number of students were being identified as being in need of follow-up. Although the majority (88.7%) of students screened met criteria for placement in the no indicators (of risk) category, 3.8% evidenced apparent need of follow-up, 4.4% qualified for notable concern, and 3.1% were deemed to be at-risk or in crisis. Several gender and ethnic differences in risk category status are also discussed. The system utilized at the school and examples of the range of interventions utilized are discussed. Evidence for the positive effects of this screening on individual students and the school as a whole are presented. Arguments for the regular use of screening measures in high schools and suggestions for implementation are also given.     

The Integration of Noninvasive Prenatal Screening into the Existing Prenatal Paradigm: a Survey of Current Genetic Counseling Practice

Since its introduction four years ago, noninvasive prenatal screening for fetal aneuploidy (NIPS) has been widely adopted as a screening tool for women at a high risk for fetal aneuploidy. As use expands into the general population, questions arise concerning the integration of NIPS into preexisting screening paradigms. This study aims to examine the use of NIPS in current practice among prenatal counselors, predominantly in the United States, in order to inform strategies for the optimal use of both new and existing screening techniques. We electronically surveyed 208 members of the National Society of Genetic Counselors to ascertain how NIPS is currently being used. Genetic counselors were also queried as to the advantages and disadvantages of offering NIPS to all patients regardless of a priori risk. Results indicate substantial variation in practice regarding which patients are offered NIPS and how counselors have incorporated this technology into existing screening routines. The majority of participants report offering NIPS in conjunction with another method of screening for fetal aneuploidy, indicating that NIPS is being used as an addition rather than as a replacement. These screening methods primarily include nuchal translucency (NT) (45.1 %, n = 78) and first trimester serum screening, with or without an NT (19.7 %, n = 34). Furthermore, the majority report that they would be concerned about losing the clinical value of an NT in a complete transition to NIPS (85.4 %, n = 164). Counselors are evenly split on the merits of expanding the use of NIPS to the general population (con: 55.3 %, n = 105; pro: 44.7 %, n = 85). The lack of consensus suggests that updated practice guidelines might benefit counselors. In addition, respondents emphasized the need to better educate patients and providers about the risks, benefits, and limitations of the test.