Psychological costs of screening.

May sometimes be bad enough to undermine the benefits ofscreening Screening inevitably has psychological costs-particularly for those who receive bad news or false positive results. The increase in screening that is occurring in many countries demands that these costs be investigated, particularly as some may be avoidable. A positive result in any screening test is invariably received with negative feelings,'5 but support at the right time may help considerably. Telling patients that they had hypertension led to absenteeism, lower self esteem, and poorer marital relationships,68 but these problems were reduced by regular supportive follow up in a controlled trial.9 Some of those who are told that they have had a positive result in a screening test will subsequently be found not to have the disease. It might be expected that this would be a source of relief, but this supposition is not supported by the few studies that have followed up such patients. Once the §eeds of doubt have been sown they seem to be difficult to remove. Bloom and Monterossa studied people who had initially been told that they were hypertensive but who after three more tests were judged normal.'" The patients reported more symptoms of depression and a lower state of general health than a matched group initially found to be normotensive. Another study found that pregnant women who had had an abnormal fetoprotein result were still significantly more anxious three weeks later, when the results of subsequent testing had shown their fetuses to be unaffected, than were women who had initially received a negative result." The parents of newborn children who were falsely diagnosed on routine screening as having congenital hypothyroidism reported great strain on their marriages and difficulties in their relationships with their children.'2 Although they knew that the results of subsequent testing were negative, they continued to be plagued by questions and uncertainties about their children's health. Possibly if the risk of a false positive result was fully explained at the outset to participants in such programmes such adverse effects might be diminished. A negative result of a screening test is usually reassuring ,3 13-" and being given the result rather than being told to assume that no news is good news provides patients with more reassurance.5 A negative result given without explanation or advice may, however, have unwanted effects. For example, it may reinforce an unhealthy lifestyle,'3 bolster a pre-existing sense of invulnerability,'6 and …