PSYCHOLOGICAL SUPPORT NEEDS FOR WOMEN AT HIGH GENETIC RISK OF BREAST-CANCER - SOME PRELIMINARY INDICATORS

The number of women in the UK seeking genetic counselling, testing and preventative treatment is rapidly increasing. In Manchester 600-800 w omen are now referred annually to the Family History Clinic. As yet th ere is no formal provision for this service within the NHS, but resear ch is underway to evaluate such clinics and to identify the psychosoci al sequelae of genetic risk counselling. To date, findings have been b ased on questionnaire data from which it is difficult to ascertain sup port needs accurately. We interviewed 158 women 3 months after genetic risk counselling because of a family history of breast cancer. Using standard assessment and diagnostic criteria, 21 (13%) women were diagn osed with an affective disorder. This compared with a prevalence of 26 % using the 28 item General Health Questionnaire (GHQ).We did not find a relationship between GHQ distress levels and women's understanding of their risk before genetic counselling, but women with accurate risk knowledge post-counsel had significantly lower GHQ scores than those who continued to over or under-estimate and this Finding warrants furt her investigation. Of women referred for psychological help, few repor ted risk of breast cancer as their main concern, but themes of loss, u nresolved grief and relationship problems were common. The value of th e GHQ as a screening instrument is discussed and we suggest a new thre shold Value based on our analysis. We conclude that risk counselling d oes not adversely affect the general mental health of attenders but a minority of women may need help with the impact of breast cancer in th e family. (C) 1998 John Wiley & Sons, Ltd.