Psychological impact of predicting individuals' risks of illness: a systematic review

The aim of this review is to determine the frequency and circumstances unde r which predicting individuals' risk of illness has adverse psychological e ffects. Using systematic review methodology, the literature was searched fo r studies that had assessed the adverse psychological outcomes of risk asse ssment programmes. The outcomes investigated are emotional (anxiety, depres sion, distress) cognitive (intrusive thoughts, perceptions of health) and b ehaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significan t effects between and within groups in the short tone month or less) and lo nger term (more than one month). Where sufficient data were available, a me ta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing indiv iduals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington's disease (10), risk of diabetes (two), risk of s pinocerebellar ataxia tone) and risk of osteoporosis (two). Overall, the qu ality of studies assessed was limited, with only two using a randomised des ign to determine the psychological impact of risk assessment. Receiving a p ositive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psych ological distress. Data were available for a quantitative synthesis of resu lts on three outcomes, anxiety, depression and distress. Anxiety and depres sion were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase f or those receiving positive test results. The five experimental studies tha t reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse p sychological effects of receiving an unfavourable test result. Adverse psyc hological effects are a common immediate consequence of positive test resul ts following risk assessment. Results from the few experimental studies rev iewed suggest that these adverse outcomes should not be seen as inevitable. (C) 1999 Elsevier Science Ltd. All rights reserved.