Psychological distress and dyadic trust in Italian women awaiting colposcopy after positive cervical cancer screening: a cross-sectional study

BACKGROUND: Screening programs have substantially reduced cervical cancer incidence and mortality, yet abnormal results can generate considerable psychological distress even before a diagnosis is confirmed. Interpersonal resources such as dyadic trust-the expectation of reliability and support within intimate relationships-may buffer distress, but their role in the colposcopy context is understudied. Examining both individual and relational predictors of emotional well-being may inform targeted psychosocial interventions and improve patient-centered care in cervical cancer screening. OBJECTIVES: To estimate the prevalence of depression, anxiety, and stress among Italian women referred for their first colposcopy after a positive cervical cancer screening result, and to identify associated sociodemographic, clinical, and interpersonal factors, with particular focus on dyadic trust. MATERIALS AND METHODS: This cross-sectional observational study was conducted from June 2022 to March 2024 at the Lower Genital Tract Clinic of the University of Torino, Italy. Women undergoing their first colposcopy after a positive cytology and/or human papillomavirus (HPV) DNA test within the "Prevenzione Serena" screening program completed three questionnaires at their appointment: a sociodemographic and clinical form, the Depression Anxiety Stress Scales-21 (DASS-21), and the Dyadic Trust Scale (DTS). Multivariable logistic regression models assessed associations between participant characteristics and psychological outcomes. Exploratory nomograms were developed to estimate individual risk probabilities; these were not internally validated and should not be used for clinical prediction. RESULTS: A total of 573 women participated (median age 36 years). Most were single (61%), university-educated (53%), employed (82%), and HPV-unvaccinated (83%). Mild to extremely severe symptoms of stress, depression, and anxiety were reported by 70%, 41%, and 31% of respondents, respectively. In multivariable analysis, higher dyadic trust was associated with lower risk of depression (OR 0.66, 95%CI 0.51-0.85), anxiety (OR 0.53, 95%CI 0.31-0.91) and stress (OR 0.46, 95%CI 0.25-0.85). Lower educational level was associated with higher risk of depression (OR 1.64, 95%CI 1.02-2.64), as HPV vaccination (OR 1.87, 95%CI 1.02-3.41). Younger age was associated with higher risk of anxiety (OR 1.88, 95%CI 1.25-2.86) and stress (OR 4, 95%CI 1.92-8.33) for 16-year increase. Exploratory nomograms allowed individualized risk estimation. CONCLUSIONS: Psychological distress-particularly stress-is common among women awaiting colposcopy after a positive screening result. Younger age, lower education, HPV vaccination status, and lower dyadic trust identify those at elevated risk. Integrating risk-stratified psychosocial support, enhancing relational coping, and tailoring communication may improve emotional outcomes. Prospective studies should clarify causal pathways and evaluate partner-inclusive interventions.