What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Screening for disease (n=170045). Intervention: Screening for disease vs. No screening. Primary outcome: Longer term anxiety (> 4 weeks) (SMD 0.01, 95% CI -0.10 to 0.11, p=0.92).

July 28, 2011Open Access

Emotional impact of screening: a systematic review and meta-analysis

Key Result

Screening for disease does not have a significant adverse emotional impact on longer-term anxiety (pooled SMD 0.01), depression, or quality of life compared to no screening.

Study Design

Type

Meta-Analysis (n=170,045)

Structured PICO

Does screening for disease cause adverse emotional impacts compared to no screening?

Population

170,045 adults from 12 randomized controlled trials comparing screening for various diseases versus no screening, with emotional outcomes assessed up to 14 years.

Intervention

Undergoing screening and receiving test results

Comparator

No screening

Outcome

Short (< 4 weeks) and longer term (> 4 weeks) emotional impact (anxiety, depression, general distress, quality of life)patient reported

Screening for disease does not appear to have adverse longer-term emotional impacts on anxiety, depression, or quality of life.

Main Result

Standardized Mean Difference: 0.01 (95% CI -0.1–0.11)

p-value: p=0.92

Limitations

Only half of the included studies reported outcomes on 80% or more of participants.
Relatively large heterogeneity among the included studies, with I2 scores often above 50%.
Standardized measures of generalized emotional functioning may be insufficiently sensitive to detect subtle changes like specific health worries.
Allocation concealment was adequate in only three of the twelve included studies.

Abstract

BACKGROUND: There is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short ( 4 weeks) emotional impact of such screening. METHODS: Studies selected for inclusion were (a) randomised controlled trials in which (b) participants in one arm underwent screening and received test results, and those in a control arm did not, and (c) emotional outcomes were assessed in both arms. MEDLINE via PubMed (1950 to present), EMBASE (1980 to present), PsycINFO (1985 to present) using OVID SP, and CINAHL (1982 to present) via EBSCO were searched, using strategies developed with keywords and medical subject headings. Data were extracted on emotional outcomes, type of screening test and test results. RESULTS: Of the 12 studies that met the inclusion criteria, six involved screening for cancer, two for diabetes, and one each for abdominal aortic aneurysms, peptic ulcer, coronary heart disease and osteoporosis. Five studies reported data on anxiety, five corrected on depression, two on general distress and eight on quality of life assessed between one week and 13 years after screening (median = 1.3 years).Meta-analyses revealed no significant impact of screening on longer term anxiety (pooled SMD 0.01, 95% CI -0.10, 0.11), depression (pooled SMD -0.04, 95% CI -.12, 0.20), or quality of life subscales (mental and self-assessed health pooled SMDs, respectively: 0.03; -0.01, (95% CI -.02, 0.04; 0.00, 95% CI -.04, 0.03). CONCLUSION: Screening does not appear to have adverse emotional impacts in the longer term (> 4 weeks). Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening.

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