The psychological impact of esophageal cancer screening on anxiety and depression in China

Juan Zhu; Shanrui Ma; Ru Chen; Zhaorui Liu; Zhengkui Liu; Wenqiang Wei

doi:10.3389/fpsyt.2022.933678

The psychological impact of esophageal cancer screening on anxiety and depression in China

Front Psychiatry. 2022 Oct 20:13:933678. doi: 10.3389/fpsyt.2022.933678. eCollection 2022.

Authors

Juan Zhu^{1

2}, Shanrui Ma¹, Ru Chen¹, Zhaorui Liu³, Zhengkui Liu⁴, Wenqiang Wei¹

Affiliations

¹ National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China.
³ Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China.
⁴ Chinese Academy of Sciences, Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.

Abstract

Objective: The psychological impact of screening is unclear and has been ignored. This study aimed to evaluate the psychological impact of esophageal cancer (EC) screening on anxiety and depression in China.

Materials and methods: A multicenter, population-based study in five high-risk regions of EC was conducted from 2019 to 2020. Residents were recruited and underwent endoscopic screening and then were diagnosed with normal, esophagitis, low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and EC. Subjects who did not participate in the screening were referred to as the control group. We surveyed their anxiety and depression levels at baseline and after endoscopy and informed them of different pathological results to evaluate the psychological impact of the screening process.

Results: A total of 2,337 subjects completed all surveys in the screening process (normal: 355, esophagitis: 1,713, LGIN: 213, HGIN: 43 and EC: 13), with 63 controls. The levels of anxiety and depression of screeners were significantly higher than those of controls (P < 0.001). The fluctuation of anxiety and depression showed a "V" pattern in the screening process. The prevalence of anxiety symptoms at baseline, after endoscopy and after knowing the pathological results was 5.6, 0.3, and 3.2%, respectively (P < 0.001), and the corresponding prevalence of depression was 3.6, 0.2, and 2.1%, respectively (P < 0.001). With the aggravation of pathological results, the levels of anxiety and depression increased significantly (P < 0.001), especially in patients informed of HGIN (16.3 and 9.3%) and EC (23.1 and 30.8%).

Conclusion: Participation in endoscopic screening may bring short-term adverse psychological effects, especially at baseline and knowing the pathological results. More attention should be given to participants waiting for endoscopic screening. The method of informing the screening results of HGIN and EC should be improved. Further precise screening is needed to concentrate on high-risk groups to reduce the psychological impact of screening.

Keywords: anxiety; depression; endoscopy; esophageal cancer; high-risk regions; psychological impact; screening.