Cox, S.J.; (2007) Psychological impact of cardiac testing in adolescents. Doctoral thesis , University of London.

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Abstract

Background: Anecdotal evidence suggests that at least 8 young people (aged 14-35) die of undiagnosed cardiac conditions every week. Cardiac screening will detect the majority of cardiac conditions that could lead to a sudden cardiac death (e.g. Hypertrophic Cardiomyopathy, long QT syndrome, Wolff-Parkinson-White syndrome). However, screening of apparently healthy young people may have adverse psychological consequences on those who have negative test results. Objectives The objective of the current research was to evaluate the psychological effects on young people of screening for cardiac conditions that are partly genetic. Methods: The current study (N=746) was a prospective investigation of psychological responses to screening, involving assessments at the time of invitation (T1), immediately before testing (T2), and 2-3 weeks later (T3), following receipt of results. It was carried out in the context of an innovative screening programme being developed by the charity Cardiac Risk in the Young (CRY). All participants were healthy individuals who had consented to cardiac screening in two different contexts, community (N=303) and school (N=443). Anxiety and self-rated health were evaluated using standard measures, and illness representations were assessed with the revised Illness Perception Questionnaire (IPQ-R). Between group analyses were performed for each of the key factors, gender, age, and number of symptoms at the time of screening. Two groups of young people---adolescents (14-19) and adults (20-35)---were compared. Comparisons were also made with an adolescent age-matched control group not offered screening. Results: Anxiety levels in the screening participants were significantly lower than those of the control group (not offered screening) and population norms. There were no changes in anxiety between T1 and T2, but at T3 (after receiving a negative result) anxiety levels significantly declined. Participants with symptoms were more anxious. Similar results were reported for self rated health. Patterns of response differed between adolescents and adults. Cognitive representations of the cardiac conditions were not associated with anxiety during the testing programme. Emotional representations and genetic worries were associated with anxiety at T1 and T2 and emotional representations predicted reassurance at the end of the programme. A small number of participants had positive results in response to screening, and their experiences were also tracked. Discussion: This research provides strong evidence that the tests were acceptable to the participants. The levels of anxiety reported in this study, and the impact on self rated health, are not excessive. They were reassured after the testing satisfied with the information they received reported qualitative responses that were positive and showed they had understood the process that they were engaged in. Selection factors were probably responsible for the lower levels of anxiety in participants than controls. These results suggest that screening apparently healthy young people (both adolescents and adults under the age of 35) for potentially serious cardiac conditions does not have adverse psychological effects.

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