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Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3181e66a82
Original Articles

Effect of Stress and Depression on the Frequency of Squamous Intraepithelial Lesions

Massad, L. Stewart MD1; Agniel, Denis MS2; Minkoff, Howard MD3; Watts, D. Heather MD4; D'Souza, Gypsyamber PhD5; Levine, Alexandra M. MD6; Darragh, Teresa M. MD7; Young, Mary MD8; Cajigas, Anthony MD9; Weber, Kathleen BSN2

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Objective. To explore the previously reported associations between cervical squamous lesions and psychologic measures of stress and depression.

Methods. In a multicenter cohort study, women with HIV and HIV-seronegative women had Pap tests and completed self-report questionnaires including the Perceived Stress Scale-10 (PSS), which measures perceived stress, the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), which measures symptoms of PTSD, and the Center for Epidemiologic Studies Depression (CES-D) scale, which measures depressive symptoms.

Results. Median scores were 13 (range = 0-38) for the PSS, 24 (range = 17-85) for the PCL-C, and 8 (range = 0-57) for the CES-D, indicating moderate stress and minimal depression. For PSS, compared with women in the lowest tertile of reported stress, the odds ratios (ORs) for squamous intraepithelial lesions (SIL) were 0.88 (95% confidence interval [CI] = 0.50-1.54) for women in the middle tertile and 0.96 (95% CI = 0.54-1.68) for women in the highest tertile. For PCL-C, compared with women in the lowest tertile of PTSD symptoms, ORs for SIL were 0.79 (95% CI = 0.43-1.41) for women in the middle tertile and 1.17 (95% CI = 0.68-2.01) for women in the highest tertile. Rates of SIL were similar for CES-D scores 16 or higher (compared with women with lower scores; OR = 1.41, 95% CI = 0.88-2.26) and 23 or higher (OR = 1.39, 95% CI = 0.81-2.40). In the multivariable analysis including the number of sexual partners, age, income, ethnicity, and serostatus, stress as measured by PSS and PCL-C and depressive symptoms as measured by CES-D remained unassociated with SIL.

Conclusions. We found no evidence that stress and depression affect the prevalence of cervical squamous lesions.

©2011The American Society for Colposcopy and Cervical Pathology


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