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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

Journal of Lower Genital Tract Disease: January 2011 - Volume 15 - Issue 1 - p 42-47
doi: 10.1097/LGT.0b013e3181e66a82
Original Articles

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.

Stress and depression do not affect the prevalence of cervical squamous intraepithelial lesions.

1Washington University School of Medicine, St Louis, MO; 2The CORE Center at John Stroger Hospital of Cook County, Chicago, IL; 3Maimonides Medical Center, Brooklyn, NY; 4Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, MD; 5The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 6City of Hope National Medical Center, Duarte, CA, and Keck School of Medicine, University of Southern California, Los Angeles, CA; 7University of California, San Francisco, CA; 8Georgetown University School of Medicine, Washington, DC; and 9Montefiore Medical Center, Bronx, NY

Reprint requests to: L. Stewart Massad, MD, Division of Gynecologic Oncology, 4911 Barnes-Jewish Hospital Plaza, St Louis, MO 63110. E-mail:

Supported by the National Institutes of Health.

The Women's Interagency HIV Study is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). This study is cofunded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding is also provided by the National Center for Research Resources (UCSF-CTSI grant number UL1 RR024131).

©2011The American Society for Colposcopy and Cervical Pathology