Effects of Diagnostic Labeling on Psychological Wellbeing and Quality of Life - A Systematic Review

Background: Reducing the burden of suffering caused by preventable diseases in populations is a central goal in public health. Screening is a prevention strategy the aim of which is to identify pre-symptomatic conditions, thus enabling earlier intervention in the hope to reduce morbidity and mortality. Yet screening may also cause harm, one of which is the psychological effects of receiving a diagnosis - diagnostic labeling. Aim: To conduct a systematic review of studies assessing psychological state after a diagnosis of either prostate cancer or abdominal aortic aneurysm (AAA). Method: A comprehensive literature search of studies published from 2002 to 2015 was conducted. Main inclusion criteria were that study participants had recently been diagnosed with either prostate cancer or AAA and their psychological state was assessed. Randomized controlled trials, observational cohort studies, cross-sectional studies, and qualitative studies were eligible. All studies were critically appraised and reviewed by at least 2 trained investigators. Disagreements were resolved by a third senior investigator. Results: Forty studies were included in the analysis. All eight qualitative studies on both prostate cancer and AAA showed some evidence of adverse psychological effect of detection of the condition. The results of the 32 quantitative studies were more mixed, with approximately half of the studies suggesting presence of psychological problems in newly diagnosed individuals. For a third of the studies the presence of psychological problems could not be conclusively evaluated due to study design (lack of comparison group) and presentation of the results (average scores only). Conclusions: Few studies were designed to evaluate the effect of receiving a diagnosis of prostate cancer or AAA. The results suggest that diagnostic labeling may cause some degree of psychological harm in at least some individuals; more research is needed to better estimate the frequency and severity of these harms. Labeling is a potential psychological harm that should be considered when planning screening programs.Master of Public Healt