Dysfunction Subscales Research Articles

P1-496 An examination of the psychometric properties of the GHQ-28 subscales in a bi-ethnic antenatal sample in the UK: preliminary results from the born in Bradford cohort

IntroductionBorn in Bradford is a large multi-ethnic birth cohort drawn from the North of England. As background to comparing mental health across our sample we conducted a confirmatory factor analysis...

Self-Reported Differences on Measures of Executive Function and Hypersexual Behavior in a Patient and Community Sample of Men

ABSTRACTPatients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n == 87) and a non-hypersexual community sample (n == 92) of men using the Behavior Rating Inventory of Executive Function—Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r == .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.

Brain volume and dysexecutive behavior in schizophrenia

Objective Behaviors associated with frontal/executive impairments are common in patients with schizophrenia. Our aim was to reconfirm that morphological brain abnormalities in schizophrenia patients would overlap the areas underpinning frontal systems behavior, and examine whether any specific association exists between abnormalities of brain structures and frontal behavioral deficits in schizophrenia patients. Method Twenty-six schizophrenia patients and 26 matched healthy controls underwent structural magnetic resonance imaging and their frontal function was assessed by a self-rating questionnaire, Frontal Systems Behavior Scale (FrSBe). We applied voxel-based morphometry (VBM) to investigate regional brain volume alternations. Result Compared with healthy controls, schizophrenia patients showed reduced gray matter volume in multiple frontal and temporal structures, namely, the bilateral dorsolateral prefrontal cortices (DLPFC), bilateral medial prefrontal cortices, left ventrolateral prefrontal cortex, bilateral anterior cingulate cortices, and bilateral superior temporal gyri. The scores on the executive dysfunction subscale of the FrSBe were correlated with volume reduction in the bilateral DLPFC in the patient group. Conclusion Our result suggests that pathology of the DLPFC could be the neural basis of real-life dysexecutive behaviors in schizophrenia patients.

Body dysmophic factors and mental health in people seeking rhinoplastic surgery

Background and Aims:There has been increasing number of requests for cosmetic rhinoplastic surgery among Iranians in different age groups in recent years. One risk for those who undergo such plastic operations is the presence of body dysmorphic disorder (BDD) which might complicate the results and decrease the rate of satisfaction from surgery. This study was aimed to find the rate of BDD symptoms and mental problems in people demanding rhinoplastic surgery and a control group.Methods:The scores of General Health Questionnaire (GHQ) and DCQ (Dysmorphic Concerns Questionnaire) were obtained for 50 people who were candidates for rhinoplastic surgery and the results were compared with normal control group.Results:The total GHQ score (p=0.0001) and scores in anxiety (p=0.009), depression (p=0.009), and social dysfunction (p<0.001) sub-scales were higher among the study group compared with the control. Similarly, the DCQ score in the study group (10.67±2.93) was obviously higher than the control group (2.54±2.34) (p=0.0001). However, the score of somatisation sub-scale of GHQ (p=0.06) was not significantly different between the two groups.Conclusions:Psychiatric evaluation in candidates of rhinoplastic surgery seems necessary to prevent unnecessary and repetitive surgical operations.

Symptoms of Sexual Dysfunction in Patients Treated for Major Depressive Disorder

Spontaneous reports of sexual side effects were infrequent during placebo-controlled clinical trials of selegiline transdermal system (STS). The objective of this study was to examine the impact of STS 6 mg/24 hours on various domains of sexual function in patients with major depressive disorder (MDD), using a patient-rated questionnaire. Data from 4 short-term (6 to 8 weeks), randomized, double-blind, placebo-controlled trials of STS in patients with MDD (DSM-IV criteria) were included in the meta-analysis (STS, N = 389; placebo, N = 400). The Medex Sexual Dysfunction Subscale was used to assess sexual interest, arousal, maintenance of interest, orgasm, and satisfaction. Estimates of the average effect of study drug on each item of sexual function and 95% confidence intervals were calculated using a fixed-effects model due to homogeneity of study means. The direct effect of STS versus placebo was estimated using multivariate regression models, with baseline item score as a covariate and controlling for improvement in depression. Analyses were performed on the total population and by gender. Data were collected between January 1997 and April 2000. Estimates of difference between STS and placebo demonstrated a nonsignificant trend toward a positive treatment effect of STS on most sexual function items and significant improvement in sexual satisfaction. For women, there was a significant positive effect on interest, maintaining interest during sex, and satisfaction. The direct effect of STS on changes in individual item scores was minimal in men and showed a trend for improvement in women. This meta-analysis suggests that short-term therapy with STS 6 mg/24 hours does not impair any aspect of sexual function in MDD patients as measured using a patient-rated questionnaire.

Comparison between administration via Internet and paper-and-pencil administration of two clinical instruments: SCL-90-R and GHQ-28

The objective of this study is to compare the results of the Symptom Check List (SCL)-90-R and the General Health Questionnaire (GHQ)-28 administered on paper with the results of administration via Internet. Forty university students were asked to respond to the two questionnaires, first in one format (Internet or paper), and 1 week later in the other format. For the GHQ-28, no statistically significant differences were found between the two forms of presentation, Internet or paper, except in the social dysfunction subscale. In the case of the SCL-90-R, there were differences in the Positive Symptoms Distress Index (PSDI) and in the somatization and obsession–compulsion subscales. The effect of using the two formats in combination was also analyzed. Internal consistency of the instruments is high for both types of presentation ( α=0.91 in GHQ-28; α=0.97 in SCL-90-R). Correlation between the two formats is also high, with values ranging between 0.76 and 0.92, p<0.001, except in the social dysfunction subscale. Finally, correlation between the GHQ-28 and SCL-90-R is also high, for both the paper and Internet results ( r=0.88, p<0.01 on paper and r=0.83, p<0.01 via Internet). The differences found should be verified in future research with other types of sample.

Detecting mental disorders in dental patients with occlusion‐related problems

Dentists often treat patients who may be suffering from comorbid mental disorders without paying attention to their symptoms. This leads to a delay in starting the treatment of mental disorders and to inappropriate dental treatments for physical symptoms originating from mental disorders. In the present study, the ways in which dentists can easily detect mental disorders in dental patients with occlusion-related problems were examined. Fifty-three patients who visited the Occlusion Clinic of Kanagawa Dental College were interviewed by a psychiatrist and a dentist specialized in psychosomatic medicine. Thirty-five patients (66.0%) were diagnosed as having DSM-IV Axis I disorders. The demographic and psychological factors that correlate with the presence of mental disorders are duration of chief complaint, number of clinics and hospitals visited for the current symptom, total score of the General Health Questionnaire (GHQ), the scores of the anxiety and insomnia and social dysfunction subscales in the GHQ and the scores of the confusion-bewilderment and fatigue-inertia subscales in the Profile of Mood States (POMS). A logistic regression analysis indicated that number of clinics and hospitals visited markedly correlated with cormobidity of a mental disorder. This information may be useful for screening mental disorder patients. Dental patients having comorbid mental disorders should be treated both odontologically and psychologically.

Validation of a Spanish Version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA)

The purpose of this study was to develop a linguistically appropriate, culturally adapted, and appropriately validated Spanish version of the SMFA (SMFA-Mex). Validation of a survey-based outcome instrument. Busy state hospital in southern Mexico. Consecutive trauma patients with a variety of orthopedic disorders. N/A. The SMFA-Mex was forward and back translated, administered to orthopedic trauma patients, and compared against the Spanish version of the SF-36s for criterion validity. Statistical analysis included factor analysis, criterion validation with the SF-36, and internal measures of reliability. Factor analysis demonstrated three separate subscale dimensions: 1) upper-extremity dysfunction, 2) lower-extremity dysfunction, and 3) lifestyle alterations. Item analysis showed a high degree of internal consistency for the three subscales (subscale 1, r = 0.95; subscale 2, r = 0.94; subscale 3, r = 0.92). Test-retest reliability at 7 days was 0.93 for the upper-extremity dysfunction subscale, 0.95 for the lower-extremity dysfunction subscale, and 0.92 for the lifestyle-alterations subscale. Construct validity was established by comparison of the Brazilian version of the SF-36. The SMFA-Mex was successfully translated and culturally adapted from the English original. The SMFA-Mex demonstrated adequate scale reliability and validity and yielded three distinct subscales using factor analysis.

Expanded Newborn Screening for Biochemical Disorders: The Effect of a False-Positive Result

Newborn screening programs now identify children with >30 biochemical genetic disorders. False-positive identifications may increase as disorders are added to screening panels. Concerns arise regarding the potential impact on parental stress, family relationships, and perceptions of the child's health. Parents of 173 infants with false-positive screening results for a biochemical genetic disorder in the expanded newborn screening panel were compared with parents of 67 children with normal screening results. Parents completed an interview that elicited information about demographic features, child and parental health, and understanding of newborn screening. Parents also completed the parenting stress index. Parents in the false-positive group attained higher total scores on the PSI than did parents in the normal-screened group, scoring higher on the parent-child dysfunction subscale and the difficult child subscale. Only approximately one third of parents in the false-positive group reported knowing the correct reason for repeat screening. Mothers who reported knowing the correct reason for their child's repeat screening test experienced less total stress than did mothers who were misinformed, were not informed, or did not remember. False-positive screening results may affect parental stress and the parent-child relationship. Improved communication with parents regarding the need for repeat screening tests may reduce the negative impact of false-positive results.

Executive dysfunction in substance dependent individuals during drug use and abstinence: An examination of the behavioral, cognitive and emotional correlates of addiction

Increasing evidence indicates that substance-dependent individuals (SDI) are impaired in executive control tasks relying on different systems within the prefrontal cortex (PFC). Three different functional systems have been described: the dorsolateral prefrontal cortex (DLPC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) circuits. Dysfunction within each PFC system is associated with different behavioral, cognitive, and emotional abnormalities. Few studies have conducted an exhaustive examination of all these different factors in SDI. In this study, SDI (including alcohol, cocaine, and methamphetamine polysubstance users, n=35) were compared with healthy controls (n=36) on a series of behavioral (Frontal Systems Behaviour Scale, FrSBe), cognitive (N-back, Go-No Go, and Wisconsin Card Sorting Tasks), and emotional (International Affective Picture System, IAPS) tasks, each of which was thought to tax a different component of these PFC functional systems. SDI showed greater behavioral problems in the apathy, disinhibition, and executive dysfunction subscales of the FrSBe. Behavioral deficits were significantly associated with several real-life domains in which SDI typically have problems. SDI also showed poorer performance on cognitive tests of working memory, response inhibition and mental flexibility, and abnormal processing of affective images from the IAPS. Cognitive, behavioral, and emotional measures were moderately correlated.

Methadone Maintenance and Male Sexual Dysfunction

Purpose. This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone maintenance for opioid dependence, and describes factors which may contribute to sexual dysfunction. Methods. Ninety-two opioid-dependent men were recruited from a methadone maintenance clinic and completed two questionnaires, a research interview and laboratory measures. Results. Fourteen percent reported some sexual dysfunction. Erectile dysfunction (r = 0.24, p = 0.020), libido dysfunction (r = 0.30, p = 0.003), and global dysfunction (r = 0.26, p = 0.013) increased with increasing age of the patient. Methadone dose showed a significant direct correlation with increased orgasm dysfunction, both before and after adjusting for duration of treatment (p = 0.012). None of the sexual dysfunction subscales or global dysfunction were associated with plasma testosterone or plasma prolactin levels. Conclusions. The rate of global sexual dysfunction in methadone-treated men is similar to general population studies and should be evaluated using general population guidelines. Orgasm dysfunction is a special case and may respond to methadone dose reduction.

A Review of Rating Scales for Measuring Behavior Change Due to Frontal Systems Damage

To perform a critical review of scales designed to measure frontal behavior change. Changes in cognition due to frontal disease or damage have been well described, but noncognitive changes in behavior are often more deleterious functionally for frontal patients. The review concentrates on five behavior rating scales: the Behavior Rating Inventory of Executive Functions (BRIEF), the Dysexecutive Questionnaire (DEX), the Frontal Behavior Inventory (FBI), the Frontal Systems Behavior Scale (FrSBe), the Iowa Rating Scales of Personality Change (IRSPC), and the Neuropsychiatric Inventory (NPI). Other scales purporting to measure specific aspects of frontal functioning, but having less research support, are described briefly. The BRIEF and FrSBe have good reliability and large-scale norms. No norms are available for the other scales. The FrSBe and IRSPC have been shown to be valid in discriminating frontal from nonfrontal lesioned patients, but this has not been shown in the other scales. The FBI and NPI require trained raters, whereas the FrSBe, IRSPC, and BRIEF are administered to patients and/or family informants directly. The NPI and FBI are sensitive to certain changes in behavior attributed to frontal systems disruption but have been used primarily in dementia.

A measurement issue in the assessment of social dysfunction and dysphoria in the third trimester of pregnancy

Summary Objective Screening for psychological disturbance during pregnancy is clinically desirable, however the current battery of brief screening instruments have limited utility in this group. A short-version of the General Health Questionnaire (GHQ), the GHQ-8 comprising two sub-scales has recently been developed. The current investigation sought to determine if common covariates (age and level of education) impacted on item responsiveness within the two GHQ-8 sub-scales. Design A cross sectional design was used with GHQ-8 item scores, age and level of education as dependent variables evaluated within a structural equation model. Setting Women in the third trimester of pregnancy recruited from one obstetric out-patient clinic of a public teaching hospital in Hong Kong. Main outcome measure The 8-item GHQ-8 [Kalliath, T.J., O’Driscoll, M.P., Brough, P., 2004. A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health 20, 11–20]. Results The GHQ-8 was shown to have good factorial validity, however, one of the GHQ-8 items in the social dysfunction sub-scale was found to be differentially influenced by age. Conclusions The GHQ-8 may have to be revised, or age-normed cut-off scores developed, in order to prevent screening accuracy of a clinically-applied version of the instrument being compromised by the age of the individual being screened.

Post-SARS Psychological Morbidity and Stigma Among General Practitioners and Traditional Chinese Medicine Practitioners in Singapore

Introduction: The severe acute respiratory syndrome (SARS) outbreak has been unique in recent history in its rapidity of transmission, its concentration in healthcare settings, and the large number of healthcare workers who have been infected. This study aims to examine the psychological impact of SARS on general practitioners (GPs) and traditional Chinese medicine (TCM) practitioners in Singapore. Materials and Methods: Two months after the SARS outbreak, all the GPs and TCM practitioners in Singapore were mailed a set of self-reported questionnaires, which included the General Health Questionnaire (GHQ), the Impact of Event Scale-R (IES-R), and a questionnaire to measure the perception of stigma. Results: A total of 721 (29%) GPs and 329 (22%) TCM practitioners responded to the survey. Significantly more GPs had worked in SARS affected facilities and had been directly involved in the care of patients with SARS than the TCM practitioners (P &lt;0.001). Those GPs who were directly involved in the care of patients with SARS were significantly more likely to be GHQ case as compared to those not involved in the care of patients with SARS (P = 0.02; OR = 2.9; 95% CI, 1.3-6.3). The mean score of the GHQ somatic, anxiety and social dysfunction subscales were significantly higher in GPs as compared to TCM Practitioners (P &lt;0.001). The GHQ total score as well as the subscales was significantly correlated with the IES-R and stigma subscales (P &lt;0.05). Conclusion: The fear, uncertainty and stigma caused by SARS are associated with psychological distress among some of the primary healthcare providers in Singapore.

Effect of expanded newborn screening for biochemical genetic disorders on child outcomes and parental stress.

Tandem mass spectrometry now allows newborn screening for more than 20 biochemical genetic disorders. Questions about the effectiveness and risks of expanded newborn screening for biochemical genetic disorders need to be answered prior to its widespread acceptance as a state-mandated program. To compare newborn identification by expanded screening with clinical identification of biochemical genetic disorders and to assess the impact on families of a false-positive screening result compared with a normal result in the expanded newborn screening program. Prospective study involving an inception cohort of newly diagnosed children. Massachusetts, Maine, and a private laboratory in Pennsylvania with expanded newborn screening; other New England states with limited screening. Families of 50 affected children identified through expanded newborn screening (82% of eligible cases); 33 affected children identified clinically (97% of eligible cases); 94 screened children with false-positive results (75% of eligible cases); and 81 screened children with normal results (63% of eligible cases). Child's health and development and the Parental Stress Index. Within the first 6 months of life, 28% of children identified by newborn screening compared with 55% of clinically identified children required hospitalization (P =.02). One child identified by newborn screening compared with 8 (42%) identified clinically performed in the range of mental retardation (P<.001). Mothers in the screened group reported lower overall stress on the Parental Stress Index than mothers in the clinically identified group (z = 3.38, P<.001). Children with false-positive results compared with children with normal results were twice as likely to experience hospitalization (21% [n = 20] vs 10% [n = 8], respectively; P =.06). Mothers of children in the false-positive group compared with mothers of children with normal screening results attained higher scores on the Parental Stress Index (z = 4.25, P<.001) and the Parent-Child Dysfunction subscale (z = 5.30, P<.001). Expanded newborn screening may lead to improved health outcomes for affected children and lower stress for their parents. However, false-positive screening results may place families at risk for increased stress and parent-child dysfunction.

Measuring Well-Being in Aphasia: The GHQ-28 Versus the NHP

This study aimed to get the opinions of people with aphasia on two subjective well-being measures: the General Health Questionnaire 28-item version (GHQ-28) (Goldberg & Hillier, 1979) and the Nottingham Health Profile (NHP) (Hunt, McKenna, McEwen, Williams, & Papp, 1981). Twelve persons with moderate to mild aphasia of at least 2-years duration completed the GHQ-28 and the NHP. In a semistructured intenriew, they gave their feedback on the two questionnaires. All participants were able to complete both instruments. Nine out of 12 participants showed high psychological distress (> 5/28) in the GHQ-28. The NHP (part 1 less the physical abilities section) had a correlation of 0.78 (p < .01) with the GHQ-28. The social dysfunction subscale of the NHP identified more problems in the participants with aphasia than the social isolation subscale of the GHQ-28. The majority of the participants (10 out of 12) preferred the NHP, as they found it easier to understand and respond to. This small-scale study indicated that both the GHQ-28 and the NHP can be administered to people with moderate to mild aphasia and provide useful information on their well-being. Participants reported that the NHP was easier to do, and it asked questions more relevant to their situation.

Health-Related Quality of Life in Parkinson's Disease after Pallidotomy and Deep Brain Stimulation

This study explored the multidimensional outcome of three neurosurgical interventions for Parkinson's disease (PD): pallidotomy (N = 23), pallidal deep brain stimulation (DBS) (N = 9), and thalamic DBS (N = 7). All patients completed the Sickness Impact Profile (SIP) and the Beck Depression Inventory. Pallidotomy patients also completed the Profile of Mood States, the Beck Anxiety Inventory, and a disease-specific quality of life (QOL) measure, the Parkinson's Disease Questionnaire (PDQ-39). Three months after surgery, all neurosurgical groups showed significant improvements in mood and function, including physical, psychosocial, and overall functioning. Pallidal DBS and pallidotomy patients who completed additional QOL measures reported decreased anxiety and tension, increased vigor, improved mobility and ability to perform activities of daily living, and decreased perceived stigma. Psychosocial dysfunction scores from the SIP were related to depressed mood both at baseline (r = .42) and at followup (r = .45), but the physical dysfunction subscale was not related to mood at either time point, suggesting that disruption of social relationships due to PD may have more impact on affective distress than physical symptoms alone. Results suggest that neurosurgical interventions for PD improve disabling PD motor symptoms and also improve several domains of quality of life.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)

The purpose of the present study was to develop a reliable and valid self-report questionnaire to assess the perceived influence of Multiple Sclerosis (MS) symptoms on sexual activity and satisfaction and the perceived influence of MS symptoms on the overall quality of intimate relationships. This instrument was called the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ). The initial item pool consisted of 72 items reflecting primary, secondary, and tertiary sexual dysfunction. The MSISQ was revised by eliminating items assessing the impact of MS symptoms on the overall quality of intimate relationships because they were redundant with items assessing the impact of MS symptoms on sexual activity and satisfaction. Factor analysis, reliability analysis, and item analysis demonstrated that the MSISQ could be further shortened without diminishing the statistical integrity of the instrument. Hence, it was shortened to a 19-item questionnaire (MSISQ-19), with primary, secondary, and tertiary sexual dysfunction subscales. Reliability analyses provided evidence for high internal consistency for the total MSISQ-19 (α = .91) and for the primary(α = .82), secondary (α = .85) and tertiary (α = .87) subscales. The MSISQ-19 demonstrated concurrent validity with measures of: (1) marital satisfaction, specifically satisfaction with affective communication, problem solving communication, and sexual dissatisfaction, (2) neurological impairment and level of disability in MS, (3) psychological distress and well-being, and (4) global sexual dysfunction in MS. In addition, a comparison of the distribution of scores of the MSISQ-19 and the Sexual Function Scale (SFS) of the Minimal Record of Disability (MRD) in MS demonstrated that the MSISQ-19 was more sensitive to moderate and high levels of sexual difficulty. Study limitations, theoretical, clinical, and research implications, and directions for further research are discussed.

Early life stress, negative paternal relationships, and chemical intolerance in middle-aged women: support for a neural sensitization model.

This study (ntotal = 35) compared early life stress ratings, parental relationships, and health status, notably orthostatic blood pressures, of middle-aged women with low-level chemical intolerance (CI group) and depression, depressives without CI (DEP group), and normals. Environmental chemical intolerance is a symptom of several controversial conditions in which women are overrepresented, that is, sick building syndrome, multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. Previous investigators have postulated that people with CI have variants of somatization disorder, depression, posttraumatic stress disorder (PTSD) initiated by childhood abuse or a toxic exposure event. One neurobehavioral model for CI, somatization disorder, recurrent depression, and PTSD is neural sensitization, that is, the progressive amplification of host responses (e.g., behavioral, neurochemical) to repeated intermittent stimuli (e.g., drugs, chemicals, endogenous mediators, stressors). Females are more vulnerable to sensitization than are males. Limbic and mesolimbic pathways mediate central nervous system sensitization. Although both CI and DEP groups had high levels of life stress and past abuse, the CI group had the most distant and weak paternal relationships and highest limbic somatic dysfunction subscale scores. Only the CI group showed sensitization of sitting blood pressures over sessions. Together with prior evidence, these data are consistent with a neural sensitization model for CI in certain women. The findings may have implications for poorer long-term medical as well as neuropsychiatric health outcomes of a subset of women with CI. Subsequent research should test this model in specific clinical diagnostic groups with CI.

THE PSYCHOLOGICAL EFFECTS OF BREAST SCREENING IN TERMS OF PATIENTS' PERCEIVED HEALTH ANXIETIES

SUMMARY This study aimed to assess and compare the impact of letter of invitation, initial breast screening mammography, and subsequent recall procedures on the level of anxiety over breast problems. The survey of females undergoing routine breast screening procedures in a primary care setting is part of the first wave of a national breast screening programme in the UK. Women aged 50‐64 registered with six general practices (n=2618) were invited by letter to attend for screening. Their self‐perceived impact of receipt of invitation letter, attendance at initial screening, and recall, in terms of anxiety and concern about breast problems, was measured by a self‐report questionnaire and the physical, emotional and social dysfunction subscales of the Psychological Consequences of Screening Mammography Questionnaire (PCQ). Overall, subjects' anxiety levels diminished between the receipt of their invitation letter and the completion of their screening examination. Subjects did not, however, respond to the letter of invitation and screening procedure in a homogeneous manner. In a sample of 1253, the letter of invitation reduced anxiety about breast problems in 39.7%, increased anxiety in 24.6%, and had no appreciable effect in 35.7%. In the 1280 who attended for breast screening, the examination procedure reduced anxiety about breast problems in 55.9%, increased anxiety in 12.8%, and had no appreciable effect in 31.3%. In a smaller sample (n=33) who completed questionnaires at recall, there were significant increases in PCQ‐measured anxiety. Throughout the study, the PCQ was sensitive to change in anxiety over breast problems. We conclude that screening procedures can either increase or reduce anxiety about breast problems, or have no appreciable effect. Subjects' perception of the impact of receiving the letter of invitation and undergoing the screening examination procedure is related to previous levels of concern over breast problems. Conclusions about the psychological effect of breast screening cannot be drawn without consideration of the time and place of the baseline assessment. Participants in breast screening programmes therefore cannot be considered a homogeneous entity. Caution should be exercised when assessing the impact of screening procedures on entire populations as this approach might mask an important diversity of response.