Hopefulness predicts resilience after hereditary colorectal cancer genetic testing: a prospective outcome trajectories study

Abstract

Background: Genetic testing for hereditary colorectal cancer (HCRC) had significant psychological consequences for test recipients. This prospective longitudinal study investigated the factors that predict psychological resilience in adults undergoing genetic testing for HCRC.

Methods: A longitudinal study was carried out from April 2003 to August 2006 on Hong Kong Chinese HCRC family members who were recruited and offered genetic testing by the Hereditary Gastrointestinal Cancer Registry to determine psychological outcomes after genetic testing. Self-completed questionnaires were administered immediately before (pre-disclosure baseline) and 2 weeks, 4 months and 1 year after result disclosure. Using validated psychological inventories, the cognitive style of hope was measured at baseline, and the psychological distress of depression and anxiety was measured at all time points.

Results: Of the 76 participating subjects, 71 individuals (43 men and 28 women; mean age 38.9 +/- 9.2 years) from nine FAP and 24 HNPCC families completed the study, including 39 mutated gene carriers. Four patterns of outcome trajectories were created using established norms for the specified outcome measures of depression and anxiety. These included chronic dysfunction (13% and 8.7%), recovery (0% and 4.3%), delayed dysfunction (13% and 15.9%) and resilience (76.8% and 66.7%). Two logistic regression analyses were conducted using hope at baseline to predict resilience, with depression and anxiety employed as outcome indicators. Because of the small number of participants, the chronic dysfunction and delayed dysfunction groups were combined into a non-resilient group for comparison with the resilient group in all subsequent analysis. Because of low frequencies, participants exhibiting a recovery trajectory (n = 3 for anxiety and n = 0 for depression) were excluded from further analysis. Both regression equations were significant. Baseline hope was a significant predictor of a resilience outcome trajectory for depression (B = -0.24, p < 0.01 for depression); and anxiety (B = -0.11, p = 0.05 for anxiety).

Conclusions: The current findings suggest that hopefulness may predict resilience after HCRC genetic testing in Hong Kong Chinese. Interventions to increase the level of hope may be beneficial to the psychological adjustment of CRC genetic testing recipients.

Figure 1

Hypothesized Prototypical Outcome Trajectories after a Stressful Event

Figure 2

Outcome Trajectories of HADS Anxiety after HCRC Genetic Testing. (1) T1 = Immediately before disclosure of genetic testing result; T2 = Two weeks post-result disclosure; T3 = Four months post-result disclosure; T4 = One year post-result disclosure. (2) A small portion of the sample (4.3%) evidenced a variable pattern that could not be categorized into one of the four prototypical patterns was not shown in the figure.

Figure 3

Outcome trajectories of HADS Depression after HCRC Genetic Testing. (1) T1 = Immediately before disclosure of genetic testing result; T2 = Two weeks post-result disclosure; T3 = Four months post-result disclosure; T4 = One year post-result disclosure. (2) A small portion of the sample (2.9%) evidenced a variable pattern that could not be categorized into one of the four prototypical patterns was not shown in the figure.