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Socioeconomic Status Differences in Coping With a Stressful Medical Procedure

From the Department of Epidemiology and Public Health, University College London, UK.

Address correspondence and reprint requests to Jane Wardle, PhD, Cancer Research UK Health Behavior Unit, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK. E-mail: j.wardle{at}ucl.ac.uk

Objective: The objective of this study was to test the hypothesis that socioeconomic disadvantage results in adverse emotional reactions to a novel, stressful, medical examination.

Methods: Sigmoidoscopy screening for colorectal cancer was identified as a potential stressor. A subset of participants (N = 3535) from the U.K. Flexible Sigmoidoscopy Trial completed pre- and postscreening questionnaires regarding psychologic well-being. All trial participants were sent a postscreening questionnaire after 3 months (post-flexible sigmoidoscopy [FS] sample, N = 29,804), including measures of distress (the General Health Questionnaire), anxiety (State-Trait Anxiety Inventory), a single-item measure of bowel cancer worry, and a 6-item measure of positive consequences of screening. Socioeconomic status (SES) was coded from postcodes with the Townsend Index. SES differences in changes in emotional well-being over the course of screening were evaluated in the longitudinal sample. SES differences in postscreening well-being in relation to screening outcome were evaluated in the post-FS sample.

Results: Bowel cancer worry and anxiety were higher in lower SES groups before screening. Both reduced after screening, but there were no SES differences in the change. In the post-FS sample, there was an SES gradient in anxiety but not in distress. Lower SES groups indicated more positive reactions. There were no interactions between SES and screening outcome for any indicator of well-being.

Conclusions: Lower SES was associated with worse psychologic well-being before and after screening, but lower SES participants did not show any differentially greater adverse reactions compared with higher SES participants. Moderately stressful experiences in everyday life do not necessarily more unfavorably affect those with fewer educational and economic resources.

Key Words: SES • bowel cancer • colorectal cancer • screening • psychologic well-being • stress • distress

Abbreviations: SES = socioeconomic status; FS = flexible sigmoidoscopy.