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Posttraumatic Stress Associated With Cancer History and BRCA1/2 Genetic Testing

From the Departments of Psychiatry (H.A.H., A.B.) and Psychology (T.J.S., A.W.S., S.S.I., A.B.), the University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Heidi A. Hamann, PhD, Department of Psychology, Washington State University, PO Box 644820, Pullman, WA 99164-4820. E-mail: hamann{at}wsu.edu

Objective: A subset of women who are at elevated cancer risk due to family history exhibit evidence of cancer-specific distress. These stress responses may represent symptoms of posttraumatic stress disorder (PTSD). The present study assessed rates of PTSD related to personal or family cancer history and BRCA1/2 testing.

Methods: Participants were 84 women enrolled in a larger project focused on genetic testing decisions. Semistructured diagnostic interviews were used to identify instances of threshold and subthreshold PTSD.

Results: Results indicated that 16.7% of the women reported current threshold or subthreshold PTSD related to personal or family cancer history. An additional 26.2% reported past-only cancer-related threshold or subthreshold PTSD. Of the 65 women who received BRCA1/2 results and completed the test-related PTSD module, only 7.7% reported threshold or subthreshold PTSD related to the genetic testing process. However, when rates were examined based on carrier status, 25.0% of BRCA1/2 carriers reported test-related threshold or subthreshold PTSD compared with only 10.0% of variants and 2.3% of noncarriers.

Conclusions: Results from this study suggest that both personal and family cancer diagnoses can be significant stressors for a subset of high-risk women. Rates of threshold and subthreshold PTSD related to genetic testing appear to be less common, although carriers may be at higher risk for significant posttraumatic symptoms.

Key Words: genetic testing • posttraumatic stress • cancer • structured clinical interview • BRCA1/2

Abbreviations: CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; GAD = generalized anxiety disorder; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; SCID = Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SPSS = Statistical Package for the Social Sciences.

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