Assessment of the Magnitude and Determinants of Psycological Distress among Women Who Tested positive for HPV During Cervical Cancer Screening in Addis Ababa ,Ethiopia ,2025.
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Date
2025-06
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Addis Ababa University
Abstract
Background: Cervical cancer is a major public health cocern and remains the leading cause of cancer-related deaths among women in developing countries. In Ethiopia, HPV testing was first introduced in 2021 for women living with HIV and is expected to become the primary screening method for all women in future national guidelines. While HPV testing is highly sensitive, it has a low positive predictive value. Consequently, the test often identifies many women as HPV-positive even in the absence of precancerous lesions. Being informed of an HPV infection can cause significant psychological distress, as many women may associate the diagnosis directly with cervical cancer.
Objective: To assess the magnitude of psychological distress and its associated factors among women who tested positive for HPV, including both women living with HIV (WLHIV) and those in the general population in Addis Ababa.
Method: An explanatory sequential mixed-methods study was conducted from February to May 2025 in selected HPV screening facilities in Addis Ababa, Ethiopia. For the quantitative component, a facility-based cross-sectional study design was employed. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10), with scores calculated by summing the values of 10 individual responses, yielding a total score ranging from 10 to 50. Cut-off points of <20, 20–24, 25–29, and ≥30 were used to categorize psychological distress as likely to be well, mild, moderate, and severe, respectively. Descriptive statistics and logistic regression analyses were performed to identify factors associated with psychological distress. Thematic analysis was used for qualitative data analysis.
Result : From a total of 423 participants, 146(34.5%) were found to have severe mental distress while 63 (14.9%) had moderate mental distress, 40 (9.4%) had mild mental distress and 174 (41.1%) were likely to be well. The respondants who had poor knowledge about HPV (AOR = 5.26, 95% CI: 2.82-9.80), negative social and cultural perception associated with HPV (AOR = 1.91, 95% CI: 1.0–3.6) , lack of support from their partners (AOR = 4.59, 95% CI: 2.43-8.71) and negative experience during screening and follow up services experience (AOR = 2.63, 95% CI:1.43-4.83) were found to be significantly associated with mental distress among HPV positive women. The qualitative findings revealed that some of the emotional reactions to an HPVpositive screening included fear of stigma,blame and abandonment which inturn resulted fear of reporting the result to partners or family. Follow-up care difficulty was also reported, such as access barriers, vague information, and emotional resistance to return for reassessment.
Conclusion and Recommendation : The study reveals that a significant proportion of HPV-positive women experienced mild to severe psychological distress following their screening results. knowledge gaps, sociocultural stigma, limited partner support, and negative experiences with screening and follow-up services have been negatively associated with the psychological conditions after the screening. Addressing these factors through improved health education, strengthened social support systems, and the integration of mental health care into screening programs is essential to mitigate the psychological impact associated with HPV positive results after screening.
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Keywords
HPV testing, HPV positive, Psychological Distress, Cervical cancer, Counselling