Degree Name

Doctor of Philosophy


School of Psychology


Background This thesis describes the psychological impact of an anal cancer screening program on Human immunodeficiency virus (HIV) -infected men who have sex with men (MSM). It also explores the effect of the personal characteristics psychological flexibility (PF) and difficulty identifying and describing feelings (DIDF) on the mental health of these men in the context of anal cancer screening. Anal cancer screening is a relatively new public health initiative, as it is being realised that HIV-infected MSM are at a high risk for this disease. The potential for cancer screening programs to create uncertainty and distress has been highlighted by studies of other screening programs. Very little research has focussed on the impact of anal cancer screening and the role of PF and DIDF in this process. Three hypotheses were proposed: 1. The anal cancer screening process will decrease well-being, especially, in men who receive higher risk grades of cytology and histology results. 2. The impact of adverse medical results will depend on how much DIDF and PF the participant displays. 3. The level of DIDF and PF will determine the development of positive mental health regardless of medical results.

Methodology A prospective longitudinal survey of 291 men was conducted at three time points over 14 weeks at a public HIV clinic in Sydney, Australia. Self-report questionnaires measuring worry, distress, depression, anxiety, stress and health-related quality of life (QOL) were collected. PF was assessed by the Acceptance and Action Questionnaire II and DIDF by the Toronto Alexithymia Scale-20.

Results Following initial screening, men who had a follow-up biopsy recommended were significantly more worried about anal cancer, rated their anal health worse and were less optimistic about their future health than the control group who needed no further medical investigation. Subsequently men receiving high grade histology results remained worried about anal cancer. Getting initial bad results and then reassuring results lead to higher optimism than getting an initial good result. After follow-up testing, the reassured group became more optimistic about their health than either the low threat or high threat group. There was no evidence that general anxiety, depression or QOL was significantly affected by the screening process.

There was no evidence that levels of PF and DIDF impacted the level of worry about cancer through the screening process. However, both DIDF and PF were reliable predictors of mental health. When levels of baseline mental health were controlled, greater DIDF predicted increases in depression, anxiety and stress, and decreases in mental and physical QOL over the screening period. The link between PF and mental health was entirely mediated by DIDF.

Conclusions These results provide a better understanding of how anal cancer specific worry increases throughout the screening process for some men and the role of PF and DIDF to enhance mental health. Being chronically low in PF could lead to greater DIDF and thereby worse mental health. More research is needed to determine whether having more PF promotes the ability to identify and differentiate the nuances of pleasant and unpleasant emotions which enhance an individual’s mental health. Intentionally enhancing men’s ability to identify and describe feelings or PF may assist them to better manage a range of difficult life experiences such as health screenings and other potentially threatening information. Recommendations are also made for appropriate supports and implementation of clear communication prior to and during anal cancer screening.