Psychological distress and dyadic trust in Italian women awaiting colposcopy after positive cervical cancer screening: a cross-sectional study

Background: Screening programs have substantially reduced cervical cancer incidence and mortality, yet abnormal results can generate considerable psychological distress even before a diagnosis is confirmed. Interpersonal resources such as dyadic trust—the expectation of reliability and support within intimate relationships—may buffer distress, but their role in the colposcopy context is understudied. Examining both individual and relational predictors of emotional well-being may inform targeted psychosocial interventions and improve patient-centered care in cervical cancer screening. Objectives: To estimate the prevalence of depression, anxiety, and stress among Italian women referred for their first colposcopy after a positive cervical cancer screening result, and to identify associated sociodemographic, clinical, and interpersonal factors, with particular focus on dyadic trust. Materials and methods: This cross-sectional observational study was conducted from June 2022 to March 2024 at the Lower Genital Tract Clinic of the University of Torino, Italy. Women undergoing their first colposcopy after a positive cytology and/or human papillomavirus (HPV) DNA test within the “Prevenzione Serena” screening program completed three questionnaires at their appointment: a sociodemographic and clinical form, the Depression Anxiety Stress Scales-21 (DASS-21), and the Dyadic Trust Scale (DTS). Multivariable logistic regression models assessed associations between participant characteristics and psychological outcomes. Exploratory nomograms were developed to estimate individual risk probabilities; these were not internally validated and should not be used for clinical prediction. Results: A total of 573 women participated (median age 36 years). Most were single (61%), university-educated (53%), employed (82%), and HPV-unvaccinated (83%). Mild to extremely severe symptoms of stress, depression, and anxiety were reported by 70%, 41%, and 31% of respondents, respectively. In multivariable analysis, higher dyadic trust was associated with lower risk of depression (OR 0.66, 95%CI 0.51–0.85), anxiety (OR 0.53, 95%CI 0.31–0.91) and stress (OR 0.46, 95%CI 0.25–0.85). Lower educational level was associated with higher risk of depression (OR 1.64, 95%CI 1.02–2.64), as HPV vaccination (OR 1.87, 95%CI 1.02–3.41). Younger age was associated with higher risk of anxiety (OR 1.88, 95%CI 1.25–2.86) and stress (OR 4, 95%CI 1.92–8.33) for 16-year increase. Exploratory nomograms allowed individualized risk estimation. Conclusions: Psychological distress—particularly stress—is common among women awaiting colposcopy after a positive screening result. Younger age, lower education, HPV vaccination status, and lower dyadic trust identify those at elevated risk. Integrating risk-stratified psychosocial support, enhancing relational coping, and tailoring communication may improve emotional outcomes. Prospective studies should clarify causal pathways and evaluate partner-inclusive interventions.