ABSTRACT
This seminal paper was the first properly controlled trial designed to determine the putative benefits of counselling, in particular the ability of a specialist nurse to prevent the psychiatric morbidity associated with mastectomy. Seventy-five women received counselling pre-and post-surgery and were visited by the specialist nurse at home and follow-up clinics to monitor their progress. A control group of 77 women received normal surgical unit care. Psychological morbidity was assessed by a trained interviewer using a standardized, semi-structured psychiatric interview, the Present State Examination (PSE), shortly after surgery and then at 3, 12 and 18 months later. Although the counselling failed to prevent psychiatric morbidity, regular monitoring by the nurse meant that problems were recognized and 76% of those needing psychiatric help were referred on. By contrast, only 15% of the control group who merited referral had their psychological diffculties recognized and as a result received help. At 12-18 months post-surgery, psychiatric morbidity was less in the counselled group (12%) than in the controls (39%), probably due to their referral on for appropriate help.
