Genetic Counseling for Mental Health Predisposition: Psychological Impact and Decision-Making Patterns Following Polygenic Risk Score Disclosure

Background. Polygenic risk scores (PRS) for common psychiatric disorders are increasingly available and may inform personalized prevention. However, psychological and behavioral effects of disclosing PRS for depression, anxiety, and bipolar disorder remain understudied. Objective. We evaluated the short- and medium-term psychological outcomes of PRS disclosure and examined whether elevated genetic risk influenced preventive behaviors, treatment-seeking behaviors, and life planning. Methods. In a mixed-methods design, a randomized longitudinal trial involved 487 adults (25–55 years) who were assigned to either immediate PRS disclosure or a 6-month wait-list control. Participants completed the GAD-7, PHQ-9, a modified IES-R, measures of health behavior engagement, treatment-seeking behavior, and the Genetic Discrimination Concerns Scale at baseline, 1 week, 1 month, 3 months, and 6 months. Quantitative analyses used linear mixed-effects models, ANCOVA, logistic regression, bootstrapped structural equation modeling for mediation, and moderation tests; missing data were multiply imputed. Semi-structured interviews were conducted with 60 participants to explore qualitative experiences. Results. High-risk (top quartile) recipients showed a pronounced but transient anxiety increase at 1 week versus low-risk participants; anxiety returned to baseline by 1 month and remained stable through 6 months. High-risk status predicted greater adoption of preventive behaviors at 6 months and increased treatment-seeking. Genetic-discrimination concerns were reported by 34.2% overall and were higher among high-risk participants and partially mediated behavioral outcomes. Neuroticism amplified, and genetic literacy attenuated, anxiety responses. Qualitative analysis revealed themes of initial shock followed by empowerment and proactive health management. Conclusions. PRS disclosure produced short-lived distress among high-risk individuals but facilitated sustained preventive behaviors and treatment engagement when paired with standardized counseling without producing durable psychological harm overall.