OBJECTIVES: To elucidate risk factors for high state anxiety in women referred for colposcopy. DESIGN: Prospective cohort study. SETTING: Department of Gynaecology, Malmö University Hospital, Sweden. POPULATION: A total of 100 consecutive women referred for colposcopy for the first time after an abnormal cervical smear. METHODS: Women in the study group completed prior to colposcopy the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale-self-rate, and were interviewed about their psychosocial situation. MAIN OUTCOME MEASURES: Variables related to high state anxiety were determined in bivariate and multiple logistic regression analysis. RESULTS: High depression scores and the wording of the referral letter for colposcopy were related to high state anxiety in a multivariate analysis. Women with high depression scores had a nine-fold risk for higher levels of state anxiety and did not respond with lower state anxiety levels after information and examination. Women who received a letter stating 'some changes' were at a five-fold increased risk for high levels of state anxiety than those who received a letter stating 'light changes'. CONCLUSION: A depressive mood and the wording of the referral letter for colposcopy after an abnormal smear were predictive of high state anxiety levels.