This article was downloaded by: [New York University] On: 15 May 2015, At: 11:11 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Psychology, Health & Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/cphm20
Mental health of Chinese primary care patients with lower urinary tract symptoms a
a
a
Edmond P.H. Choi , Cindy L.K. Lam & Weng Yee Chin a
Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong Published online: 17 Apr 2015.
Click for updates To cite this article: Edmond P.H. Choi, Cindy L.K. Lam & Weng Yee Chin (2015): Mental health of Chinese primary care patients with lower urinary tract symptoms, Psychology, Health & Medicine To link to this article: http://dx.doi.org/10.1080/13548506.2015.1032309
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
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Psychology, Health & Medicine, 2015 http://dx.doi.org/10.1080/13548506.2015.1032309
Mental health of Chinese primary care patients with lower urinary tract symptoms Edmond P.H. Choi*, Cindy L.K. Lam and Weng Yee Chin Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
Downloaded by [New York University] at 11:11 15 May 2015
(Received 24 July 2014; accepted 16 March 2015) The aim of this study was to evaluate the mental health of Chinese primary care patients with lower urinary tract symptoms (LUTS). This was a cross-sectional observational study. Five hundred and nineteen subjects with LUTS completed a structured questionnaire containing the Depression, Anxiety, and Stress Scale-Short Form, the International Prostate Symptom Score, the adapted International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and questions about socio-demographics. Overall, 17.7% of subjects reported depressive symptoms, 24.3% anxiety symptoms and 9.6% stress symptoms. In males, demographic factors associated with poorer mental health included being not married; clinical factors included higher LUTS severity, weak stream, straining and mixed urinary incontinence. In females, demographic factors associated with poorer mental health included being younger, not married and lower household income; clinical factors included higher LUTS severity, incomplete bladder emptying, urgency and weak stream. Chinese primary care patients with LUTS appear to be an at-risk group for poorer mental health with increased prevalence of anxiety and depressive symptoms and may require routine screening to identify those who may require more tailored interventions to address both their urinary symptoms and psychological distress. Keywords: urology; lower urinary tract symptoms; Chinese; depression; anxiety; stress
Introduction Lower urinary tract symptoms (LUTS) are highly prevalent in men and women worldwide. It is estimated around 2.3 billion individuals will be affected by at least one type of LUTS by 2018. Estimated numbers of people suffering from LUTS are greatest in Asia, followed by Europe, Africa, North America and South America (Irwin, Kopp, Agatep, Milsom, & Abrams, 2011). LUTS rarely cause death, but studies have shown that patients with LUTS have poorer mental health. A study in Taiwan found that women suffering from LUTS felt stress, uneasiness and anxiety because of self-perceived bodily filthiness and embarrassment to explain their symptoms to male doctors (Wang, Chen, Jou, & Tsao, 2011). Males with LUTS are often anxious about cancer and the decline in sexual function (Gannon, Glover, O’Neill, & Emberton, 2004). Most epidemiological studies have found that LUTS patients have poorer mental health than healthy controls. A multi-country study found that men and women with LUTS had higher levels of depression and *Corresponding author. Email: [email protected] © 2015 Taylor & Francis
Downloaded by [New York University] at 11:11 15 May 2015
2
E.P.H. Choi et al.
anxiety than healthy controls (Coyne et al., 2008, 2009). A study in the US found that LUTS increased the odds of depressive symptoms (Laumann, Kang, Glasser, Rosen, & Carson, 2008). There have however been some conflicting findings with studies from the UK which have found that the depression and anxiety levels of most male patients with LUTS fell within the normal range (Glover, Gannon, McLoughlin, & Emberton, 2004). To date, findings about the effect of LUTS on mental health have lacked generalizability. Most studies have focused on specific patient subsets such as males, elderly patients or working people, making it difficult to generalize or compare findings. Moreover, most studies have been conducted in non-Chinese populations and the impact of LUTS on mental health in Chinese patients is still poorly understood. The lack of knowledge about the impact of LUTS on mental health in both Chinese males and females necessitates the present study. This study aimed to evaluate the mental health of Chinese male and female primary care patients with LUTS and to identify the risk factors associated with poorer mental health. Methods Subjects and sampling This was a cross-sectional observational study. Subjects were recruited from two primary care settings: A. Primary care continence care clinic patients LUTS patients attending nurse-led primary care continence care clinics for LUTS treatment were recruited by consecutive sampling. All new patients attending the clinics were screened by an instrument adapted from the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). A cut-off score ≥3 was used to identify eligible subjects. B. Government-funded primary care clinic waiting room patients All patients attending government-funded primary care clinics for medical consultation were screened. They completed an instrument adapted from the ICIQ-UI SF in waiting room before medical consultation. Patients with ICIQ-UI SF score ≥3 were considered to have LUTS. Patients from both settings were excluded if they were aged 2§§, 2 > 1§§
3 > 1§§, 3 > 2§§, 2 > 1§§
87.7 61.5 36.0
92.3 70.4 44.0
100.0 94.2 89.7
96.2 80.3 66.7
3 > 1§§, 3 > 2§
2.64 (2.96) 3.82 (4.27) 5.64 (4.85) 2 > 1§, 3 > 1§§
96.2 88.3 74.4
Normal (%)
3 > 1§
Significant difference
1.96 (3.05) 3.58 (6.01) 5.33 (5.85)
Mean score (SD)
12.3 38.5 64.0
7.7 29.6 56.0
0 5.8 10.3
3.8 19.7 33.3
3.8 11.7 25.6
Mild to Extremely severe (%)
Mean DASS-21 scores and prevalence of depressive, anxiety and stress symptoms by IPSS severity.
Males Depressive symptoms Mild LUTS*,# Moderate LUTS*,# Severe LUTS*,# Anxiety symptoms Mild LUTS**,# Moderate LUTS**,# Severe LUTS**,#
Table 3.
3.1 13.3 12.0
3.8 15.6 16.0
0 2.2 7.7
1.9 6.6 10.3
1.9 5.1 12.8
Mild (%)
Downloaded by [New York University] at 11:11 15 May 2015
0
0
7.7 18.5 20.0
3.1 8.1 20.0
2.2 2.6
10.9 17.9
1.9 2.9 10.3
Moderate (%)
3.0 4.0
.7
1.9 .7 5.1
2.2 2.6
4.4 20.0
0
0
0
0
0
Severe (%)
1.5 2.2 12.0
.8 3.0 16.0
.7
1.5
1.5
(Continued)
0
0
0
0
0
0
Extremely severe (%)
Psychology, Health & Medicine 7
(Continued).
3.98 (6.11) 8.12 (7.26) 13.92 (10.99)
Mean score (SD)
3 > 1§§, 3 > 2§§, 2 > 1§§
Significant difference
94.6 84.4 60.0
Normal (%)
5.4 15.6 40
Mild to Extremely severe (%)
1.5 8.9 16.0
Mild (%)
2.3 3.7 8.0
Moderate (%)
.8 2.2 8.0
Severe (%)
Notes: Group 1: mild LUTS; Group 2; moderate LUTS; and Group 3: severe LUTS. # 2 χ test to compare the prevalence of depressive, anxiety and stress symptoms (normal vs. mild to extremely severe) among different LUTS severities (p < .01). *One-way ANOVA to compare the mean DASS scores among different LUTS severities (p < .05). **One-way ANOVA to compare the mean DASS scores among different LUTS severities (p < .01). § Significant difference between groups by post hoc Tukey’s HSD test (p < .05). §§ Significant difference between groups by post hoc Tukey’s HSD test (p < .01).
Stress symptoms Mild LUTS**,# Moderate LUTS**,# Severe LUTS**,#
Table 3.
Downloaded by [New York University] at 11:11 15 May 2015
.8 .7 8.0
Extremely severe (%)
8 E.P.H. Choi et al.
.43 .21 −.04 −.07 .71# .06 .13 −2.05 .11 4.3# .03 −3.71* 1.32 .40 1.09 .55 19%
Males Clinical factors Incomplete bladder emptying score Frequency score Intermittency score Urgency score Weak stream score Straining score Nocturia score Stress incontinence vs. no incontinence Urge incontinence vs. no incontinence Mixed incontinence vs. no incontinence
Socio-demographic factors Age (years) Currently married vs. not currently married Working vs. not working Household Income > $20,000 vs. $20,000 vs.
Psychology, Health & Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/cphm20
Mental health of Chinese primary care patients with lower urinary tract symptoms a
a
a
Edmond P.H. Choi , Cindy L.K. Lam & Weng Yee Chin a
Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong Published online: 17 Apr 2015.
Click for updates To cite this article: Edmond P.H. Choi, Cindy L.K. Lam & Weng Yee Chin (2015): Mental health of Chinese primary care patients with lower urinary tract symptoms, Psychology, Health & Medicine To link to this article: http://dx.doi.org/10.1080/13548506.2015.1032309
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [New York University] at 11:11 15 May 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Psychology, Health & Medicine, 2015 http://dx.doi.org/10.1080/13548506.2015.1032309
Mental health of Chinese primary care patients with lower urinary tract symptoms Edmond P.H. Choi*, Cindy L.K. Lam and Weng Yee Chin Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong
Downloaded by [New York University] at 11:11 15 May 2015
(Received 24 July 2014; accepted 16 March 2015) The aim of this study was to evaluate the mental health of Chinese primary care patients with lower urinary tract symptoms (LUTS). This was a cross-sectional observational study. Five hundred and nineteen subjects with LUTS completed a structured questionnaire containing the Depression, Anxiety, and Stress Scale-Short Form, the International Prostate Symptom Score, the adapted International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and questions about socio-demographics. Overall, 17.7% of subjects reported depressive symptoms, 24.3% anxiety symptoms and 9.6% stress symptoms. In males, demographic factors associated with poorer mental health included being not married; clinical factors included higher LUTS severity, weak stream, straining and mixed urinary incontinence. In females, demographic factors associated with poorer mental health included being younger, not married and lower household income; clinical factors included higher LUTS severity, incomplete bladder emptying, urgency and weak stream. Chinese primary care patients with LUTS appear to be an at-risk group for poorer mental health with increased prevalence of anxiety and depressive symptoms and may require routine screening to identify those who may require more tailored interventions to address both their urinary symptoms and psychological distress. Keywords: urology; lower urinary tract symptoms; Chinese; depression; anxiety; stress
Introduction Lower urinary tract symptoms (LUTS) are highly prevalent in men and women worldwide. It is estimated around 2.3 billion individuals will be affected by at least one type of LUTS by 2018. Estimated numbers of people suffering from LUTS are greatest in Asia, followed by Europe, Africa, North America and South America (Irwin, Kopp, Agatep, Milsom, & Abrams, 2011). LUTS rarely cause death, but studies have shown that patients with LUTS have poorer mental health. A study in Taiwan found that women suffering from LUTS felt stress, uneasiness and anxiety because of self-perceived bodily filthiness and embarrassment to explain their symptoms to male doctors (Wang, Chen, Jou, & Tsao, 2011). Males with LUTS are often anxious about cancer and the decline in sexual function (Gannon, Glover, O’Neill, & Emberton, 2004). Most epidemiological studies have found that LUTS patients have poorer mental health than healthy controls. A multi-country study found that men and women with LUTS had higher levels of depression and *Corresponding author. Email: [email protected] © 2015 Taylor & Francis
Downloaded by [New York University] at 11:11 15 May 2015
2
E.P.H. Choi et al.
anxiety than healthy controls (Coyne et al., 2008, 2009). A study in the US found that LUTS increased the odds of depressive symptoms (Laumann, Kang, Glasser, Rosen, & Carson, 2008). There have however been some conflicting findings with studies from the UK which have found that the depression and anxiety levels of most male patients with LUTS fell within the normal range (Glover, Gannon, McLoughlin, & Emberton, 2004). To date, findings about the effect of LUTS on mental health have lacked generalizability. Most studies have focused on specific patient subsets such as males, elderly patients or working people, making it difficult to generalize or compare findings. Moreover, most studies have been conducted in non-Chinese populations and the impact of LUTS on mental health in Chinese patients is still poorly understood. The lack of knowledge about the impact of LUTS on mental health in both Chinese males and females necessitates the present study. This study aimed to evaluate the mental health of Chinese male and female primary care patients with LUTS and to identify the risk factors associated with poorer mental health. Methods Subjects and sampling This was a cross-sectional observational study. Subjects were recruited from two primary care settings: A. Primary care continence care clinic patients LUTS patients attending nurse-led primary care continence care clinics for LUTS treatment were recruited by consecutive sampling. All new patients attending the clinics were screened by an instrument adapted from the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). A cut-off score ≥3 was used to identify eligible subjects. B. Government-funded primary care clinic waiting room patients All patients attending government-funded primary care clinics for medical consultation were screened. They completed an instrument adapted from the ICIQ-UI SF in waiting room before medical consultation. Patients with ICIQ-UI SF score ≥3 were considered to have LUTS. Patients from both settings were excluded if they were aged 2§§, 2 > 1§§
3 > 1§§, 3 > 2§§, 2 > 1§§
87.7 61.5 36.0
92.3 70.4 44.0
100.0 94.2 89.7
96.2 80.3 66.7
3 > 1§§, 3 > 2§
2.64 (2.96) 3.82 (4.27) 5.64 (4.85) 2 > 1§, 3 > 1§§
96.2 88.3 74.4
Normal (%)
3 > 1§
Significant difference
1.96 (3.05) 3.58 (6.01) 5.33 (5.85)
Mean score (SD)
12.3 38.5 64.0
7.7 29.6 56.0
0 5.8 10.3
3.8 19.7 33.3
3.8 11.7 25.6
Mild to Extremely severe (%)
Mean DASS-21 scores and prevalence of depressive, anxiety and stress symptoms by IPSS severity.
Males Depressive symptoms Mild LUTS*,# Moderate LUTS*,# Severe LUTS*,# Anxiety symptoms Mild LUTS**,# Moderate LUTS**,# Severe LUTS**,#
Table 3.
3.1 13.3 12.0
3.8 15.6 16.0
0 2.2 7.7
1.9 6.6 10.3
1.9 5.1 12.8
Mild (%)
Downloaded by [New York University] at 11:11 15 May 2015
0
0
7.7 18.5 20.0
3.1 8.1 20.0
2.2 2.6
10.9 17.9
1.9 2.9 10.3
Moderate (%)
3.0 4.0
.7
1.9 .7 5.1
2.2 2.6
4.4 20.0
0
0
0
0
0
Severe (%)
1.5 2.2 12.0
.8 3.0 16.0
.7
1.5
1.5
(Continued)
0
0
0
0
0
0
Extremely severe (%)
Psychology, Health & Medicine 7
(Continued).
3.98 (6.11) 8.12 (7.26) 13.92 (10.99)
Mean score (SD)
3 > 1§§, 3 > 2§§, 2 > 1§§
Significant difference
94.6 84.4 60.0
Normal (%)
5.4 15.6 40
Mild to Extremely severe (%)
1.5 8.9 16.0
Mild (%)
2.3 3.7 8.0
Moderate (%)
.8 2.2 8.0
Severe (%)
Notes: Group 1: mild LUTS; Group 2; moderate LUTS; and Group 3: severe LUTS. # 2 χ test to compare the prevalence of depressive, anxiety and stress symptoms (normal vs. mild to extremely severe) among different LUTS severities (p < .01). *One-way ANOVA to compare the mean DASS scores among different LUTS severities (p < .05). **One-way ANOVA to compare the mean DASS scores among different LUTS severities (p < .01). § Significant difference between groups by post hoc Tukey’s HSD test (p < .05). §§ Significant difference between groups by post hoc Tukey’s HSD test (p < .01).
Stress symptoms Mild LUTS**,# Moderate LUTS**,# Severe LUTS**,#
Table 3.
Downloaded by [New York University] at 11:11 15 May 2015
.8 .7 8.0
Extremely severe (%)
8 E.P.H. Choi et al.
.43 .21 −.04 −.07 .71# .06 .13 −2.05 .11 4.3# .03 −3.71* 1.32 .40 1.09 .55 19%
Males Clinical factors Incomplete bladder emptying score Frequency score Intermittency score Urgency score Weak stream score Straining score Nocturia score Stress incontinence vs. no incontinence Urge incontinence vs. no incontinence Mixed incontinence vs. no incontinence
Socio-demographic factors Age (years) Currently married vs. not currently married Working vs. not working Household Income > $20,000 vs. $20,000 vs.
