Health-related quality of life and mental health of Chinese primary care patients with lower urinary tract symptoms

Abstract

Introduction Lower urinary tract symptoms (LUTS) negatively affect social life, activities of daily living, health-related quality of life (HRQOL) and mental health. This study aimed to examine the HRQOL and mental health of Chinese primary care patients with LUTS so as to assess the impacts of LUTS and to identify health service needs. Methods The content validity of the Chinese translations of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the International Prostate Symptom Score (IPSS), the Incontinence Impact Questionnaire-Short Form (IIQ-7), were established by cognitive debriefing interviews involving 20 patients. A cross-sectional survey of 519 patients with LUTS recruited from primary care in Hong Kong was carried out with the ICIQ-UI SF, the IPSS, the IIQ-7, the Chinese (HK) Short Form-12 Health Survey version 2 (SF-12v2) and the Depression Anxiety Stress Scales (DASS-21) together with a structured questionnaire on socio-demographics. The pilot data collected from 233 patients were analysed to assess the psychometric properties (construct validity, reliability and sensitivity) of the ICIQ-UI SF, the IPSS and the IIQ-7. The data of all 519 subjects were analysed to evaluate the HRQOL and mental health of LUTS patients. Results Some wordings of the original IPSS (Hong Kong Chinese version) were found not to be equivalent to the English original, which were revised to form the IPSS (Hong Kong Chinese version 2). The IPSS (Hong Kong Chinese version 2) and the Chinese IIQ-7 achieved the expected standards in construct validity and reliability for both male and female patients. Some item and total scale score correlations and the internal consistency of the ICIQ-UI SF did not reach the expected standards. All three measures were more sensitive than the SF-12v2 in detecting differences between patients from different clinic settings. LUTS patients reported significantly lower scores in the general health and vitality domains and the physical component summary scale but higher score in the role- emotional domain of the SF-12v2 than the age-sex adjusted Hong Kong population norm. Higher IPSS total symptom score, storage symptoms, mixed urinary incontinence, depression, anxiety, stress, female gender, not currently married, being in employment and lower monthly household income were associated with poorer HRQOL in LUTS patients. LUTS patients had significantly higher mean DASS-21 anxiety score than that found in primary care patients without medically unexplained physical symptoms. Higher IPSS total symptom score, mixed urinary incontinence, younger age, not currently married and smoker were associated with poorer mental health. Mental Health was found to mediate the relationship between LUTS severity and HRQOL. Conclusions The study demonstrated the validity and reliability of the IPSS and the IIQ-7 in both male and female patients with LUTS but the psychometric properties of the ICIQ-UI SF required further evaluation. The primary treatment goal for LUTS should be symptom relief since symptom severity is the most significant factor associated with HRQOL and mental health. LUTS seemed to impair perceived general well-being the most in Chinese patients. Interventions to help LUTS patients adjust their general health perception and reduce anxiety may improve their HRQOL.