title: Natural history of prostatism: worry and embarrassment from urinary symptoms and health care-seeking behavior.
abstract: OBJECTIVE
  To assess the interrelationships among psychosocial symptoms of worry and embarrassment about urinary function, prevalent urinary symptoms, psychological well-being, and health care-seeking behavior in a population-based cohort of men.
  
  
  METHODS
  A cohort of 2,119 men aged forty to seventy-nine years, randomly selected from the Olmsted County, Minnesota population between December 1989 and March 1991, were administered a previously validated questionnaire that elicited information about the frequency of urinary symptoms, the degree to which they were perceived as a bother, and if the participant had seen a doctor in the previous twelve months for evaluation of any of these urinary symptoms. Psychological well-being was assessed by a subset of the Psychological General Well-Being Index, and sociodemographic information was also sought.
  
  
  RESULTS
  Urinary symptom indices (measured by American Urological Association frequency and bother scores and psychological general well-being subscales) were significantly associated with worry and embarrassment about urinary symptoms in bivariate analyses. Multiple logistic regression analyses demonstrated that men with moderate or severe urinary symptoms or impaired psychological well-being were more likely to be worried or embarrassed about their urinary symptoms than men with mild symptoms. Furthermore, men who were worried about their urinary function were more likely to have sought medical care for their symptoms than men who were not worried. The association between health care-seeking behavior and embarrassment was especially strong among men with little bother associated with their urinary symptoms.
  
  
  CONCLUSIONS
  Worry and embarrassment about urinary symptoms reflect quality-of-life issues that appear important in the health care-seeking behavior of men with prostatism. The results underscore findings that prevalent urinary symptoms alone do not determine a man's health care-seeking behavior, and treatment for psychosocial symptoms may be beneficial in some men with symptoms of prostatism.
authors.affiliation: Section of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: R O
authors.initials: RO
authors.lastname: Roberts
authors.forename: T
authors.initials: T
authors.lastname: Rhodes
authors.forename: L A
authors.initials: LA
authors.lastname: Panser
authors.forename: C J
authors.initials: CJ
authors.lastname: Girman
authors.forename: C G
authors.initials: CG
authors.lastname: Chute
authors.forename: J E
authors.initials: JE
authors.lastname: Oesterling
authors.forename: M M
authors.initials: MM
authors.lastname: Lieber
authors.forename: S J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011470:Prostatic Hyperplasia / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology / Q000523:psychology*