Psychological predictors of symptoms of urinary tract infection and bacteriuria in patients treated with clean intermittent catheterization: a prospective 7-year study.
OBJECTIVE
One of the major clinical problems in relation to clean intermittent catheterization (CIC) are symptoms of urinary tract infection (UTI) and bacteriuria. The aim of the present work was to study to what extent measures of psychological well-being, distress and neurotic personality traits in patients performing CIC could predict symptoms of UTI or bacteriuria 7 years later.


METHODS
Included in the study were 170 patients with a mean age of 57 years, who had used CIC for 105 months. CIC was practised due to neurogenic bladder dysfunction in two thirds of the patients, and non-neurogenic dysfunction in the remaining patients. All patients had been clinically examined 7 years prior to inclusion. Information about subjective symptoms of UTI and examination of bacteriuria in urine samples had been assessed. All subjects had also undergone repeated psychometric evaluations of psychosocial function, well-being and distress (General Health Questionnaire; GHQ-28; Spielberger State-Trait Anxiety Inventory; STAI X-1) and neuroticism (Eysenck Personality Questionnaire; EPQ-N). The results from selected assessments done 7 years earlier were used to predict reported UTI and findings of bacteriuria in urine samples in 1995.


RESULTS
Clinical UTI symptoms were reported by 35% of the patients. These patients had significantly higher GHQ-28 scores in 1988, 1989 and 1995 compared to the remaining 65%. Patients without clinical UTI during 1988/89, but with symptoms suggesting UTI in 1995, had significantly higher GHQ-28, STAI-X1 and EPQ-N scores in 1988 compared to those who did not report symptoms 7 years later. Patients with UTI during 1988/89 who were free of symptoms of UTI in 1995 had scores similar to those who were free of symptoms of UTI both in 1988/89 and in 1995. GHQ-28, STAI X-1 and EPQ-N scores in 1988/89 did not predict current bacteriuria, found in 62% of the urine samples in 1995.


CONCLUSIONS
Social function, well-being and distress are significant predictors of long-term urinary tract complaints, but not of bacteriuria. This finding indicates that the aetiology of UTI complaints and of actual bacteriuria is different. Complaints of UTI may often express distress and not symptomatic infection. Physicians' non-recognition of distress may lead to unnecessary and aggressive interventions for assumed infection such as the prescription of antibiotics. Identification and treatment of psychological distress and impaired social function should become routine in the clinical follow-up of CIC patients. Such a routine could reduce urinary tract complaints, lower the unnecessary use of antibiotics and increase the tolerability of CIC. Prospective intervention studies are needed to verify this hypothesis.
Bakke
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Department of Surgery, Haukeland Hospital, Bergen, Norway. August.M.Bakke@kir.Haukeland.no
Malt
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D001007:Anxiety / Q000150:complications; D001294:Attitude to Health; D001437:Bacteriuria / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010551:Personality; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires; D001750:Urinary Bladder, Neurogenic / Q000523:psychology / Q000628:therapy; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*