title: Correlation between psychological stress levels and the severity of overactive bladder symptoms.
abstract: BACKGROUND
  The relationship between psychological stress and interstitial cystitis/bladder pain syndrome (IC/BPS) has been well described. Even though there is some overlapping of symptoms between overactive bladder (OAB) and IC/BPS, there have been very few studies that specifically investigated the relationship between psychological stress and urinary symptoms in OAB patients who do not have pelvic pain. Here we examined the relationship between psychological stress levels and the severity of overactive bladder (OAB) symptoms.
  
  
  METHODS
  Patients diagnosed with OAB (n=51), IC/BPS (n=27), and age-matched healthy controls (n=30) participated in a case control study that inquired about their psychological stress levels using the perceived stress scale (PSS). PSS reported by the three patient groups were compared. Among OAB patients, their responses on the PSS was correlated to OAB symptoms using the following questionnaires: 1) international consultation on incontinence - urinary incontinence (ICIQ-UI), 2) international consultation on incontinence - overactive bladder (ICIQ-OAB), 3) OAB-q short form, 4) urogenital distress inventory (UDI-6), 5) incontinence impact questionnaire (IIQ-7), 6) urgency severity scale (USS), 7) numeric rating scales of urgency symptom, and 8) frequency symptom. Spearman's correlation tests were performed to examine the relationship between psychological stress levels and the severity of OAB symptoms.
  
  
  RESULTS
  OAB patients reported psychological stress levels that were as high as IC/BPS patients (median 17.0 versus 18.0, p=0.818, Wilcoxon sum rank test), and significantly higher than healthy controls (17.0, versus 7.5, p=0.001). Among OAB patients, there was a positive correlation between perceived stress levels and urinary incontinence symptoms (ICIQ-UI, Spearman's correlation coefficient=0.39, p=0.007), and impacts on quality of life (UDI-6, IIQ-7, OAB-q quality of life subscale; Spearman's correlation coefficient=0.32, 0.31, 0.39, and p=0.028, 0.005, 0.029, respectively). No significant correlation was observed between perceived stress levels and urgency or frequency symptoms (ICIQ-OAB, USS, numeric ratings of urgency and frequency).
  
  
  CONCLUSIONS
  OAB patients reported psychological stress levels that were as high as IC/BPS patients, and significantly higher than healthy controls. There was a positive correlation between perceived stress levels and urinary incontinence symptoms, and its impacts on quality of life among OAB patients.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. laih@wudosis.wustl.edu.|Department of Anesthesiology, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. laih@wudosis.wustl.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Lai
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. gardnerv@wudosis.wustl.edu.
authors.forename: Vivien
authors.initials: V
authors.lastname: Gardner
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. vetterj@wudosis.wustl.edu.
authors.forename: Joel
authors.initials: J
authors.lastname: Vetter
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St Louis, MO, 63110, USA. andrioleg@wudosis.wustl.edu.
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010465:Perception; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000523:psychology*; D053202:Urinary Incontinence, Urge / Q000453:epidemiology / Q000523:psychology*; D014563:Urodynamics