Mental Health Mediating the Relationship Between Symptom Severity and Health-Related Quality of Life in Patients with Lower Urinary Tract Symptoms.
OBJECTIVE
Lower urinary tract symptoms (LUTS) can impact both mental health and health-related quality of life (HRQOL). To date, however, their associations with outcomes have only been examined in isolation and the interactive relationship between LUTS, mental health and HRQOL remains poorly understood. The aim of this study was to determine whether mental health mediates the relationship between LUTS severity and HRQOL.


METHODS
Five hundred and nineteen primary care subjects with LUTS completed a structured questionnaire including the International Prostate Symptom Score (IPSS), the adapted Incontinence Impact Questionnaire-7 (IIQ-7), the Chinese (HK) SF-12 Health Survey Version 2 (SF-12 v2) and the Depression, Anxiety and Stress Scale-21 (DASS-21). Mediation modeling was tested using Baron and Kenney's multistage regression approach and bootstrapping method.


RESULTS
Overall, mental health partially mediated the association between LUTS severity and HRQOL as measured by the SF-12 v2 physical component summary (PCS) and the IIQ-7. The depression, anxiety and stress scores all have similar mediation effects in the relationship between LUTS severity and HRQOL. Subgroup analysis by gender showed that anxiety fully mediated the relationship between LUTS severity and HRQOL as measured by the SF-12 v2 PCS in males whilst the mediation effects of mental health in the relationship between LUTS severity and HRQOL as measured by the SF-12 v2 PCS could not be found in females.


CONCLUSIONS
In order to enhance HRQOL, LUTS interventions should address the mental health of patients in addition to providing physical relief of symptoms.
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong. h0714919@connect.hku.hk.
Edmond P H
EP
Choi
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Cindy L K
CL
Lam
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
Weng Yee
WY
Chin
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D012737:Sex Factors; D055815:Young Adult
anxiety; depression; health-related quality of life; lower urinary tract symptoms; stress