NATURAL-HISTORY OF PROSTATISM - WORRY AND EMBARRASSMENT FROM URINARY SYMPTOMS AND HEALTH CARE-SEEKING BEHAVIOR

Objective. To assess the interrelationships among psychosocial symptom s 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 ag ed forty to seventy-nine years, randomly selected from the Olmsted Cou nty, Minnesota population between December 1989 and March 1991, were a dministered a previously validated questionnaire that elicited informa tion 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 s ymptoms. Psychological well-being was assessed by a subset of the Psyc hological General Well-Being Index, and sociodemographic information w as 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. Multi ple logistic regression analyses demonstrated that men with moderate o r severe urinary symptoms or impaired psychological well-being were mo re likely to be worried or embarrassed about their urinary symptoms th an men with mild symptoms. Furthermore, men who were worried about the ir urinary function were more likely to have sought medical care for t heir symptoms than men who were not worried. The association between h ealth care-seeking behavior and embarrassment was especially strong am ong men with little bother associated with their urinary symptoms. Con clusions. Worry and embarrassment about urinary symptoms reflect quali ty-of-life issues that appear important in the health care-seeking beh avior of men with prostatism. The results underscore findings that pre valent urinary symptoms alone do not determine a man's health care-see king behavior, and treatment for psychosocial symptoms may be benefici al in some men with symptoms of prostatism.