The Relationship Between Emotional Disorders and the Duration of Remission in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The cause of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is often multifactorial and not fully known. Despite limitations and variations in sample size, study design, and diagnostic procedures, there are many studies that show an association between CP/CPPS and psychological problems. The existing evidence does not permit to conclude whether emotional problems are risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease. The objective: to examine the association of subclinical anxiety, depression, and stress with exacerbation of urological symptoms in patients with CP/CPPS. Materials and methods. The study included 78 patients with established CP/CPPS. Mean age of patients was 46.9±9.3 years. All patients were referred from various urological clinics and underwent a thorough urological examination. All of them signed informed consent to participate in the study. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to comprehensively assess symptoms of CP/CPPS and evaluate the dynamics of prostatitis symptoms. The patients emotional state and its relationship to stress was assessed using the “Depression, Anxiety and Stress Scale-21” questionnaire (DASS-21). The patients were observed for one year period and over. The exacerbation of urological symptoms was studied as endpoint of evaluation. The design of the study was planned as a “case-control” study. The “case” (Group 1 – 28 patients) were patients with depression, anxiety and stress observed simultaneously according to the DASS-21 questionnaire. The “control” (Group 2 – 26 patients) included patients without depression, anxiety, and stress, matched for age and other factors to Group 1. Results. The Quality of Life (QoL) Score NIH-CPSI in Group 1 is significantly higher than in Group 2 – (8.13±1.4) points in Group 1 and (5.42±1.4) points in Group 2. The Pain and Dysuria Score did not differ significantly in both groups. All DASS-21 indicators in Group 1 were significantly higher. However, this was determined by the study conditions. Group 1 recruited patients whose Depression score, Anxiety score, and Stress score corresponded to moderate symptoms, while Group 2 included patients whose levels of these indicators were below moderate. In addition, the duration of remission in Group 1 was significantly shorter than in Group 2. The correlation coefficients between the scale scores and the duration of remission were also studied. The duration of CP/CPPS remission was associated with strong negative relationships with NIH-CPSI Quality of Life score (rs=–0.666), DASS-21 Depression score (rs=–0.779), DASS-21 total score (rs=–0.603) and had a moderate correlation with DASS-21 Stress score (rs=–0.364). The mutual influence of the indicators of the two scales on each other was also revealed. Thus, the QoL score NIH-CPSI had a significant positive correlation with the Depression score DASS-21 (rs= 0.714) and a moderate positive correlation with the Stress score DASS-21 (rs= 0.305). Conclusions. It was shown that depression signs form an affective style of response to stress and closely relate with remission duration. The DASS-21 questionnaire can be an available tool for diagnosing disorders of the emotional state and possible prediction of subsequent exacerbations of CP/CPPS.