Hypothesis / aims of study
Urinary tract infections (UTIs) account for 3 million healthcare consultations in the UK every year, equating up to 6% of all medical visits. Around 20-30% of women will experience recurrence of UTIs with a lifetime incidence of 50-60% in adult women. Recurrent/chronic UTIs (RUTI) are symptomatic UTIs that follow resolution of a previous UTI.
The physical discomfort of RUTI, the lack of appropriate testing and consensus on effective treatment pathways causes substantial psychological and physiological burden. Recent research suggests that there may be a bidirectional relationship between anxiety and depression and RUTI through systemic pathways involving the neuroendocrine and immune system pathways.
The study aimed to explore the existence of distinct psychological coping and support profiles of women who currently or previously experienced recurrent or chronic urinary tract infections and whether these profiles would impact symptom status.
Study design, materials and methods
Data was collected in a cross-sectional online survey disseminated in collaboration with patient advocacy non-profit, Live UTI Free and on social media. A Latent Profile Analysis using JAMOVI was conducted to classify survey participants based on clustering of responses to a range of latent characteristics (well-being, illness perceptions, social support [health-related; relational and allied health social support] and psychological strategies [positive and negative]). All profiling variables were converted to standardized Z-scores to facilitate comparison between profiles. One-way analyses of variance (ANOVAs) were conducted in JAMOVI to determine significant profile differences in severity, recovery, and symptoms.
Results
Data of 785 women was used for analysis. Latent profile analysis indicated the emergence of three distinct profiles: (1) independent self-managers, (2) allied health support seekers and (3) heightened support needs. Independent self-managers had the highest levels of psychological wellbeing, engaged in active coping strategies, utilised health and social support but had lower levels of use of allied-healthcare professional support and lower illness perceptions.
Allied health support seekers had the highest access to allied health professional support, as well as engaging in health and social support and had average psychological wellbeing, coping strategies and illness perceptions. Those in the heightened support needs profile, had the worse psychological wellbeing, highest level of negative illness perceptions and reduced coping and support access (across health, allied and social support).
One-way ANOVAs revealed that independent self managers had lower levels of symptoms compared to the other two profiles. Independent self managers also had less severe symptoms compared to those with heightened support needs but not alien health support seekers.
Interpretation of results
Coping and support needs for women experiencing RUTI vary. Psychological wellbeing, illness perceptions and coping strategies covary with symptom status and recovery, suggesting that they may also impact symptom trajectory although more research is needed. The present results demonstrate that individuals who have poorer psychological wellbeing, and more negative illness perceptions may benefit from additional allied health professional support to improve quality of life and potentially symptom experiences.