The association between personality traits and treatment outcomes in Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a preliminary study Jun Sung Koh, Hyo Jung Ko, Kang Joon Cho, Joon Chul Kim, SooJung Lee, Chi-Un Pae MD, Ph.D. PII: DOI: Reference:
S0163-8343(14)00122-4 doi: 10.1016/j.genhosppsych.2014.05.015 GHP 6867
To appear in:
General Hospital Psychiatry
Received date: Revised date: Accepted date:
11 February 2014 14 May 2014 16 May 2014
Please cite this article as: Koh Jun Sung, Ko Hyo Jung, Cho Kang Joon, Kim Joon Chul, Lee Soo-Jung, Pae Chi-Un, The association between personality traits and treatment outcomes in Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a preliminary study, General Hospital Psychiatry (2014), doi: 10.1016/j.genhosppsych.2014.05.015
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT ---Short Communication---
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The association between personality traits and treatment outcomes in Korean patients with
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preliminary study
RI P
lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a
Running title: personality trait and treatment response in LUTS/BPH
MA NU
Jun Sung Koha, Hyo Jung Kob, Kang Joon Choa, Joon Chul Kima, Soo-Jung Leec, Chi-Un Paec,d a
Department of Urology, The Catholic University of Korea College of Medicine, Seoul,
Korea; bDepartment of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea; Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul,
ED
c
Duram, NC, USA
PT
Korea; dDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center,
Chi-Un Pae, MD
CE
Address for Correspondence:
AC
Department of Psychiatry
Bucheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine 2 Sosa-Dong, Wonmi-Gu, Bucheon 420717, Kyeonggi-Do, Republic of Korea Tel; 82-32-340-7067 Fax: 82-32-340-2255 Email: [email protected]
Acknowledgment: This study was funded by the Ministry of Health and Welfare, Korea (A120004). However, the funding source has no involvement in the study design, data collection, data analysis, manuscript preparation and/or publication decisions
1
ACCEPTED MANUSCRIPT Highlights -Few studies have investigated the effect of personality traits on treatment outcomes in patients with LUTS/BPH
RI P
T
-In the present study, an association between treatment response and personality traits of neuroticism, extraversion, and openness in patients with LUTS/BPH. -Further studies with more statistical power and an improved design are needed to support
AC
CE
PT
ED
MA NU
SC
our findings.
2
ACCEPTED MANUSCRIPT Abstract Objective: We investigated the association between personality traits and treatment outcomes in male Korean patients with lower urinary tract symptoms suggestive of benign prostatic
T
hyperplasia (LUTS/BPH).
RI P
Method: We evaluated the personality traits and the severity of LUTS/BPH symptoms at baseline using the Korean versions of the 44-item Big Five Inventory (BFI-K) and
SC
International Prostate Symptom Score (IPSS), respectively. The IPSS was re-administered following a 12-week routine treatment regime, and we examined the relationship between
MA NU
treatment outcome and personality traits.
Results: Of the 176 patients initially screened, 101 agreed to participate in the study. Of those, 93 (92.1%) completed the 12-week trial and the BFI-K. Neuroticism was associated with a significantly worse treatment response, whereas extraversion was associated with a significantly better treatment response, and openness was associated with a high responder
ED
rate. Agreeableness, openness, and conscientiousness were associated with improved week12 IPSS total scores; however, the results were not statistically significant.
PT
Conclusions: We found an association between treatment response and personality traits of neuroticism, extraversion, and openness in patients with LUTS/BPH. However, further
AC
CE
studies with larger samples and an improved design are needed to support our findings.
Keywords: lower urinary tract symptoms, benign prostatic hyperplasia, personality trait, treatment outcomes, response, clinical variable.
Introduction Personality traits have been shown to influence self-perception, treatment compliance, coping strategies, and the clinical status of mental health and physical diseases; for example, high neuroticism and low extraversion are consistently associated with poor quality of life in various diseases [1-7]. High agreeableness, conscientiousness, and openness and low neuroticism are associated with improved self-rated health and chronic disease management self-efficacy [1,8,9]. High neuroticism and low conscientiousness are also commonly 3
ACCEPTED MANUSCRIPT associated with non-compliance [7]. Given previous findings suggesting that personality plays a key role in an individual’s response to treatment, we hypothesized that personality traits would influence the outcome of routine treatment for lower urinary tract
RI P
T
symptoms/benign prostatic hyperplasia (LUTS/BPH).
Few studies have investigated the effect of personality traits on treatment outcomes in
SC
patients with LUTS/BPH [10-14] using a validated, brief personality scale in an Asian population. Thus, we investigated the association between personality traits and treatment
MA NU
outcome in Korean patients with LUTS/BPH to identify the individuals who were more likely to benefit from treatment interventions under various clinical conditions [1].
Methods Study design
ED
We conducted a 12-week prospective observational study in a naturalistic treatment setting.
PT
Subjects
Male patients with LUTS/BPH were recruited from an outpatient clinic in the Department of
CE
Urology at Bucheon St. Mary’s Hospital in Bucheon, Kyeonggi-Do, Korea, between March
AC
2011 and February 2012.
The inclusion criteria included Korean males aged ≥40 years, a clinical diagnosis of LUTS/BPH evaluated by medical history, a thorough physical examination, and laboratory tests including prostate-specific antigen (PSA) levels. We limited the number of exclusion criteria because it was an observational study; however, patients who exhibited the following symptoms were excluded for diagnostic consistency: 1) PSA level >10 ng/mL; 2) a history or evidence of prostate cancer based on prostate biopsy; 3) previous prostatic surgery; 4) causes of LUTS other than BPH (i.e., neurogenic bladder, bladder neck contracture, urethral stricture, bladder malignancy, acute or chronic prostatitis, or acute or chronic urinary tract infections); and 5) speech or language deficits and cognitive dysfunction.
The primary treatment was alpha-blockers, 5-alpha-reductase inhibitors, or a combination of both. The patients received the same medication and dosage throughout the study period. 4
ACCEPTED MANUSCRIPT
The present study was performed in accordance with the Declaration of Helsinki and ethical principles regarding human experimentation, and the protocol was approved by the
T
Institutional Review Board of Bucheon St. Mary’s Hospital in Bucheon, Kyeonggi-Do, Korea
RI P
(HC11OISE0004).
Clinical outcomes
SC
Rating scales
We used the Korean version of the International Prostate Symptom Score (IPSS) to measure
MA NU
the severity of LUTS/BPH symptoms [15]. The Big Five Inventory (BFI) measures the Big Five personality dimensions: extraversion, agreeableness, conscientiousness, neuroticism, and openness. The BFI, which is based on a five-factor model (FFM), consists of 44 items for which higher scores represent higher levels of each personality trait [16]. We used the
ED
validated Korean version of the BFI (BFI-K) to assess personality traits [16,17].
Primary and secondary endpoints
PT
The patients were categorized as high or low for each personality domain based on median values as described previously [1]. The primary endpoint was the IPSS total score change
CE
from baseline to week 12 according to the five personality domains. The secondary endpoints were changes in the IPSS storage, obstruction, and quality of life (QoL) subscores between
AC
baseline and week 12 according to personality traits.
Furthermore, we assessed responders according to their scores on the BFI. A responder was defined as a patient who showed a ≥50% decrease in the IPSS total score between baseline and week 12, as reported in previous studies [18,19].
Statistical analyses Demographic and clinical variables were described and compared according to each personality trait using the Student’s t-test, chi-square test with Yate’s correction, or Fisher’s test as appropriate. To determine the influence of personality traits on treatment outcome, the changes in IPSS subscale scores from baseline to week 12 were assessed using analysis of covariance (ANCOVA) controlling for age, medication, and duration of disease. We used Fisher’s exact tests to assess responder rates using an a priori definition. 5
ACCEPTED MANUSCRIPT
We used two-tailed tests for all statistical analyses, and p-values
S0163-8343(14)00122-4 doi: 10.1016/j.genhosppsych.2014.05.015 GHP 6867
To appear in:
General Hospital Psychiatry
Received date: Revised date: Accepted date:
11 February 2014 14 May 2014 16 May 2014
Please cite this article as: Koh Jun Sung, Ko Hyo Jung, Cho Kang Joon, Kim Joon Chul, Lee Soo-Jung, Pae Chi-Un, The association between personality traits and treatment outcomes in Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a preliminary study, General Hospital Psychiatry (2014), doi: 10.1016/j.genhosppsych.2014.05.015
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT ---Short Communication---
T
The association between personality traits and treatment outcomes in Korean patients with
SC
preliminary study
RI P
lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a
Running title: personality trait and treatment response in LUTS/BPH
MA NU
Jun Sung Koha, Hyo Jung Kob, Kang Joon Choa, Joon Chul Kima, Soo-Jung Leec, Chi-Un Paec,d a
Department of Urology, The Catholic University of Korea College of Medicine, Seoul,
Korea; bDepartment of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea; Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul,
ED
c
Duram, NC, USA
PT
Korea; dDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center,
Chi-Un Pae, MD
CE
Address for Correspondence:
AC
Department of Psychiatry
Bucheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine 2 Sosa-Dong, Wonmi-Gu, Bucheon 420717, Kyeonggi-Do, Republic of Korea Tel; 82-32-340-7067 Fax: 82-32-340-2255 Email: [email protected]
Acknowledgment: This study was funded by the Ministry of Health and Welfare, Korea (A120004). However, the funding source has no involvement in the study design, data collection, data analysis, manuscript preparation and/or publication decisions
1
ACCEPTED MANUSCRIPT Highlights -Few studies have investigated the effect of personality traits on treatment outcomes in patients with LUTS/BPH
RI P
T
-In the present study, an association between treatment response and personality traits of neuroticism, extraversion, and openness in patients with LUTS/BPH. -Further studies with more statistical power and an improved design are needed to support
AC
CE
PT
ED
MA NU
SC
our findings.
2
ACCEPTED MANUSCRIPT Abstract Objective: We investigated the association between personality traits and treatment outcomes in male Korean patients with lower urinary tract symptoms suggestive of benign prostatic
T
hyperplasia (LUTS/BPH).
RI P
Method: We evaluated the personality traits and the severity of LUTS/BPH symptoms at baseline using the Korean versions of the 44-item Big Five Inventory (BFI-K) and
SC
International Prostate Symptom Score (IPSS), respectively. The IPSS was re-administered following a 12-week routine treatment regime, and we examined the relationship between
MA NU
treatment outcome and personality traits.
Results: Of the 176 patients initially screened, 101 agreed to participate in the study. Of those, 93 (92.1%) completed the 12-week trial and the BFI-K. Neuroticism was associated with a significantly worse treatment response, whereas extraversion was associated with a significantly better treatment response, and openness was associated with a high responder
ED
rate. Agreeableness, openness, and conscientiousness were associated with improved week12 IPSS total scores; however, the results were not statistically significant.
PT
Conclusions: We found an association between treatment response and personality traits of neuroticism, extraversion, and openness in patients with LUTS/BPH. However, further
AC
CE
studies with larger samples and an improved design are needed to support our findings.
Keywords: lower urinary tract symptoms, benign prostatic hyperplasia, personality trait, treatment outcomes, response, clinical variable.
Introduction Personality traits have been shown to influence self-perception, treatment compliance, coping strategies, and the clinical status of mental health and physical diseases; for example, high neuroticism and low extraversion are consistently associated with poor quality of life in various diseases [1-7]. High agreeableness, conscientiousness, and openness and low neuroticism are associated with improved self-rated health and chronic disease management self-efficacy [1,8,9]. High neuroticism and low conscientiousness are also commonly 3
ACCEPTED MANUSCRIPT associated with non-compliance [7]. Given previous findings suggesting that personality plays a key role in an individual’s response to treatment, we hypothesized that personality traits would influence the outcome of routine treatment for lower urinary tract
RI P
T
symptoms/benign prostatic hyperplasia (LUTS/BPH).
Few studies have investigated the effect of personality traits on treatment outcomes in
SC
patients with LUTS/BPH [10-14] using a validated, brief personality scale in an Asian population. Thus, we investigated the association between personality traits and treatment
MA NU
outcome in Korean patients with LUTS/BPH to identify the individuals who were more likely to benefit from treatment interventions under various clinical conditions [1].
Methods Study design
ED
We conducted a 12-week prospective observational study in a naturalistic treatment setting.
PT
Subjects
Male patients with LUTS/BPH were recruited from an outpatient clinic in the Department of
CE
Urology at Bucheon St. Mary’s Hospital in Bucheon, Kyeonggi-Do, Korea, between March
AC
2011 and February 2012.
The inclusion criteria included Korean males aged ≥40 years, a clinical diagnosis of LUTS/BPH evaluated by medical history, a thorough physical examination, and laboratory tests including prostate-specific antigen (PSA) levels. We limited the number of exclusion criteria because it was an observational study; however, patients who exhibited the following symptoms were excluded for diagnostic consistency: 1) PSA level >10 ng/mL; 2) a history or evidence of prostate cancer based on prostate biopsy; 3) previous prostatic surgery; 4) causes of LUTS other than BPH (i.e., neurogenic bladder, bladder neck contracture, urethral stricture, bladder malignancy, acute or chronic prostatitis, or acute or chronic urinary tract infections); and 5) speech or language deficits and cognitive dysfunction.
The primary treatment was alpha-blockers, 5-alpha-reductase inhibitors, or a combination of both. The patients received the same medication and dosage throughout the study period. 4
ACCEPTED MANUSCRIPT
The present study was performed in accordance with the Declaration of Helsinki and ethical principles regarding human experimentation, and the protocol was approved by the
T
Institutional Review Board of Bucheon St. Mary’s Hospital in Bucheon, Kyeonggi-Do, Korea
RI P
(HC11OISE0004).
Clinical outcomes
SC
Rating scales
We used the Korean version of the International Prostate Symptom Score (IPSS) to measure
MA NU
the severity of LUTS/BPH symptoms [15]. The Big Five Inventory (BFI) measures the Big Five personality dimensions: extraversion, agreeableness, conscientiousness, neuroticism, and openness. The BFI, which is based on a five-factor model (FFM), consists of 44 items for which higher scores represent higher levels of each personality trait [16]. We used the
ED
validated Korean version of the BFI (BFI-K) to assess personality traits [16,17].
Primary and secondary endpoints
PT
The patients were categorized as high or low for each personality domain based on median values as described previously [1]. The primary endpoint was the IPSS total score change
CE
from baseline to week 12 according to the five personality domains. The secondary endpoints were changes in the IPSS storage, obstruction, and quality of life (QoL) subscores between
AC
baseline and week 12 according to personality traits.
Furthermore, we assessed responders according to their scores on the BFI. A responder was defined as a patient who showed a ≥50% decrease in the IPSS total score between baseline and week 12, as reported in previous studies [18,19].
Statistical analyses Demographic and clinical variables were described and compared according to each personality trait using the Student’s t-test, chi-square test with Yate’s correction, or Fisher’s test as appropriate. To determine the influence of personality traits on treatment outcome, the changes in IPSS subscale scores from baseline to week 12 were assessed using analysis of covariance (ANCOVA) controlling for age, medication, and duration of disease. We used Fisher’s exact tests to assess responder rates using an a priori definition. 5
ACCEPTED MANUSCRIPT
We used two-tailed tests for all statistical analyses, and p-values
