The association of personality trait on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome: An exploratory study

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Abstract

Objective

This study investigated the association of personality traits with the baseline clinical characteristics and treatment outcomes of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods

Subjects were evaluated at baseline and at week 12 following routine treatment for CP/CPPS using the Korean version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) to measure the severity of CP/CPPS; the Korean version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression; the Korean version of the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatization; and the Korean version of the EuroQol Questionnaire-5 Dimensions (EQ-5D), specifically the EQ-5D utility index and the EQ-5D visual analog scale (EQ-5D VAS), to assess quality of life (QoL). Personality traits including extraversion, agreeableness, conscientiousness, neuroticism, and openness were determined at baseline using the 44-item Big Five Inventory (BFI). The influence of personality traits on the clinical characteristics and treatment outcomes of patients with CP/CPPS was assessed using relevant statistical analyses.

Results

Neuroticism was associated with a significantly poorer treatment response and higher levels of depression and somatization. Extraversion, agreeableness, and conscientiousness had some influence on clinical characteristics but openness did not affect overall symptoms or the treatment response in patients with CP/CPPS.

Conclusions

We found that neuroticism may be the most important personality trait associated with treatment response and the severity of depression and somatization in patients with CP/CPPS. However, our exploratory findings should be confirmed by additional studies with adequate power and improved designs.

Introduction

An increasing amount of evidence clearly suggests that the personality profile of an individual is involved in the development of, and the treatment response to, various neuropsychiatric disorders [1], [2], [3]. In this context, a recent study found that the psychometric profiles of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) exhibited significantly higher scores on all assessments, except type-A behavior, relative to healthy controls [4], [5].

According to the first unselected population-based study to explore personality features in patients with prostatitis syndromes [6], patients with prostatitis were significantly more occupied, nervous, and meticulous than controls. Likewise, several studies, although limited and incomplete, have proposed that personality may be involved in the susceptibility of an individual to prostatitis and/or related disorders [7], [8], [9], [10], [11], [12]. The trait nature of one's personality profile is supported by findings from a 2-year observation of illness behavior and personality changes in a small sample of patients with CP, which found that the subjective well-being (psychosocial and somatic aspects) of patients was impaired, but the personality of patients did not change [13].

The recent turn towards a novel understanding of CP/CPPS as a heterogenous syndrome rather than a homogeneous disease has led to the development of specific classification criteria and treatment strategies based on individual patients' clinical characteristics [14], [15], [16], [17]. Almost half of the patients in one study were clinically heterogenous [18]. Specific personality facets have also been found to be related to depression and treatment outcomes, and it has been proposed that screening for certain personality traits at the start of treatment might help to identify patients at risk for an inadequate response to treatment [2].

Thus, it has been hypothesized that personality traits may affect the severity of CP/CPPS, as well as the treatment outcomes of CP/CPPS patients, following routine treatment, because a person's personality profile is a crucial factor that can influence their response to given stressors and/or diseases, and may be a strong predictor of perceived health status and use of coping strategies [19], [20], [21]. However, there is a paucity of data regarding the role of personality traits in the treatment of CP/CPPS, particularly using a validated and brief personality scale and in an Asian population.

Section snippets

Study design

This study was a 12-week prospective observational study with routine treatment.

Patients

Male participants were recruited at an outpatient clinic treating prostatitis in the Department of Urology at Bucheon St. Mary's Hospital in Bucheon, Kyeonggi-Do, Korea between April 2011 and March 2012. The clinical diagnosis of CP/CPPS was based on an NIH consensus regarding CP/CPPS symptoms [22].

Few exclusion criteria were applied because our study was performed during routine practice. However, patients who were

Baseline characteristics

Of the 324 patients screened (reasons for exclusion: refusal to participate n = 218, pyuria with urinalysis/urine culture n = 15, BPH n = 9, prostatic cancer n = 2), 80 agreed to be enrolled in the study and 66 (82.5%) returned for the completion of all rating scales at the final visit. Descriptive data of the demographic and clinical characteristics of all participants are summarized and compared by personality traits (Table 1).

The mean age of the population ranged from 45 to 52 years and the majority

Discussion

Despite the fact that this study is preliminary, our findings suggest that personality traits may be associated with various clinical parameters at baseline, and affect the treatment response after 12 weeks of routine treatment. To our knowledge, this is the first study to assess the association of personality traits with treatment response based on a longitudinal follow-up in an Asian population.

One merit of this study is that the follow-up design made it possible to investigate the role of

Conflict of interest

None.

Acknowledgment

This study was funded by the Ministry of Health and Welfare, Korea (A120004).

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