Characterizing the Psychosocial Needs among Urology Patients with Urinary Incontinence
Anna Chen, B.S.1, Jennie G. David, Ph.D.2, Anne E. Dawson, Ph.D.2, Daryl J. McLeod, M.D., M.P.H.2.
1Ohio State University, Columbus, OH, USA, 2Nationwide Children's Hospital, Columbus, OH, USA. Background Emerging research highlights that pediatric patients with urinary incontinence have some known psychosocial needs (e.g., quality of life), the broad scope of these needs is not well characterized. In part due to lack of universal psychosocial supports in urology centers, it is unclear if assessing psychosocial screening in an outpatient pediatric urology clinic is feasible. Identifying patients with psychosocial needs is essential to optimize appropriate treatment and advocate for increased integrated care models. This work aimed to 1) characterize the psychosocial needs of outpatient pediatric urinary incontinence patients, and 2) assess feasibility of psychosocial screening in an outpatient urology clinic. Methods Pediatric patients who 1) had daytime or nocturnal urinary incontinence in their electronic health record (EHR) problem list, 2) were ≥5 years of age at the time of their clinic visit, and 3) presented to in-person outpatient urology clinic visits at an urban tertiary hospital were recruited. Following IRB approval, patients and caregivers were given brief measures to complete at check-in and as they waited for their medical visit. Measures included Vanderbilt, Center for Youth Wellness Adverse Childhood Experiences Questionnaire Child (CYW-ACE), Pediatric Incontinence Questionnaire (PIN-Q), Bowel and Bladder Dysfunction (BBD), Center for Epidemiological Studies Depression Scale for Children (CES-DC), and Screen for Child Anxiety Related Disorders (SCARED). Data was analyzed via descriptive and frequency statistics. Results Patients and caregivers (N=100) completed surveys in the outpatient clinic setting. Pediatric patients ranged from 5 to 19 years old (Mean age =11.3 years), were 66% female, and 95% of caregiver respondents were the child’s parent. At the time of the visit, 25% were not diagnosed with incontinence (e.g., resolved incontinence with or without persistent urinary urgency or frequency), 18% had isolated daytime enuresis, 29% had isolated nighttime enuresis, and 29% had day/night enuresis. On the PIN-Q, 99% of children were classified as moderate or severe, and 78% met the BBD clinical threshold based on caregiver report. Half of the cohort had a history of behavioral health support and 24% were actively in behavioral health care. Nearly one third (31%) of patients had a 504 plan or an IEP established in the school setting. Based on caregiver ratings on the Vanderbilt, 20% had significant attention-deficit hyperactivity disorder (ADHD) symptoms, with 15% meeting criteria for oppositional defiant disorder (ODD). On child report, 23% had clinically elevated depression scores (CES-DC). Self-reported anxiety (SCARED) also met clinical thresholds (generalized anxiety: 23%, separation anxiety: 38%, social anxiety: 30%, and school avoidance: 29%). Most children had experienced an adverse childhood event (65%), most experienced one (37%) or two (13%) based on the CYW-ACE. Conclusion Pediatric patients with urinary incontinence in the outpatient setting demonstrated notable rates of psychosocial need including high utilization of behavioral health care, need for school accommodations ADHD, ODD, depression, anxiety, exposure to ACEs, and low quality of life related to urological conditions. This work demonstrates the feasibility of brief caregiver and patient screening in an outpatient pediatric urological population and highlights the need for integrated care.
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