Psychosocial outcomes and related factors in adolescents using clean intermittent catheterization.

Abstract

Background: Clean intermittent catheterization (CIC) is an established treatment for lower urinary tract dysfunction and has been used across age groups with voiding problems due to various etiologies. Although medically safe and straightforward, CIC may create social and emotional challenges for adolescents and their caregivers. During adolescence, when autonomy and peer acceptance become central, the need for continuous catheterization in daily life and, at times, dependence on another person can be difficult to cope with and may affect psychological well-being and peer relations. This study aimed to examine factors associated with potential psychopathology, self-perception, peer relationship characteristics, and quality of life in adolescents performing CIC.

Methods: This prospective cross-sectional study included 50 adolescents aged 12-18 years: 25 performing CIC and 25 age and sex-matched healthy controls. Participants with intellectual disability, low mental capacity preventing comprehension of study procedures, or uncorrected vision/hearing deficits were excluded. Psychiatric diagnoses were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version DSM-5 (K-SADS-PL). Self-perception, quality of life, behavioral difficulties, and peer relationships were evaluated using the Piers-Harris Children's Self-Concept Scale, Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire, and Peer Relationship Scale. Parental attitudes and caregivers' psychological symptoms were assessed using the Parental Attitude Research Instrument and the General Health Questionnaire-28. Statistical analyses were performed using SPSS version 23.0. Group comparisons were conducted using the independent samples t-test or Mann-Whitney U test as appropriate; categorical variables were analyzed with the Chi-square or Fisher's exact test. Multiple linear regression analysis was performed to identify independent predictors. A two-tailed p value <0.05 was considered statistically significant.

Results: The groups were similar in age, sex and sociodemographic characteristics. Adolescents performing CIC showed higher social avoidance and poorer peer relationships. Eight adolescents (32%) in the CIC group met criteria for at least one psychiatric disorder according to DSM-5. Negative parental attitudes, maternal mental disorders, primary etiology requiring CIC, age at self-catheterization initiation, and catheterization performed by another individual were identified as significant predictors of lower self-esteem, reduced quality of life, and poorer peer relationships.

Conclusion: CIC may have meaningful psychological and psychosocial effects on adolescents, influenced by clinical variables and parental factors. Early identification of risk indicators and strengthening of protective factors are essential. A multidisciplinary approach incorporating psychiatric, familial, and psychosocial components should be included in the management and follow-up of adolescents performing CIC.