Effect of designed self-care educational program on anxiety, stress, and depression in patients with benign prostatic hyperplasia undergoing prostate surgery

Mehdi Beiramijam, Monireh Anoosheh, Eesa Mohammadi

DOI: 10.22122/cdj.v1i2.34


BACKGROUND: Stress, anxiety, and depression are common psychological problems in prostatic conditions. The aim of this study was to investigate the effects of designed self-care educational program on anxiety, stress, and depression in patients with benign prostatic hyperplasia undergoing prostate surgery.

METHODS: This was a quasi-experimental study including 33 participants in the intervention group and 34 participants in the control group. During the study demographic data and the rate of stress, anxiety, and depression were measured. In the intervention group, self-care educational program was presented in two sessions and was followed up one month after surgery. Stress, anxiety, and depression were measured before surgery, and during and one month after discharge using depression anxiety stress scales (DASS-21), which is a standard questionnaire. Later data were analyzed using SPSS software.

RESULTS: Participants in the study were between 45-80 years of age. Student’s independent t-test before the intervention revealed no significant difference in mean score of stress (P = 0.684), anxiety (P = 0.937), and depression (P = 0.727) between the two groups. Mean score of stress and anxiety significantly reduced in the intervention group on discharge (stress: P = 0.031, anxiety: P = 0.043), and a month after the operation (stress:
P ≤ 0.001, anxiety: P = 0.016). However, mean score of depression revealed no significant difference on discharge (P = 0.514), and a month after operation (P = 0.221).

CONCLUSION: The results showed that designed self-care educational program was effective in stress and anxiety reduction in patients under prostate surgery.


Self-Care, Stress, Anxiety, Depression, Benign Prostatic Hyperplasia

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Schenk JM, Kristal AR, Neuhouser ML, Tangen CM, White E, Lin DW, et al. Biomarkers of systemic inflammation and risk of incident, symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol 2010; 171(5): 571-82.

Emberton M. The Hallmarks of BPH Progression and Risk Factors. European Urology Supplements 2003; 2(8): 2-7.

Safarinejad MR. Prevalence of benign prostatic hyperplasia in a population-based study in Iranian men 40 years old or older. Int Urol Nephrol 2008; 40(4): 921-31.

McVary KT. BPH: epidemiology and comorbidities. Am J Manag Care 2006; 12(5 Suppl): S122-S128.

Emberton M, Martorana G. BPH: Social Impact and Patient's Perspective. European Urology Supplements 2006; 5(20): 991-6.

Quek KF. Factors affecting health-related quality of life among patients with lower urinary tract symptoms. Int J Urol 2005; 12(12): 1032-6.

Tsang KK, Garraway WM. Impact of benign prostatic hyperplasia on general well-being of men. Prostate 1993; 23(1): 1-7.

Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int 2009; 103(Suppl 3): 4-11.

Quek KF, Low WY, Razack AH, Loh CS. The psychological effects of treatments for lower urinary tract symptoms. BJU Int 2000; 86(6): 630-3.

Orem DE, Taylor SG, McLaughlin Renpenning K. Nursing: Concepts of Practice. 6th ed. Philadelphia, PA: Mosby; 2001

Brunner LS, Suddarth DS, O'Connell Smeltzer SC, Bare BG. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

Oldman M, Moore D, Collins S. Drug patient information leaflets in anaesthesia: effect on anxiety and patient satisfaction. Br J Anaesth 2004; 92(6): 854-8.

Pocock SJ. Clinical trials: a practical approach. Hoboken, NJ: Wiley; 1983. p. 834.

Quek KF, Razack AH, Chua CB, Low WY, Loh CS. Effect of treating lower urinary tract symptoms on anxiety, depression and psychiatric morbidity: a one-year study. Int J Urol 2004; 11(10): 848-55.

Lovibond PF, Lovibond SH. The structure of pression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3): 335-43.

Ghafari S, Ahmadi F, Nabavi M, Memarian R. Effects of applying progressive muscle relaxation technique on depression, anxiety and stress of multiple sclerosis patients in Iran National MS Society. Pejouhesh 2008; 32(1): 45-53.

Aghebati N, Mohammadi E, Pour Esmaeil Z. The effect of relaxation on anxiety and stress of patients with cancer during hospitalization. Iran J Nurs 2010; 23(65): 15-22.

Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol 2003; 42(Pt 2): 111-31.

Chinchai P, Marquis R, Passmore A. Functional performance, depression, anxiety and stress in people with spinal cord injuries in Thailand: a transition from hospital to home. Asia Pacific Disability Rehabilitation Journal 2003; 14(1): 30-40.

Pieper B, Sieggreen M, Freeland B, Kulwicki P, Frattaroli M, Sidor D, et al. Discharge information needs of patients after surgery. J Wound Ostomy Continence Nurs 2006; 33(3): 281-9.

Sun YC, Cheng HY, Wang YH. Influence of cognitive psychology nursing on preoperative anxiety and depression of the patients with benign prostatic hyperplasia. Journal of Hainan Medical University 2010. Available from: URL:


Callaghan P, Cheung YL, Yao KY, Chan SL. The effect of pre-operative information on post-operative anxiety, satisfaction with information, and demand for analgesia in Chinese men having transurethral resection of the prostate (TURP). J Clin Nurs 1998; 7(5): 479-80.

Zhang QN, Xiaoyu LJ. Investigation of psychological health condition in patients with benign prostate hyperplasia before and after operation. Journal of Hebei Medical College for Continuing Education 2004. Available from: URL: http://en.cnki.com.cn/Article_en/CJFDTOTAL-XBHB200402017.htm/

Larsson K, Sundberg HM, Karlbom U, Nordin K, Anderberg UM, Loof L. A group-based patient education programme for high-anxiety patients with Crohn disease or ulcerative colitis. Scand J Gastroenterol 2003; 38(7): 763-9.

Asilioglu K, Celik SS. The effect of preoperative education on anxiety of open cardiac surgery patients. Patient Educ Couns 2004; 53(1): 65-70.

Laumann EO, Kang JH, Glasser DB, Rosen RC, Carson CC. Lower urinary tract symptoms are associated with depressive symptoms in white, black and Hispanic men in the United States. J Urol 2008; 180(1): 233-40.

Tibaek S, Klarskov P, Lund HB, Thomsen H, Andresen H, Schmidt JC, et al. Pelvic floor muscle training before transurethral resection of the prostate: a randomized, controlled, blinded study. Scand J Urol Nephrol 2007; 41(4): 329-34.

Wong SY, Chan D, Hong A, Leung PC, Woo J. Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China. Int J Urol 2006; 13(10): 1304-10.

Lee SS. Erectile Dysfunction-A Missed Part of Benign Prostate Hyperplasia. Incont Pelvic Floor Dysfunct 2007; 1(Suppl 1): 15-8.

Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F. The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 2011; 29(2): 205-10.

Schulman CC, Asplund R, Desgrandchamps F, Jonas U. The Impact of Nocturia on Health Status and Quality of Life in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS/BPH). European Urology Supplements 2005; 4(2): 1-8.


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