Psychological impact of an ongoing battle. Evidence from Italy.

The questionnaire consists of questions organized into thematic sections. It starts with the daily experience of cystitis and its impact (frequency, symptoms, and aspects of life affected), continues with the medical history and course of management (how long have you suffered from it, professionals consulted, possible diagnosis and diagnostic tools, strategies used to cope with symptoms). It then includes a section on lifestyle and habits (contextual factors, daily routine, possible intolerances) and a section on the intimate and sexual area, to explore possible correlations between relationships, pain, and intimate hygiene practices.

Translation is done through a proven machine translation system. Then, for each language, the text is carefully proofread by native speakers to ensure correctness, clarity and consistency of language.

The questionnaire is available in Italian, French, Spanish and German. Most of the completions come from Italy, France, Spain and Germany. A smaller share also comes from other countries where these languages are spoken or from people living abroad.

The minimum age of 18 has been established to ensure compliance with European ethical and legal regulations on participation in the Dimann quiz and the processing of personal data. Those over the age of 18 can provide independent and informed consent, especially when questions concern sensitive aspects such as health, physical symptoms, and psychological well-being. In addition, cystitis in adulthood has different clinical features, risk factors, and management modalities than pediatric and adolescent age, making the data more homogeneous and comparable.

Mood and stress are elements closely related to cystitis, especially in recurrent or chronic forms. Indeed, there is a bidirectional relationship between these factors: psychophysical stress and mood alterations can affect the immune system, pain perception, and urinary tract function, contributing to the onset or worsening of symptoms. At the same time, cystitis can profoundly affect quality of life, generating emotional distress, anxiety, irritability, and mood changes.

A bidirectional relationship is one in which two factors influence each other. In the case of cystitis, it means that stress, anxiety, and mood alterations can promote or intensify urinary symptoms, while the presence of painful, persistent, or recurrent symptoms can in turn increase stress, anxiety, and emotional distress. Thus, it is not a one-way link, but a circle of mutual influences that can maintain or exacerbate the disorder if not addressed comprehensively.