title: Lower urinary tract dysfunction in male Iraq and Afghanistan war veterans: association with mental health disorders: a population-based cohort study.
abstract: OBJECTIVE
  To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use.
  
  
  METHODS
  We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications.
  
  
  RESULTS
  Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56).
  
  
  CONCLUSIONS
  In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: bbreyer@urology.ucsf.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.affiliation: New England Research Institutes, Watertown, MA.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA; San Francisco Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007493:Iraq; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D008889:Military Personnel; D015995:Prevalence; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D014481:United States; D058014:Veterans Health; D014857:Warfare; D055815:Young Adult