title: The association of lower urinary tract symptoms, depression and suicidal ideation: data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  We examine the association among depression, suicidal ideation and self-reported lower urinary tract symptoms using a large, cross-sectional, population based study.
  
  
  METHODS
  The study included 2,890 men from the 2005-2006 or 2007-2008 cycles of the NHANES (National Health and Nutrition Examination Survey) who were 40 years old or older. Men were asked if they experienced nocturia, urinary hesitancy and/or incomplete bladder emptying. The PHQ-9 (Patient Health Questionnaire-9) was used to determine the likelihood of clinical depression and suicidal ideation.
  
  
  RESULTS
  The prevalence of lower urinary tract symptoms was 33.7% and 10.3% for men reporting 1 and 2 or more symptoms, respectively. Moderate to severe depression (PHQ-9 score 10 or greater) and suicidal ideation were reported by 181 (6.3%) and 105 (3.6%) men, respectively. Men reporting moderate to severe depression (compared to those reporting minimal depression) had a higher odds of reporting lower urinary tract symptoms (adjusted odds ratio [AOR] 5.09, 95% CI 3.17-8.17 for PHQ-9 score 5 to 9 and AOR 7.62, 95% CI 3.90-14.87 for PHQ-9 score 10 or greater; p trend <0.0001). More lower urinary tract symptoms were associated with a significantly higher odds of moderate to severe depression (AOR 3.09, 95% CI 1.86-5.15 for 1 symptom and AOR 8.06, 95% CI 4.18-15.53 for 2 or more symptoms, p trend <0.0001) and a higher odds of suicidal ideation (AOR 1.70, 95% CI 0.85-3.42 and AOR 2.71, 95% CI 1.40-5.25, respectively, p trend = 0.004).
  
  
  CONCLUSIONS
  A significant relationship was observed between lower urinary tract symptoms and depression/suicidal ideation. While the pathophysiology of the relationship and its significance in clinical practice remain unclear, clinicians may consider screening men with severe lower urinary tract symptoms for depression.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California. Electronic address: bbreyer@urology.ucsf.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Kenfield
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Blaschko
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D059020:Suicidal Ideation; D013997:Time Factors
keywords: depression; lower urinary tract symptoms; suicide