title: Lower Urinary Tract Symptoms, Depression, Anxiety and Systemic Inflammatory Factors in Men: A Population-Based Cohort Study.
abstract: BACKGROUND
  The relationship between lower urinary tract symptoms (LUTS) and common mental health disorders such as depression and anxiety in men remains unclear. Inflammation has recently been identified as an independent risk factor for LUTS and depression. This study aimed to assess the association between depression, anxiety and LUTS, and the moderating influence of systemic inflammation, in the presence of other biopsychosocial confounders.
  
  
  METHODS
  Participants were randomly-selected from urban, community-dwelling males aged 35-80 years at recruitment (n = 1195; sample response rate:67.8%). Of these, 730 men who attended baseline (2002-5) and follow-up clinic visits (2007-10), with complete outcome measures, and without prostate or bladder cancer and/or surgery, neurodegenerative conditions, or antipsychotic medications use, were selected for the present study. Unadjusted and multi-adjusted regression models of incident storage and voiding LUTS and incident depression and anxiety were combined with serum inflammatory markers (high-sensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), myeloperoxidase (MPO), soluble e-selectin (e-Sel)) and socio-demographic, lifestyle, and health-related factors. Hierarchical multiple regression was used to assessed the moderating effect of inflammatory markers.
  
  
  RESULTS
  The incidence of storage, voiding LUTS, depression and anxiety was 16.3% (n = 108), 12.1% (n = 88), 14.5% (n = 108), and 12.2% (n = 107). Regression models demonstrated that men with depression and anxiety at baseline were more likely to have incident storage, but not voiding LUTS (OR: 1.26, 99%CI: 1.01-4.02; and OR:1.74; 99%CI:1.05-2.21, respectively). Men with anxiety and storage LUTS at baseline were more likely to have incident depression (OR: 2.77, 99%CI: 1.65-7.89; and OR:1.45; 99%CI:1.05-2.36, respectively), while men with depression and voiding LUTS were more likely to have anxiety at follow-up (OR: 5.06, 99%CI: 2.81-9.11; and OR:2.40; 99%CI:1.16-4.98, respectively). CRP, TNF-α, and e-Sel were found to have significant moderating effects on the development of storage LUTS (1.06, 0.91-1.96, R2 change: 12.7%), depression (1.17, 1.01-1.54, R2 change: 9.8%), and anxiety (1.35, 1.03-1.76, R2 change: 10.6%), respectively.
  
  
  CONCLUSIONS
  There is a bidirectional relationship between storage, but not voiding, LUTS and both depression and anxiety. We observed variable moderation effects for selected inflammatory markers on the development of depression, anxiety and storage LUTS.
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Martin
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Population Research and Outcome Studies, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Evan
authors.initials: E
authors.lastname: Atlantis
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewski
authors.affiliation: Chemical Pathology, SA Pathology, Adelaide, South Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Loughlin
authors.affiliation: Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology; D002097:C-Reactive Protein / Q000378:metabolism; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D019040:E-Selectin / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000473:pathology; D015850:Interleukin-6 / Q000097:blood; D008019:Life Style; D059411:Lower Urinary Tract Symptoms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000097:blood; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D019040:E-Selectin; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D009195:Peroxidase