title: Men With Severe Lower Urinary Tract Symptoms Are at Increased Risk of Depression.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) comprise a set of common, bothersome symptoms in middle-aged and elderly men. Recent research suggests that depressive symptoms may influence the symptoms of benign prostatic hyperplasia (BPH). We performed a community-based cross-sectional study to evaluate the correlation between LUTS and depression.
  
  
  METHODS
  The survey was conducted in a rural community during four periods in August 2009, 2010, 2011, and 2012. Two validated questionnaires were used to examine LUTS and depressive symptoms. These included the International Prostate Symptom Score/quality of life (IPSS/QoL) and the Korean version of the Center for Epidemiological Studies-Depression scale (CES-D-K). Patients were categorized in the depressive symptom group if their CES-D-K score was >16 points.
  
  
  RESULTS
  A total of 711 men were included in this study. Thirty-five participants (4.92%) were found to have depressive symptoms. There was a positive correlation between depressive symptoms and LUTS severity (P<0.001). As compared to the mild LUTS group, the odds ratio (OR) of depression was 2.868 (95% confidence interval [CI], 1.293-6.362; P for trend<0.001) in the moderate LUTS group, and 4.133 (95% CI, 1.510-11.313; P for trend<0.001) in the severe LUTS group. In a model considering multiple variables such as age, education level, smoking, and exercise, the OR in the moderate LUTS group was 2.534 (1.125-5.708, 95% CI, P for trend=0.005), while that in the severe LUTS group was 3.910 (95% CI, 5.708-11.154; P for trend=0.005). In addition, depression was related to voiding symptoms.
  
  
  CONCLUSIONS
  Men with severe LUTS are at higher risk of depression than those with less severe urinary symptoms. The severity of voiding symptoms worsens depression. More aggressive urological diagnosis and treatment is needed in patients with severe LUTS, due to the impact on depressive symptoms and QoL.
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Won Sik
authors.identifier: 0000-0001-7862-7135
authors.initials: WS
authors.lastname: Jeong
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hong Yong
authors.initials: HY
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Nam
authors.affiliation: Center for Farmer's Safety and Health, Dankook University Hospital, Cheonan, Korea.
authors.forename: Shin Ah
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Bo Youl
authors.initials: BY
authors.lastname: Choi
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hong Sang
authors.initials: HS
authors.lastname: Moon
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Kyu Shik
authors.identifier: 0000-0001-8755-0774
authors.initials: KS
authors.lastname: Kim
keywords: Depression; Lower Urinary Tract Symptoms; Prostatic Hyperplasia