title: Interactions Between Depression and Lower Urinary Tract Symptoms: The Role of Adverse Life Events and Inflammatory Mechanisms. Results From the European Male Ageing Study.
abstract: Depression and lower urinary tract symptoms (LUTSs) have been found to co-occur among aging men. The present study attempted to clarify the nature of this relationship, considering adverse life events as potential moderators and the inflammation as an underlying biological mechanism.
  
  
  
  The relationship between depression and LUTS was evaluated using data from the European Male Ageing Study, the largest multicenter population-based study of aging in European men. The sample included 3369 men who were assessed by means of several self-reported questionnaires, including the Beck Depression Inventory-II, the International Prostate Symptom Score, and the Adverse Life Events Scale. Participants were asked to provide information regarding general health and life-style, and medical comorbidities. Biological measures including prostate-specific antigen, testosterone, and C-reactive protein were measured.
  
  
  
  LUTS and depressive symptoms were correlated (R = 0.32, β = .10, p < .001), even after adjusting for life-style, psychological, and medical variables. A history of adverse life events was associated with both higher LUTS and Beck Depression Inventory scores. Furthermore, adverse life events moderated the LUTS-depression association (F = 22.62, b = 0.061, p < .001), which increased as a function of the number of life events. C-reactive protein was found to mediate the LUTS-depression association. This mediation effect was moderated by number of adverse life events.
  
  
  
  Participants with a history of adverse life events represent a vulnerable population in whom the association between somatic and depressive symptoms is stronger. One of the biological mechanisms underlying this association could be an activation of the central inflammatory signaling pathways.
authors.affiliation: From the Sexual Medicine and Andrology Unit (Castellini, Rastrelli, Maggi), Department of Experimental, Clinical and Biomedical Sciences, and Psychiatric Unit (Castellini, Ricca), Department of Neuropsychiatric Sciences, University of Florence, Florence, Italy; Andrology Research Unit (Wu, Rutter), Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical Human Sciences, The University of Manchester, Manchester, UK; Manchester Royal Infirmary (Wu, Rutter), Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Arthritis Research UK Epidemiology Unit (Finn, O'Neill), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Department of Human Nutrition (Lean), University of Glasgow, Glasgow, UK; School of Community Based Medicine (Pendleton), The University of Manchester, Salford Royal NHS Trust, Salford, UK; Manchester Diabetes Centre (Rutter), Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Oncology (Gacci), Urology Unit, University Hospital Careggi (AOUC), University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castellini
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.forename: Terrence W
authors.initials: TW
authors.lastname: OʼNeill
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008016:Life Change Events; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D053448:Prostatism / Q000453:epidemiology