Korean J Urol.  2013 Nov;54(11):762-766.

Effect of Urgency Symptoms on the Risk of Depression in Community-Dwelling Elderly Men

• Lee YI
• Kim JW
• Bae SR
• Paick SH
• Kim KW
• Kim HG
• Lho YS
• Park HK

Abstract

PURPOSE
To evaluate the association of a specific type of lower urinary tract symptom (LUTS) and the depression in community-dwelling elderly Korean men.
MATERIALS AND METHODS
A total of 392 men aged 65 years or older, who completed urological and psychiatric evaluations as a participant of the Korean Longitudinal Study on Health and Aging, were included. From each subject, an interview on the demographic characteristics and medical history, IPSS, and psychiatric questionnaire were taken. Subjects were divided into two groups; depression and euthymic. Subjects with IPSS subscore more than 3 points was considered 'high' subscore. IPSS subscores were compared between the two groups, and the relationship between depression and LUTS severity was assessed.
RESULTS
The mean age of the subjects was 75, and 6.4% of the subjects were diagnosed to have major depressive disorders. The depression group showed higher IPSS scores than the euthymic group (16.1+/-9.9 vs. 11.6+/-8.6, p=0.01). IPSS subscores of question 1 (incomplete empty), question 3 (intermittency), question 4 (urgency) and question 6 (straining to void) were higher in the depression group compared with the euthymic group. Chi-square test revealed subjects with high IPSS 1, 3, 4, and 6 score were associated with depression, but multivariate analysis identified only high IPSS question 4 as a significant prognostic factor for depression.
CONCLUSIONS
Elderly population with depression is more likely to have more severe LUTS than population without depression. Among the urinary symptoms, urgency was strongly associated with depression. Patients with moderate to severe LUTS and especially urgency may need their mental health status evaluation.

Keyword

Depression; Longitudinal studies; Lower urinary tract symptoms

MeSH Terms

Aging
Depression*
Depressive Disorder, Major
Humans
Longitudinal Studies
Lower Urinary Tract Symptoms
Male
Mental Health
Multivariate Analysis
Urinary Tract

Figure

• 

  FIG. 1 The difference in International Prostate Symptom Score subscores between the euthymic group and the depression group. Data are expressed as mean±standard deviation. *p <0.05, depression group vs. euthymic group.

Reference

1. Rom M, Schatzl G, Swietek N, Rucklinger E, Kratzik C. Lower urinary tract symptoms and depression. BJU Int. 2012; 110(11 Pt C):E918–E921.

2. Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009; 103:Suppl 3. 4–11.

3. Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Owen-Smith A, Raison CL, et al. IPSS quality of life question: a possible indicator of depression among patients with lower urinary tract symptoms. Can J Urol. 2012; 19:6100–6104.

4. Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD. Urinary incontinence and depression. J Urol. 1999; 162:82–84.

5. Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol. 2003; 101:149–156.

6. Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005; 165:537–542.

7. Asplund R, Henriksson S, Johansson S, Isacsson G. Nocturia and depression. BJU Int. 2004; 93:1253–1256.

8. van der Vaart CH, Roovers JP, de Leeuw JR, Heintz AP. Association between urogenital symptoms and depression in community-dwelling women aged 20 to 70 years. Urology. 2007; 69:691–696.

9. Steers WD. Overactive bladder (OAB): what we thought we knew and what we know today. Eur Urol Suppl. 2002; 1:3–10.

10. Tubaro A. Defining overactive bladder: epidemiology and burden of disease. Urology. 2004; 64:6 Suppl 1. 2–6.

11. Yoo ES, Kim BS, Kim DY, Oh SJ, Kim JC. The impact of overactive bladder on health-related quality of life, sexual life and psychological health in Korea. Int Neurourol J. 2011; 15:143–151.

12. Milsom I, Kaplan SA, Coyne KS, Sexton CC, Kopp ZS. Effect of bothersome overactive bladder symptoms on health-related quality of life, anxiety, depression, and treatment seeking in the United States: results from EpiLUTS. Urology. 2012; 80:90–96.

13. Park HK, Paick SH, Kim HG, Lho YS, Byun SS, Lee SB, et al. Effect of depression on the risk and severity of lower urinary tract symptoms in community-dwelling elderly Korean men. Low Urin Tract Symptoms. 2012; 4:63–67.

14. Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994; 151:979–986.

15. Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, et al. Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry. 2001; 179:308–316.

16. Steffens DC, Skoog I, Norton MC, Hart AD, Tschanz JT, Plassman BL, et al. Prevalence of depression and its treatment in an elderly population: the Cache County study. Arch Gen Psychiatry. 2000; 57:601–607.

17. Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, et al. Anxiety and depression in COPD patients: The roles of gender and disease severity. Respir Med. 2006; 100:1767–1774.

18. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD: relationship to functional capacity. Chest. 1985; 87:35–38.

19. Kurina LM, Goldacre MJ, Yeates D, Gill LE. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health. 2001; 55:716–720.

20. Addolorato G, Capristo E, Stefanini GF, Gasbarrini G. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol. 1997; 32:1013–1021.

21. Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med. 2002; 64:52–60.

22. Janson C, Bjornsson E, Hetta J, Boman G. Anxiety and depression in relation to respiratory symptoms and asthma. Am J Respir Crit Care Med. 1994; 149(4 Pt 1):930–934.

23. Blazer DG, Moody-Ayers S, Craft-Morgan J, Burchett B. Depression in diabetes and obesity: racial/ethnic/gender issues in older adults. J Psychosom Res. 2002; 53:913–916.

24. Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Cuffe MS, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001; 161:1849–1856.

25. Havranek EP, Ware MG, Lowes BD. Prevalence of depression in congestive heart failure. Am J Cardiol. 1999; 84:348–350. A9

26. Wong SY, Hong A, Leung J, Kwok T, Leung PC, Woo J. Lower urinary tract symptoms and depressive symptoms in elderly men. J Affect Disord. 2006; 96:83–88.

27. Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Raison CL, Master VA. Nocturia associated with depressive symptoms. Urology. 2011; 77:183–186.

28. Foley DJ, Vitiello MV, Bliwise DL, Ancoli-Israel S, Monjan AA, Walsh JK. Frequent napping is associated with excessive daytime sleepiness, depression, pain, and nocturia in older adults: findings from the National Sleep Foundation '2003 Sleep in America' Poll. Am J Geriatr Psychiatry. 2007; 15:344–350.

29. Asplund R, Johansson S, Henriksson S, Isacsson G. Nocturia, depression and antidepressant medication. BJU Int. 2005; 95:820–823.

30. Coyne KS, Sexton CC, Kopp ZS, Ebel-Bitoun C, Milsom I, Chapple C. The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: results from EpiLUTS. BJU Int. 2011; 108:1459–1471.