The association between lower urinary tract symptoms and depressive symptoms in older Korean adults: a cross-sectional study

This study aimed to investigate the relationship between lower urinary tract symptoms (LUTS) and depressive symptoms in Korean adults aged 60 and above. We prospectively collected data from 524 older adults (68.7% male, 31.3% female) who visited a community center called Bitgoeul Senior Health Town, Gwangju, Korea, between 2021 and 2022. The mean age of the participants was 77.78 ± 5.44 years. All participants completed a set of questionnaires, including the International Prostate Symptom Score (IPSS), Subjective Memory Complaints Questionnaire (SMCQ), and Geriatric Depression Scale Short Form (GDS-SF). The mean total IPSS score was 8.76 ± 6.10, the mean SMCQ 3.68 ± 2.66, and the mean GDS-SF score 2.75 ± 3.15, respectively. Severe voiding symptoms were more prevalent in older adults with advanced age, insomnia and high SMCQ and GDS-SF scores. Multivariable analyses revealed that IPSS was significantly associated with depressive symptoms (β = 3.233, p < 0.001). Furthermore, female gender (95% confidence interval (CI): 1.11–4.07, odds ratio (OR) = 2.12, p = 0.023). Moderate or severe IPSS scores (95% CI: 1.03–2.98, OR = 1.75, p = 0.040) and high SMCQ scores (95% CI: 2.14–6.15, OR = 3.62, p < 0.001) were identified as independent risk factors for depression in older adults. Our findings indicate a significant association between the severity of subjective voiding symptoms and depressive symptoms in older Korean adults. These results underscore the necessity of assessing and managing LUTS in this demographic, considering patients’ mental health and overall well-being.

Aged; Health care surveys; Lower urinary tract symptoms; Depression

[1] Lee DY, Kam SC. The need for prospective cohort study of the association between lower urinary tract symptoms and cognitive decline in elderly individuals. The World Journal of Men’s Health. 2023; 41: 974.

[2] Mohamad Anuar MF, Solihin Rezali M, Mohamed Daud MA, Ismail SB. A community-based study on lower urinary tract symptoms in Malaysian males aged 40 years and above. Scientific Reports. 2022; 12: 2345.

[3] Rom M, Schatzl G, Swietek N, Rücklinger E, Kratzik C. Lower urinary tract symptoms and depression. BJU International. 2012; 110: E918–921.

[4] Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annual Review of Clinical Psychology. 2009; 5: 363–389.

[5] Wong SYS, Hong A, Leung J, Kwok T, Leung PC, Woo J. Lower urinary tract symptoms and depressive symptoms in elderly men. Journal of Affective Disorders. 2006; 96: 83–88.

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

[7] 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 International. 2009; 103: 4–11.

[8] Tzeng N, Chang H, Chung C, Kao Y, Yeh H, Yeh C, et al. Risk of psychiatric disorders in overactive bladder syndrome: a nationwide cohort study in Taiwan. Journal of Investigative Medicine. 2019; 67: 312–318.

[9] Martin SA, Tully PJ, Kahokehr AA, Jay A, Wittert GA. The bidirectional association between depression and lower urinary tract symptoms (LUTS) in men: a systematic review and meta-analysis of observational studies. Neurourology and Urodynamics. 2022; 41: 552–561.

[10] Okamura K, Nojiri Y, Osuga Y, Tange C. Psychometric analysis of international prostate symptom score for female lower urinary tract symptoms. Urology. 2009; 73: 1199–1202.

[11] Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FDR, Fourcade R, et al. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU International. 2003; 92: 409–414.

[12] Terai A, Matsui Y, Ichioka K, Ohara H, Terada N, Yoshimura K. Comparative analysis of lower urinary tract symptoms and bother in both sexes. Urology. 2004; 63: 487–491.

[13] Youn JC, Kim KW, Lee DY, Jhoo JH, Lee SB, Park JH, et al. Development of the subjective memory complaints questionnaire. Dementia and Geriatric Cognitive Disorders. 2009; 27: 310–317.

[14] Sultana N, Nguyen TTP, Hossain A, Asaduzzaman M, Nguyen MH, Jahan I, et al. Psychometric properties of the short-form geriatric depression scale (GDS-SF) and its associated factors among the elderly in Bangladesh. International Journal of Environmental Research and Public Health. 2022; 19: 7935.

[15] Ninomiya S, Kawahara T, Tsutsumi S, Ito H, Makiyama K, Uemura H. Lower urinary tract symptoms are elevated with depression in Japanese women. Lower Urinary Tract Symptoms. 2023; 15: 116–121.

[16] Chow PM, Chuang YC, Hsu KCP, Shen YC, Liu SP. Impact of female stress urinary incontinence on quality of life, mental health, work limitation, and healthcare seeking in China, Taiwan, and South Korea (LUTS Asia): results from a cross-sectional, population-based study. International Journal of Women’s Health. 2022; 14: 1871–1880.

[17] Glaser AP, Mansfield S, Smith AR, Helfand BT, Lai HH, Sarma A, et al. Impact of sleep disturbance, physical function, depression and anxiety on male lower urinary tract symptoms: results from the symptoms of lower urinary tract dysfunction research network (LURN). The Journal of Urology. 2022; 208: 155–163.

[18] Liu S, Chuang Y, Sumarsono B, Chang H. The prevalence and bother of lower urinary tract symptoms in men and women aged 40 years or over in Taiwan. Journal of the Formosan Medical Association. 2019; 118: 170–178.

[19] Zuluaga L, Caicedo JI, Mogollón MP, Santander J, Bravo-Balado A, Trujillo CG, et al. Anxiety and depression in association with lower urinary tract symptoms: results from the COBaLT study. World Journal of Urology. 2023; 41: 1381–1388.

[20] Park JS, Ham WS, Hong CH, Chung BH, Koo KC. The association of depression with lower urinary tract symptoms: data from the National Health and Nutrition Examination Survey, 2005–2008. PeerJ. 2019; 7: e7795.

[21] Vartolomei L, Cotruș A, Tătaru SO, Vartolomei MD, Man A, Ferro M, et al. Lower urinary tract symptoms are associated with clinically relevant depression, anxiety, and stress symptoms. The Aging Male. 2022; 25: 62–66.

[22] Mahjoob DM, Janssen JMW, van Koeveringe GA, Leue C, van Osch FHM, Vrijens DMJ. Psychiatric disorders in patients with lower urinary tract symptoms: a systematic review including a subgroup meta-analysis on the association between LUTS and depressive symptoms. Continence. 2023; 6: 100589.

[23] Yoo SS, Shim BS, Lee DH, Lee HW, Yoon H. Correlation between nocturia and sleep: a questionnaire based analysis. Korean Journal of Urology. 2010; 51: 757.

[24] Hughes FM Jr, Odom MR, Cervantes A, Livingston AJ, Purves JT. Why are some people with lower urinary tract symptoms (LUTS) depressed? New evidence that peripheral inflammation in the bladder causes central inflammation and mood disorders. International Journal of Molecular Sciences. 2023; 24: 2821.

[25] Ng QX, Lim YL, Loke W, Yeo WS, Chee KT. Obsessive-compulsive disorders and functional urinary disorders: a fortuitous association? Behavioural Sciences. 2021; 11: 89.

[26] Ng QX, Lim YL, Loke W, Chee KT, Lim DY. Females with eating disorders and urinary incontinence: a psychoanalytic perspective. International Journal of Environmental Research and Public Health. 2022; 19: 4874.

[27] Barone B, De Luca L, Napolitano L, Reccia P, Crocetto F, Creta M, et al. Lower urinary tract symptoms and mental health during COVID-19 pandemic. Archives of Italian Urology and Andrology. 2022; 94: 46–50.