Interactions Between Depression and Lower Urinary Tract... : Biopsychosocial Science and Medicine (original) (raw)

ORIGINAL ARTICLES

Interactions Between Depression and Lower Urinary Tract Symptoms: The Role of Adverse Life Events and Inflammatory Mechanisms. Results From the European Male Ageing Study

Castellini, Giovanni PhD; Wu, Frederick C.W. PhD; Finn, Joseph D. PhD; O'Neill, Terrence W. PhD; Lean, Michael E.J. PhD; Pendleton, Neil PhD; Rastrelli, Giulia PhD; Rutter, Martin K. PhD; Gacci, Mauro MD; Ricca, Valdo MD; Maggi, Mario MD, PhD

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.

Address correspondence and reprint requests to Mario Maggi, MD, PhD, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, Florence University School of Medicine, Viale Pieraccini 6, 50139 Florence, Italy. E-mail: [email protected]

The EMAS Study Group: Florence (Gianni Forti, Luisa Petrone, Giovanni Corona), Leuven (Dirk Vanderschueren, Herman Borghs, Leen Antonio), Łódź (Krzysztof Kula, Jolanta Slowikowska-Hilczer, Renata Walczak-Jedrzejowska), London (Ilpo Huhtaniemi), Malmö (Aleksander Giwercman), Manchester (Frederick Wu, Alan Silman, Terence O'Neill, Joseph Finn, Philip Steer, Stephen Pye), Santiago (Felipe Casanueva, Mary Lage, Ana I. Castro), Szeged (Gyorgy Bartfai, Imre Földesi, Imre Fejes), Tartu (Margus Punab, Paul Korrovitz).

Received for publication March 16, 2015; revision received December 8, 2015.

Abstract

Objectives

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.

Methods

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.

Results

LUTS and depressive symptoms were correlated (_R_2 = 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.

Conclusions

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.