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已发表论文
中国老年男性亚临床抑郁与下尿路症状/良性前列腺增生严重程度的关系及睡眠质量的中介作用
Authors Wu Y , Sheng J, Liu X, Huang Y, Zhang Y , Feng N
Received 12 March 2025
Accepted for publication 14 October 2025
Published 22 October 2025 Volume 2025:21 Pages 2371—2384
DOI https://doi.org/10.2147/NDT.S527763
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Taro Kishi
Yifan Wu,1,2,* Jiayi Sheng,1,* Xinwei Liu,1,2 Yongneng Huang,1,2 Yuwei Zhang,1,3 Ninghan Feng1,2
1Department of Urology, Jiangnan University Medical Center, Wuxi, Jiangsu Province, People’s Republic of China; 2Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China; 3Medical School of Nantong University, Nantong, Jiangsu Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ninghan Feng, Department of Urology, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, 214002, People’s Republic of China, Email n.feng@jiangnan.edu.cn Yuwei Zhang, Medical School of Nantong University, 9 Qiangyuan Road, Nantong, 226019, People’s Republic of China, Email zhangyw0123@njmu.edu.cn
Background and Objective: Subclinical depression and lower urinary tract symptoms (LUTS) /benign prostatic hyperplasia (BPH) are both common diseases. Studies have shown that there is an association between them, and sleep disturbances may play an important role in this relationship, however, the underlying mechanisms remain unknown. This study aims to explore the potential association between subclinical depression and LUTS/BPH, and to investigate the role of sleep quality in this relationship.
Methods: This is a cross-sectional study based on clinical patients. Inpatients with BPH were recruited from the urology department as the research subjects; all were aged 60 years or older. The Patient Health Questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and the International Prostate Symptom Score (IPSS) were used to assess subclinical depression, sleep quality, and the severity of LUTS/BPH. The patients were divided into mild and moderate-to-severe groups based on IPSS scores. Logistic regression analysis was used to assess the association between subclinical depression and LUTS/BPH severity. The mediating role of sleep quality was examined through a Structural Equation Model.
Results: 806 participants were included in this study, with 218 in the mild group and 588 in the moderate-to-severe group. Results showed significantly higher PHQ-9 and PSQI scores in the moderate-to-severe group compared with those in the mild group. Logistic regression analysis revealed that subclinical depression was significantly and positively correlated with increased severity of LUTS/BPH (OR:1.90, 95% CI:1.16– 3.11). Subgroup analysis indicated a stronger association between subclinical depression and LUTS/BPH severity among participants with poor sleep quality (OR: 2.95, 95% CI:1.12– 7.73). Mediation analysis showed that sleep quality partially mediated this relationship (β=0.006, P< 0.001).
Conclusion: The study illustrates that subclinical depression can serve as a predictor of the severity of LUTS/BPH, with sleep partially mediating this relationship. Consequently, it is crucial to incorporate mental health assessment and intervention into the treatment plan when managing patients with LUTS/BPH.
Keywords: subclinical depression, sleep quality, LUTS/BPH, mediating effect
1Department of Urology, Jiangnan University Medical Center, Wuxi, Jiangsu Province, People’s Republic of China; 2Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, People’s Republic of China; 3Medical School of Nantong University, Nantong, Jiangsu Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ninghan Feng, Department of Urology, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, 214002, People’s Republic of China, Email n.feng@jiangnan.edu.cn Yuwei Zhang, Medical School of Nantong University, 9 Qiangyuan Road, Nantong, 226019, People’s Republic of China, Email zhangyw0123@njmu.edu.cn
Background and Objective: Subclinical depression and lower urinary tract symptoms (LUTS) /benign prostatic hyperplasia (BPH) are both common diseases. Studies have shown that there is an association between them, and sleep disturbances may play an important role in this relationship, however, the underlying mechanisms remain unknown. This study aims to explore the potential association between subclinical depression and LUTS/BPH, and to investigate the role of sleep quality in this relationship.
Methods: This is a cross-sectional study based on clinical patients. Inpatients with BPH were recruited from the urology department as the research subjects; all were aged 60 years or older. The Patient Health Questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and the International Prostate Symptom Score (IPSS) were used to assess subclinical depression, sleep quality, and the severity of LUTS/BPH. The patients were divided into mild and moderate-to-severe groups based on IPSS scores. Logistic regression analysis was used to assess the association between subclinical depression and LUTS/BPH severity. The mediating role of sleep quality was examined through a Structural Equation Model.
Results: 806 participants were included in this study, with 218 in the mild group and 588 in the moderate-to-severe group. Results showed significantly higher PHQ-9 and PSQI scores in the moderate-to-severe group compared with those in the mild group. Logistic regression analysis revealed that subclinical depression was significantly and positively correlated with increased severity of LUTS/BPH (OR:1.90, 95% CI:1.16– 3.11). Subgroup analysis indicated a stronger association between subclinical depression and LUTS/BPH severity among participants with poor sleep quality (OR: 2.95, 95% CI:1.12– 7.73). Mediation analysis showed that sleep quality partially mediated this relationship (β=0.006, P< 0.001).
Conclusion: The study illustrates that subclinical depression can serve as a predictor of the severity of LUTS/BPH, with sleep partially mediating this relationship. Consequently, it is crucial to incorporate mental health assessment and intervention into the treatment plan when managing patients with LUTS/BPH.
Keywords: subclinical depression, sleep quality, LUTS/BPH, mediating effect