Abstract
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.