History of Benign Prostatic Enlargement is a Risk Factor for Major Depressive Disorder

Introduction/Purpose: Quality of life (QOL) is one of the most important variables associated with benign prostatic enlargement
(BPE) and can be a driving factor in treatment. Previous studies have correlated depressive episodes with
the use of alpha-1 antagonists or 5-alpha reductase inhibitors; however, the patients were included in
Poland and used the Beck Depression Inventory scale. In this study, we aim to study patients in United
States using the patient health questionnaire (PHQ-9) to assess an association with BPE and major
depressive disorder (MDD).

Methods or Case Description: A retrospective review was performed on the 2004-2007 National Health and Nutrition Examination
Survey in patients that was diagnosed with BPH. The patients were included if self-reported prostatic
enlargement. The PHQ-9 was then used to determine depression status. Descriptive statistical analysis
was performed on patient demographics and a logistic multivariate regression was performed to identify
covariates to determine if there was an association with BPH and major depressive disorder.

Outcomes: A total of 106,236,315 weighted samples were extracted from the database. Among the total, MDD was
present in 3,445,289 of weighted samples. BPE cohort was older (64.8 vs 54.1 years), likely to be college
graduates or above (30.1% vs. 27.7%), and likely to be white (84.7% vs 75.9%) (Table 1). On
multivariate logistic regression, BPE was a risk factor for MDD (OR 1.5, 1.05-2.1, P=0.03). Additionally,
there was an association with age (OR 1.09, 1.08- 1.10, P< 0.001), education (OR 1.2, 1.09- 1.34 P< 0.01),
poverty (OR 1.16, 1.06 - 1.28, P=0.002). (Table 2).

Table 2. Multivariate Logistic Regression Associated with MDD
Multivariate Analysis
	Odds Ratio (95% CI)	P-value
Age	1.092(1.080, 1.103)	< 0.001
Education	1.210(1.089, 1.343)	< 0.001
Poverty to Income Ratio	1.163(1.055, 1.281)	0.002
Race	0.889(-0.769, 1.028)	0.113
Major Depression Disorder	1.485(1.051, 2.100)	0.025

Conclusion: BPE has an impact on quality of life and our analysis shows that it has an association with MDD. The
prevalence of BPE is predicted to rise with the aging population. Early recognition, education, and prompt
treatment should be employed to avoid MDD. Decisions to treat medically or surgically should be shared
between patient and surgeon.