Depression, anxiety common in men with pelvic pain

Istanbul, Turkey-Chronic prostatitis appears to be significantly associated with psychological disorders, such as depression, anxiety, and panic, according to the results of a German study. The study also found that pelvic pain symptoms are far less prevalent than expected (3.2%), while the mean age of afflicted men was significantly higher than noted in previous trials (60.6 years).

Notably, the depression scores of men with prostatitis symptoms were nearly twice as high as those of controls on one scale and nearly three times as high on another scale, the researchers reported at the European Association of Urology annual congress here. Overall, however, the prevalence of pelvic pain symptoms was low.

"Although recent years have established chronic pelvic pain as a common clinical entity, we did not anticipate that its prevalence was this low in the German population," said Wolfgang Weidner, MD, professor of medicine in the department of urology, Justus-Liebig University of Giessen. "In the percentage of patients with prostatitis-like symptoms, however, we noted a strong and significant association with psychological complaints."

The NIH-CPSI pain score cut-off was set to 8, which was the generally accepted borderline value for moderate prostatitis-like symptoms. Subjects with incomplete questionnaires (44 men) were excluded from the analysis. The investigators included the remaining 946 valid cases for further assessment.

Of the 946 men included in the survey, 916 (96.8%) scored below 8 in the pain domain of the NIH-CPSI (group 1: normal non-prostatitis-like findings). Their mean age was 46.6±17.4 years (range, 14 to 91 years). About half (55%) of the men in this group were married, and 61% had partners.

The researchers identified 30 subjects (3.2%) with chronic prostatitis-like symptoms (group 2), defined as a pain score of 8 or greater. The mean age in this group was 60.6±10.2 years (range, 30 to 73 years). Seventy percent of these men were married, and 83% had partners. The two groups showed no significant differences in education, employment, and income.

Psychological tests Dr. Weidner conducted the survey in collaboration with the University of Leipzig's department of psychology and social medicine, also in Germany. It revealed that the Beck Depression Index in group 1 was 14.64±13.07, while that of group 2 was almost twice as high, 30.2±16.1 (p<.001).

Furthermore, group 1 scores for anxiety and panic on the Patient Health Questionnaire were 0.03±0.17 and 3%±1.7%, respectively, compared with 0.23±0.43 and 23%±4.3%, respectively, in group 2 (p<.001). Similarly, scores on the depression scale were 2.7±2.52 in group 1 and 7.93±4.66 in group 2 (p<.001).

The average values obtained on the General Health Questionnaire were 1.3±0.26 in group 1 and 1.55±0.31 in group 2 (p<.001). The total score for general health was 1.3 in group 1 and 1.55 in group 2.

Pain may drive depression Dr. Weidner's colleagues were well aware of the association between prostatitis-like symptoms and depression. The question inevitably arose, however, as to whether the depression drives the pain, the pain drives the depression, or if the association is an independent one.

Dr. Weidner is currently conducting studies to test this effect. Although it is likely to be an independent association, his impression was that pain may drive depression in some cases.

Werner Hochreiter, MD, also an expert in chronic prostatitis, agreed.