LUTS may raise risk of suicidal ideation, according to study

San Francisco-Older men with at least two lower urinary tract symptoms are more likely to have recently thought about committing suicide, researchers say.

It’s not clear, however, whether there’s anything more than a coincidental connection between symptoms like urinary hesitancy and nocturia and so-called “suicidal ideation.” Mental illness may cause urinary symptoms, or vice versa, but it’s also possible that they don’t have anything to do with each other.

Still, there’s enough evidence to support encouraging urologists to take action in certain cases, said lead author Benjamin Breyer, MD, assistant professor of urology at the University of California, San Francisco, in an interview with Urology Times.

“If urologists see people who have lower urinary tract symptoms and appear depressed, we as clinicians should talk to them about it and potentially screen them for depression. And we should think about referring them to get mental health help,” said Dr. Breyer, whose findings were  presented at the 2013 AUA annual meeting in San Diego and recently published online in the Journal of Urology (Dec. 16, 2013).

The authors examined the responses of 2,890 men aged 40 years or older who participated in the National Health and Nutrition Examination Survey during the 2005-’06 and 2007-’08 cycles. The men were 58 years of age on average and had no history of prostate cancer.

Forty-three percent of the men reported at least one of these three symptoms: nocturia, urinary hesitancy, and incomplete bladder emptying. Six percent reported two or more of the symptoms.

Men with two symptoms linked to depression

Men with at least two urinary symptoms were more likely to report moderate to severe depression (adjusted odds ratio: 3.1, 95% CI: 1.2-8.1) and suicidal ideation (adjusted odds ratio: 1.8, 95% CI: 0.9-3.7). But depression and recent suicidal thoughts were fairly rare overall: just 6% reported symptoms that indicated moderate to severe depression, and 4% reported suicidal ideation within the past 2 weeks.

What's going on? “There may be separate or overlapping psychological mechanisms that could lead to both conditions,” Dr. Breyer said. For example, he noted, “Having problems with urination such as peeing often at night could lead to social isolation and embarrassment.”

Kenneth Sakauye, MD, professor of psychiatry at University of Tennessee Health Science Center, Memphis, who’s familiar with the study but not involved with it, pointed out that, “The men with these symptoms and depression seemed to be atypical-younger, inactive, and drank more than those without depression.” Younger men are less likely to have prostate enlargement, a common component of these types of urinary problems in older men, “so the cause of their symptoms is probably something more serious, and they may have other health issues, like being inactive and drinking more,” he told Urology Times.

Whatever the case, previous research has also suggested a link between urinary problems and mental illness. For one, researchers have linked urinary tract infections to psychosis and delirium in geriatric patients, especially patients with dementia, said Brian Miller, MD, PhD, MPH, an assistant professor of psychiatry at Georgia Regents University, Augusta.

“Our own research group has found associations between urinary tract infections and acute psychosis in adults with primary psychotic disorders-eg, schizophrenia-and mood disorders with psychotic features,” said Dr. Miller, who was not involved with the current study.

Connecting mechanisms unknown

The mechanisms connecting mental and urinary problems remain largely unknown, Dr. Miller said, although his research group has theorized that inflammatory reaction from urinary tract infections may contribute to psychosis.

“We are just beginning a new study where we are measuring a number of different inflammatory parameters in the peripheral blood (white blood cell counts, C-reactive protein, and cytokines) in patients with acute psychosis with and without comorbid UTI,” he said.

What now? Dr. Miller called for more research into urinary problems and suicidal ideation and for an investigation of the issue in women.

Urologists should be concerned about the potential for mental illness in their patients because they may spot depression that ultimately is successfully treated, Dr. Breyer said, and that may lead to better outcomes on the urinary front.UT

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