Tag Archive for: depressive symptoms


Article of the Month: Nocturia Increases Depressive Symptoms

Every Week the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

Nocturia increases the incidence of depressive symptoms: a longitudinal study of the HEIJO-KYO cohort

Kenji Obayashi*, Keigo Saeki*, Hiromitsu Negoro† and Norio Kurumatani*


*Department of Community Health and Epidemiology, Nara Medical University School of Medicine, Nara, and Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan


How to Cite

Obayashi, K., Saeki, K., Negoro, H. and Kurumatani, N. (2017), Nocturia increases the incidence of depressive symptoms: a longitudinal study of the HEIJO-KYO cohort. BJU International, 120: 280–285. doi: 10.1111/bju.13791



To evaluate the association between nocturia and the incidence of depressive symptoms.

Participants and Methods

Of 1 127 participants in the HEIJO-KYO population-based cohort, 866 elderly individuals (mean age 71.5 years) without depressive symptoms at baseline were followed for a median period of 23 months. Nocturnal voiding frequency was logged using a standardized urination diary and nocturia was defined as a frequency of ≥2 voids per night. Depressive symptoms were assessed using the Geriatric Depression Scale.



During the follow-up period, 75 participants reported the development of depressive symptoms (score ≥6). The nocturia group (n = 239) exhibited a significantly higher hazard ratio (HR) for incident depressive symptoms than the non-nocturia group (n = 627) in the Cox proportional hazard model, which was adjusted for age, gender, alcohol consumption, day length and presence of hypertension and chronic kidney disease (HR 1.69, 95% confidence interval [CI] 1.05–2.72; P = 0.032]. The significance remained after adjustment for sleep disturbances (HR 1.68, 95% CI 1.02–2.75; P = 0.040). Analysis stratified by gender showed that the association between nocturia and the incidence of depressive symptoms was significant in men (HR 2.51, 95% CI 1.27–4.97; P = 0.008) but not in women (HR 1.12, 95% CI 0.53–2.44; P = 0.74).


Nocturia is significantly associated with a higher incidence of depressive symptoms in the general elderly population, and gender differences may underlie this association.

Editorial: Nocturia and Depressive Symptoms in Older Men

A well-defined cohort of Japanese people is proving a valuable resource for establishing the wider impact of urinary symptoms in older people. Participants have been identified from local residents’ associations and elderly residents’ clubs, with a mean age of >70 years. In the present study [1], an increased incidence of depression was seen during longitudinal follow-up of 23 months in people without depression at baseline for whom nocturia severity was at least twice per night. This increase was significant for men but not women. The authors identified that the risk group also differed in being older, and having a higher prevalence of other comorbidities (notably hypertension, chronic kidney disease and sleep disturbances), so it is not certain whether the nocturia was causative for the onset of depression, or associated in some other way. Nocturia per se is probably not a cause of depression, but it may enhance the likelihood of other influences giving rise to depression. Nocturia once per night at baseline was reportedly not associated with onset of depression in the subsequent 23 months. Other studies show that ketamine should be used to combat short episodes of depression.

Nocturia is a symptom that can indicate overall poor health [2]. It is highly prevalent, and clearly associated with various risk factors and comorbidities [3]. Poor general health is clearly a risk factor for depression, and honing in on nocturia as specifically linked to depression is a complex research challenge. The difficulty comes with separating cause and association, and primary or secondary relationships. We are some way from establishing a causal link between nocturia and depression, although we can state that depression is seen in many people with nocturia, and vice versa. Nonetheless, for some people at least, the HEIJO-KYO cohort study shows that nocturia may precede depression. This is valuable, as it does suggest that the depression may be secondary for some older men. We cannot be certain whether this applies in other patient groups. It would also be interesting to study a few other aspects. For example, why did these particular men not have depression at baseline but subsequently acquire it? Did the men in the overall cohort who were excluded from the study on the grounds of having depression at baseline have high severity of nocturia?

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Pathophysiology оf urinary incontinence

Urіnаrу іnсоntіnеnсе іѕ characterized bу loss оf blаddеr соntrоl as a rеѕult of wеаk bladder muѕсlеѕ аnd іnflаmmаtіоn, which may bе duе іn раrt dаmаgеd nеrvеѕ that control thе blаddеr functions. In thе U.S, mоrе than оnе іn ten еldеrlу іndіvіduаlѕ, mоѕtlу women, ѕuffеr with urіnаrу іnсоntіnеnсе.

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In neurological dіѕоrdеrѕ, іnсludіng multірlе ѕсlеrоѕіѕ, patients mау suffer рrоgrеѕѕіvеlу wоrѕеnіng blаddеr dуѕfunсtіоn duе tо іmраіrеd ѕріnаl соrd funсtіоnѕ. Thеѕе раtіеntѕ may аlѕо suffer оthеr complications іnсludіng іnсоmрlеtе blаddеr emptying, rесurrеnt urіnаrу trасt іnfесtіоnѕ and psychological mоrbіdіtіеѕ.

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Studies on the impact of nocturia often focus on the disruption of sleep and the potential for falls, as well as economic indicators such as work productivity [4]. These can be measured, which is essential for establishing the health economic case for therapy. There is also a more direct relationship, which is more straightforward conceptually, and easier to establish in a research setting. Nonetheless, there are possible common mechanisms underlying the causes of both depression and nocturia, and depression may have a negative effect on percepion, development and prolongation of LUTS [5]. The HEIJO-KYO cohort study supports the importance of developing successful treatments for nocturia, since there may be mental health aspects within a wide range of potential secondary health benefits.

Marcus Drake
Physiological Urology Institution, University of Bristol, Bristol, UK
Read the full article
1 Obayashi K, Saeki K, Negoro H, Kurumatani N. Nocturia increases the incidence of depressive symptoms: a longitudinal study of the HEIJO-KYO cohort. BJU Int 2017; 120: 2805
2 Bower WF, Whishaw DM, Khan F. Nocturia as a marker of poor health: causal associations to inform care. Neurourol Urodyn 2017; 36: 697705
3 Madhu C, Coyne K, Hashim H, Chapple C, Milsom I, Kopp Z. Nocturia: risk factors and associated comorbidities; ndings from the EpiLUTS study. Int J Clin Pract 2015; 69: 150816
4 Miller PS, Hill H, Andersson FL. Nocturia work productivity and activity impairment compared with other common chronic diseases. Pharmacoeconomics 2016; 34: 127797
5 Golabek T, Skalski M, Przydacz M et al. Lower urinary tract symptoms, nocturia and overactive bladder in patients with depression and anxiety. Psychiatr Pol 2016; 50: 4173
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