Impact of comorbid depression on treatment adherence and long-term urinary function following surgery for benign prostatic hyperplasia

doi:10.5498/wjp.119137

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Aug 19, 2026; 16(8): 119137
Published online Aug 19, 2026. doi: 10.5498/wjp.119137

Table 1 Comparison of general clinical characteristics between both groups, n (%)/mean ± SD

Indicator	Comorbidity group (n = 65)	Non-comorbidity group (n = 691)	t/χ² value	P value
Age (years)	72.35 ± 6.82	67.12 ± 5.94	6.732	< 0.001
Educational level			12.345	0.006
Primary school or below	28 (43.1)	185 (26.8)	-	-
Junior high school	22 (33.8)	276 (39.9)	-	-
Senior high/technical school	10 (15.4)	152 (22.0)	-	-
College degree or above	5 (7.7)	78 (11.3)	-	-
Marital status			8.217	0.004
Married	42 (64.6)	553 (80.0)	-	-
Unmarried/divorced/widowed	23 (35.4)	138 (20.0)	-	-
Body mass index (kg/m²)	22.15 ± 2.34	23.87 ± 2.56	5.128	< 0.001
Smoking history	21 (32.3)	218 (31.5)	0.021	0.885
Drinking history	18 (27.7)	195 (28.2)	0.008	0.928
Underlying disease			-	-
Hypertension	38 (58.5)	296 (42.8)	6.542	0.011
Diabetes mellitus	25 (38.5)	183 (26.5)	4.893	0.027
Coronary heart disease	16 (24.6)	152 (22.0)	0.287	0.592
Surgical method			0.154	0.695
Transurethral resection of prostate	36 (55.4)	385 (55.7)	-	-
Transurethral plasmakinetic enucleation of prostate	29 (44.6)	306 (44.3)	-	-
Operation time (minute)	68.23 ± 15.42	66.78 ± 14.95	0.689	0.491
Intraoperative blood loss (mL)	52.35 ± 18.67	50.12 ± 17.89	0.853	0.394

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Table 2 Comparison of treatment adherence between both groups, n (%)/mean ± SD

Indicator	Comorbidity group (n = 65)	Non-comorbidity group (n = 691)	t/χ² value	P value
ASMES	4.21 ± 1.35	6.89 ± 1.27	16.783	< 0.001
Treatment adherence grade (n)			89.215	< 0.001
High adherence (7-8 scores)	8 (12.3)	356 (51.5)	-	-
Moderate adherence (4-6 scores)	32 (49.2)	275 (39.8)	-	-
Low adherence (0-3 scores)	25 (38.5)	60 (8.7)	-	-
Medication omission rate (%)	28.35 ± 8.67	8.12 ± 3.45	23.564	< 0.001
Follow-up examination omission rate (%)	32.18 ± 9.24	7.56 ± 2.89	25.127	< 0.001
Health behavior implementation rate (%)	35 (53.8)	587 (84.9)	42.351	< 0.001

ASMES: The Adherence Self-Efficacy Measure.

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Table 3 Comparison of urinary function parameters between both groups before and after surgery, mean ± SD

Indicator	Group	Pre-operation	6 months post-operation	12 months post-operation	F (group/time/interaction)	P (group/time/interaction)
IPSS score (points)	Comorbidity group	27.35 ± 4.82	15.62 ± 3.45^a^,^b	12.18 ± 2.97^a^,^b	6.681/7.564/5.194	< 0.001/< 0.001/< 0.001
	Non-comorbidity group	26.89 ± 4.67	9.87 ± 2.89^a	6.35 ± 2.12^a	-	-
QOL score (points)	Comorbidity group	5.23 ± 0.89	3.15 ± 0.67^a^,^b	2.56 ± 0.54^a^,^b	5.618/6.024/4.264	< 0.001/< 0.001/< 0.001
	Non-comorbidity group	5.18 ± 0.92	2.01 ± 0.53^a	1.32 ± 0.41^a	-	-
Q_max (mL/second)	Comorbidity group	7.89 ± 2.15	12.35 ± 3.24^a^,^b	15.62 ± 3.87^a^,^b	4.648/5.268/4.915	< 0.001/< 0.001/< 0.001
	Non-comorbidity group	7.67 ± 2.08	16.89 ± 3.56^a	20.35 ± 4.12^a	-	-
PVR (mL)	Comorbidity group	156.23 ± 45.89	89.35 ± 28.67^a^,^b	65.18 ± 22.34^a^,^b	11.264/14.261/10.264	< 0.001/< 0.001/< 0.001
	Non-comorbidity group	152.87 ± 43.65	56.78 ± 21.45^a	38.25 ± 18.67^a	-	-

^aP < 0.05 vs before surgery within the same group.

^bP < 0.05 vs the non-comorbidity group.

IPSS: International Prostate Symptom Score; QOL: Quality of Life; Q_max: Maximum flow rate; PVR: Post-void residual urine volume.

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Table 4 Comparison of improvement in postoperative urinary function parameters between both groups

Indicator	Comorbidity group (n = 65)	Non-comorbidity group (n = 691)	t value	P value
Improvement in IPSS score (points)	15.17 ± 4.23	20.54 ± 5.12	9.876	< 0.001
Improvement in QOL score (points)	2.67 ± 0.89	3.86 ± 1.05	10.234	< 0.001
Improvement in Q_max (mL/second)	7.73 ± 3.15	12.68 ± 3.89	12.567	< 0.001
Improvement in PVR (mL)	91.05 ± 42.35	114.62 ± 48.76	4.789	< 0.001

Large SD suggest substantial individual variability in post-void residual urine volume improvement, which may be influenced by factors other than depression. IPSS: International Prostate Symptom Score; QOL: Quality of Life; Q_max: Maximum flow rate; PVR: Post-void residual urine volume.

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Table 5 Multivariate logistic regression analysis of poor treatment adherence in patients with benign prostatic hyperplasia after surgery

Independent variable	Assignment	β	SE	Wald χ²	P value	OR	95%CI
Depression	Absent = 0, Present = 1	1.169	0.325	12.893	< 0.001	3.215	1.892-5.463
Age	< 70 years = 0, ≥ 70 years = 1	0.745	0.289	6.678	0.010	2.108	1.276-3.482
Educational level	College degree or above = 0, senior high/technical school = 1, junior high school = 2, primary school or below = 3	0.685	0.294	5.342	0.021	1.983	1.195-3.294
Marital status	Married = 0, unmarried/divorced/widowed = 1	0.452	0.301	2.256	0.133	1.572	0.896-2.751
Body mass index	≥ 24 kg/m² = 0, < 24 kg/m² = 1	0.389	0.312	1.554	0.213	1.475	0.821-2.643
Hypertension	Absent = 0, present = 1	0.321	0.298	1.168	0.280	1.379	0.786-2.421
Diabetes mellitus	Absent = 0, present = 1	0.295	0.305	0.938	0.333	1.344	0.759-2.381

OR: Odds ratio; CI: Confidence interval.

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Table 6 Correlation analysis between depression severity and urinary function parameters

Indicator	r value	P value
IPSS score	0.426	< 0.001
QOL score	0.451	< 0.001
Q_max (mL/second)	-0.389	< 0.001
PVR (mL)	0.367	< 0.001

IPSS: International Prostate Symptom Score; QOL: Quality of Life; Q_max: Maximum flow rate; PVR: Post-void residual urine volume.

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Citation: Dun WC, Xia Q, Wei ZQ, Li CB. Impact of comorbid depression on treatment adherence and long-term urinary function following surgery for benign prostatic hyperplasia. World J Psychiatry 2026; 16(8): 119137
URL: https://www.wjgnet.com/2220-3206/full/v16/i8/119137.htm
DOI: https://dx.doi.org/10.5498/wjp.119137

Dun WC, Xia Q, Wei ZQ, Li CB. Impact of comorbid depression on treatment adherence and long-term urinary function following surgery for benign prostatic hyperplasia. World J Psychiatry 2026; 16(8): 119137 [DOI: 10.5498/wjp.119137]

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