The Mediating Role of Depression in the Association Between Food Insecurity and Lower Urinary Tract Symptoms in Middle-Aged and Older Men: A Population-Based Study.

OBJECTIVE

This study aimed to explore the association between food insecurity (FI) and lower urinary tract symptoms (LUTS) in middle-aged and older men, and to evaluate the mediating role of depression in this relationship.

METHODS

Data were drawn from the National Health and Nutrition Examination Survey (NHANES) 2005-2008, including 2777 men aged 40 years and older. FI was assessed using the Household Food Security Survey Module, depression was measured by the PHQ-9 scale, and LUTS were identified via symptoms such as hesitancy, incomplete bladder emptying, incontinence, and nocturia. Weighted logistic regression and restricted cubic spline models were applied to assess associations. Mediation analysis was conducted using depression as a mediator.

RESULTS

After full adjustment, FI was significantly associated with higher odds of incomplete bladder emptying (OR = 1.94, 95% CI: 1.11-3.36), urinary incontinence (OR = 2.11, 95% CI: 1.44-3.09), nocturia (OR = 1.59, 95% CI: 1.11-2.29), and clinical LUTS (OR = 2.49, 95% CI: 1.63-3.80). Moreover, higher PHQ-9 scores were consistently associated with increased odds of all types of LUTS, including urinary hesitancy, incomplete bladder emptying, urinary incontinence, nocturia, and clinical LUTS, in a dose-dependent manner. Mediation analysis indicated that depression partially mediated the association between FI and LUTS. Specifically, depression accounted for 12.22% of the effect of FI on urinary hesitancy, 8.90% on incomplete bladder emptying, 9.90% on urinary incontinence, 7.74% on nocturia, and 6.69% on clinical LUTS (all p < 0.05). These results demonstrate that depression plays a modest but statistically significant mediating role in the pathway linking FI to LUTS.

CONCLUSIONS

FI is significantly associated with multiple LUTS among middle-aged and older men, with depression partially mediating this relationship. Addressing both food access and mental health, particularly depression, may be critical for mitigating LUTS burden in this population.

CLINICAL TRIAL REGISTRATION NUMBER: Our study does not require a clinical trial registration. The survey data of our study are publicly available on the internet for data users and researchers throughout the world (https://www.cdc.gov/nchs/nhanes/?CDC_AAref_Val=https://www.cdc.gov/nchs/nhanes/index.htm).