Risk model for depression in patients with chronic prostatitis/chronic pelvic pain syndrome: A retrospective cross-sectional study

Bing Zheng, Yuanfei Ji, Wei Zhang, Xingxing Fang, Jihao You, Junjie You
In: Journal of International Medical Research · 2025 · vol. 53(12) , pp. 3000605251399460 · doi:10.1177/03000605251399460 · PMID:41342214 · W4417035643
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This study developed a nomogram integrating seven clinical predictors to accurately assess the risk of depression in patients with chronic prostatitis/chronic pelvic pain syndrome.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This retrospective cross-sectional study examined 599 patients with chronic prostatitis/chronic pelvic pain syndrome to identify predictors of depression using clinical characteristics and laboratory measures, employing feature selection and risk modeling. Depression was associated with factors including lower educational level, diabetes, hypertension, higher prostate volume, higher IPSS scores, greater number of nights, and several blood/lipid-related variables, with a separate multivariable set highlighting prostate volume, hypertension, IPSS, number of nights, white blood cell count, triglycerides, and hemoglobin. The authors’ key limitation is the cross-sectional, retrospective design, which restricts causal inference and relies on contemporaneously collected predictors. Relevance to endometriosis: it does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index, despite focusing on chronic prostatitis/chronic pelvic pain syndrome.

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Abstract

ObjectiveThe correlation between depression and prostatitis is widely acknowledged; however, there is a dearth of comprehensive risk models that can predict the risk of depression in patients with chronic prostatitis/chronic pelvic pain syndrome. In this investigation, we devised a predictive model to ascertain the likelihood of depression in these patients.MethodsThis prospective study enrolled 599 patients with chronic prostatitis/chronic pelvic pain syndrome between January 2022 and January 2025. The patients were randomly divided into training (70%, n = 419) and validation (30%, n = 180) cohorts. Using depression (Patient Health Questionnaire-9 score ≥10) as the primary outcome, we developed a nomogram using Boruta and least absolute shrinkage and selection operator feature selection followed by multivariate logistic regression. Model performance was assessed using receiver operating characteristic curve analysis (area under the receiver operating characteristic curve), calibration plots, and decision curve analysis, with internal validation performed in the validation cohort.ResultsThe nomogram integrated seven readily available predictors (prostate progression, hypertension, International Prostate Symptom Score, number of nights with sleep disturbance, white blood cell count, triglyceride level, and hemoglobin level) and showed excellent performance (area under the receiver operating characteristic curve values = 0.864 in the training cohort and 0.911 in the validation cohort).DiscussionThis nomogram can help urologists quickly identify chronic prostatitis/chronic pelvic pain syndrome patients at high risk of depression, enable early psychological intervention, and improve the quality of life of these patients.
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Abstract

Objective

Methods

Results

Discussion

Introduction Patients and methods Study design and participants Ethics and informed consent Identification of the best predictors Definition of depression Feature selection Statistical analyses

Results

Clinical features | Characteristics | Total (N = 599) | Depressed (N = 230) | Nondepressed (N = 369) | p | |---|---|---|---|---| | Age (years) | 72.00 (67.00, 77.00) | 72.00 (66.00, 77.00) | 72.00 (67.00, 78.00) | 0.394 | | Marital status | 0.592 | ||| | 0 | 135 (22.54%) | 80 (21.68%) | 55 (23.91%) | | | 1 | 464 (77.46%) | 289 (78.32%) | 175 (76.09%) | | | Educational level | 0.029 | ||| | 0 | 443 (73.96%) | 261 (70.73%) | 182 (79.13%) | | | 1 | 156 (26.04%) | 108 (29.27%) | 48 (20.87%) | | | BMI (kg/m2) | 23.63 (21.33, 24.80) | 23.41 (21.26, 24.74) | 24.10 (22.04, 24.93) | 0.020 | | Serum PSA level | 2.09 (1.40, 2.50) | 2.09 (1.50, 2.60) | 2.08 (1.30, 2.50) | 0.481 | | Prostate volume (mL) | 42.60 (31.18, 56.82) | 40.19 (30.18, 50.98) | 49.61 (32.49, 74.50) | <0.001 | | History of electrocision | 0.688 | ||| | 0 | 494 (82.47%) | 302 (81.84%) | 192 (83.48%) | | | 1 | 105 (17.53%) | 67 (18.16%) | 38 (16.52%) | | | Smoking status | 0.792 | ||| | 0 | 401 (66.94%) | 249 (67.48%) | 152 (66.09%) | | | 1 | 198 (33.06%) | 120 (32.52%) | 78 (33.91%) | | | Alcohol consumption status | 0.526 | ||| | 0 | 372 (62.10%) | 225 (60.98%) | 147 (63.91%) | | | 1 | 227 (37.90%) | 144 (39.02%) | 83 (36.09%) | | | Diabetes | <0.001 | ||| | 0 | 405 (67.61%) | 274 (74.25%) | 131 (56.96%) | | | 1 | 194 (32.39%) | 95 (25.75%) | 99 (43.04%) | | | Hypertension | <0.001 | ||| | 0 | 513 (85.64%) | 343 (92.95%) | 170 (73.91%) | | | 1 | 86 (14.36%) | 26 (7.05%) | 60 (26.09%) | | | Constipation | 0.078 | ||| | 0 | 402 (67.11%) | 258 (69.92%) | 144 (62.61%) | | | 1 | 197 (32.89%) | 111 (30.08%) | 86 (37.39%) | | | IPSS | 7.00 (4.00;14.00) | 6.00 (4.00;10.00) | 13.50 (4.00;20.00) | <0.001 | | Number of nights | <0.001 | ||| | 0 | 380 (63.44%) | 297 (80.49%) | 83 (36.09%) | | | 1 | 219 (36.56%) | 72 (19.51%) | 147 (63.91%) | | | Urine leukocyte count (1000 cells/µL) | 2.00 (1.00, 3.00) | 2.00 (2.00, 3.00) | 2.00 (1.00, 3.00) | 0.003 | | White blood cell count (1000 cells/µL) | 6.90 (5.50, 7.80) | 6.30 (5.20, 7.50) | 7.80 (5.90, 8.57) | <0.001 | | Red blood cell count (1000 cells/µL) | 4.69 (4.35, 5.03) | 4.70 (4.36, 5.01) | 4.65 (4.33, 5.06) | 0.683 | | Neutrophil count (1000 cells/µL) | 4.55 (3.33, 5.88) | 4.44 (3.22, 5.99) | 4.77 (3.36, 5.85) | 0.405 | | Lymphocyte count (1000 cells/µL) | 2.40 (1.50, 3.10) | 2.30 (1.40, 3.10) | 2.50 (1.63, 3.20) | 0.044 | | Platelet count (1000 cells/µL) | 157.00 (126.00, 190.00) | 159.00 (127.00, 193.00) | 153.00 (124.25, 185.00) | 0.213 | | Monocyte count (1000 cells/µL) | 0.53 (0.37, 0.76) | 0.50 (0.36, 0.73) | 0.56 (0.38, 0.82) | 0.055 | | Eosinophil count (1000 cells/µL) | 0.23 (0.13, 0.37) | 0.22 (0.13, 0.34) | 0.26 (0.13, 0.41) | 0.052 | | Basophil count (1000 cells/µL) | 0.03 (0.02, 0.07) | 0.03 (0.02, 0.07) | 0.04 (0.02, 0.06) | 0.603 | | Gamma glutamyl transferase level (U/L) | 32.70 (20.90, 44.90) | 32.90 (20.60, 44.60) | 32.50 (21.15, 45.27) | 0.648 | | Alanine aminotransferase level (U/L) | 17.00 (11.00, 24.00) | 17.00 (11.00, 24.00) | 16.50 (9.00, 22.00) | 0.217 | | Alkaline phosphatase level (U/L) | 83.00 (63.50, 115.00) | 84.00 (63.00, 116.00) | 82.00 (64.00, 110.25) | 0.310 | | Glycated hemoglobin (%) | 5.20 (4.70, 5.70) | 5.20 (4.70, 5.80) | 5.20 (4.70, 5.68) | 0.341 | | Triglyceride (mmol/L) | 0.52 (0.36, 1.41) | 0.47 (0.34, 0.86) | 1.26 (0.40, 1.58) | <0.001 | | Total cholesterol level (mmol/L) | 4.11 (3.02, 4.73) | 4.26 (3.44, 4.82) | 3.99 (2.36, 4.55) | <0.001 | | High-density lipoprotein cholesterol level (µmol/L) | 1.36 (1.25, 1.49) | 1.35 (1.25, 1.48) | 1.38 (1.28, 1.50) | 0.080 | | Sodium level (mmol/L) | 139.00 (136.80, 142.20) | 139.30 (137.00, 142.40) | 138.50 (136.43, 141.67) | 0.060 | | Total bilirubin level (µmol/L) | 6.90 (4.40, 16.15) | 6.60 (4.50, 13.90) | 7.85 (4.40, 18.23) | 0.211 | | Hemoglobin level (g/dL) | 112.00 (99.00, 136.95) | 108.00 (96.00, 127.00) | 126.70 (105.00, 149.43) | <0.001 | | Potassium level (mmol/L) | 4.57 (4.08, 5.07) | 4.57 (4.09, 5.06) | 4.58 (4.08, 5.08) | 0.891 | | Uric acid level (µmol/L) | 333.40 (269.10, 420.75) | 340.80 (276.80, 430.30) | 320.90 (259.68, 387.00) | 0.095 | | Urine creatinine level (µmol/L) | 81.80 (61.25, 93.20) | 79.90 (59.40, 92.90) | 82.10 (61.90, 93.73) | 0.804 | Risk factors associated with depression | Characteristics | B | SE | OR | CI | Z | p | |---|---|---|---|---|---|---| | Age (years) | 0.021 | 0.013 | 1.021 | 1.021 (0.995–1.048) | 1.592 | 0.111 | | Marital status | −0.12 | 0.24437 | 0.887 | 0.887 (0.552–1.441) | −0.49 | 0.624 | | Educational level | −0.771 | 0.24959 | 0.462 | 0.462 (0.28–0.746) | −3.09 | 0.002 | | BMI (kg/m2) | 0.081 | 0.04442 | 1.085 | 1.085 (0.995–1.184) | 1.827 | 0.068 | | Serum PSA level | −0.039 | 0.0778 | 0.962 | 0.962 (0.823–1.118) | −0.502 | 0.616 | | Prostate volume (mL) | 0.022 | 0.00453 | 1.022 | 1.022 (1.014–1.032) | 4.905 | 0 | | History of electrocision | −0.338 | 0.28328 | 0.713 | 0.713 (0.402–1.228) | −1.193 | 0.233 | | Smoking status | −0.02 | 0.216 | 0.98 | 0.98 (0.64–1.494) | −0.092 | 0.927 | | Alcohol consumption status | −0.083 | 0.21145 | 0.92 | 0.92 (0.606–1.39) | −0.393 | 0.694 | | Diabetes | 0.694 | 0.2175 | 2.001 | 2.001 (1.307–3.068) | 3.189 | 0.001 | | Hypertension | 1.518 | 0.315 | 4.564 | 4.564 (2.497–8.645) | 4.82 | 0 | | Constipation | 0.3 | 0.21557 | 1.349 | 1.349 (0.883–2.057) | 1.39 | 0.165 | | IPSS | 0.12 | 0.01692 | 1.127 | 1.127 (1.092–1.167) | 7.087 | 0 | | Number of nights | 1.809 | 0.22467 | 6.107 | 6.107 (3.954–9.548) | 8.053 | 0 | | Urine leukocyte count (1000 cells/µL) | −0.073 | 0.06168 | 0.929 | 0.929 (0.82–1.046) | −1.188 | 0.235 | | White blood cell count (1000 cells/µL) | 0.407 | 0.07406 | 1.502 | 1.502 (1.302–1.742) | 5.49 | 0 | | Red blood cell count (1000 cells/µL) | −0.141 | 0.24354 | 0.869 | 0.869 (0.538–1.399) | −0.579 | 0.563 | | Neutrophil count (1000 cells/µL) | 0.051 | 0.0682 | 1.052 | 1.052 (0.92–1.203) | 0.743 | 0.457 | | Lymphocyte count (1000 cells/µL) | 0.121 | 0.11122 | 1.129 | 1.129 (0.908–1.405) | 1.088 | 0.277 | | Platelet count (1000 cells/µL) | −0.002 | 0.00146 | 0.998 | 0.998 (0.995–1.001) | −1.389 | 0.165 | | Monocyte count (1000 cells/µL) | 0.531 | 0.38683 | 1.701 | 1.701 (0.796–3.638) | 1.374 | 0.17 | | Eosinophils count (1000 cells/µL) | 0.832 | 0.48532 | 2.297 | 2.297 (0.92–6.28) | 1.714 | 0.087 | | Basophils count (1000 cells/µL) | 1.72 | 1.61906 | 5.583 | 5.583 (0.227–167.5) | 1.062 | 0.288 | | Gamma glutamyl transferase level (U/L) | 0.007 | 0.00736 | 1.007 | 1.007 (0.992–1.021) | 0.918 | 0.359 | | Alanine aminotransferase level (U/L) | −0.007 | 0.00913 | 0.993 | 0.993 (0.975–1.01) | −0.816 | 0.415 | | Alkaline phosphatase level (U/L) | −0.007 | 0.00291 | 0.993 | 0.993 (0.987–0.998) | −2.495 | 0.013 | | Glycated hemoglobin (%) | −0.185 | 0.13874 | 0.831 | 0.831 (0.632–1.09) | −1.331 | 0.183 | | Triglyceride level (mmol/L) | 0.964 | 0.18609 | 2.621 | 2.621 (1.826–3.791) | 5.178 | 0 | | Total cholesterol level (mmol/L) | −0.232 | 0.06725 | 0.793 | 0.793 (0.694–0.904) | −3.451 | 0.001 | | High-density lipoprotein cholesterol level (µmol/L) | 1.444 | 0.68395 | 4.237 | 4.237 (1.12–16.42) | 2.111 | 0.035 | | Sodium level (mmol/L) | 0.001 | 0.02293 | 1.001 | 1.001 (0.957–1.047) | 0.049 | 0.961 | | Total bilirubin level (µmol/L) | 0.016 | 0.01161 | 1.016 | 1.016 (0.993–1.039) | 1.335 | 0.182 | | Hemoglobin level (g/dL) | 0.02 | 0.00406 | 1.02 | 1.02 (1.012–1.029) | 4.971 | 0 | | Potassium level (mmol/L) | 0.06 | 0.14938 | 1.062 | 1.062 (0.791–1.423) | 0.401 | 0.689 | | Uric acid level (µmol/L) | 0 | 0.00093 | 1 | 1. (0.998–1.002) | −0.136 | 0.892 | | Urine creatinine level (µmol/L) | −0.001 | 0.00409 | 0.999 | 0.999 (0.991–1.007) | −0.142 | 0.887 | | Variables | B | SE | OR | CI | Z | p | |---|---|---|---|---|---|---| | Prostate volume (mL) | 0.007 | 0.00627 | 1.007 | 1.007 (0.994–1.019) | 1.124 | 0.261 | | Hypertension | 0.96 | 0.45788 | 2.613 | 2.612 (1.067–6.471) | 2.097 | 0.036 | | IPSS | 0.116 | 0.02168 | 1.123 | 1.122 (1.077–1.173) | 5.341 | 0 | | Number of nights | 1.756 | 0.27671 | 5.787 | 5.786 (3.393–10.06) | 6.344 | 0 | | White blood cell count (1000 cells/µL) | 0.365 | 0.0937 | 1.44 | 1.440 (1.202–1.738) | 3.893 | 0 | | Triglyceride level (mmol/L) | 1.182 | 0.23998 | 3.261 | 3.260 (2.053–5.273) | 4.925 | 0 | | Hemoglobin level (g/dL) | 0.018 | 0.00528 | 1.018 | 1.018 (1.007–1.029) | 3.436 | 0.001 | Modal chart model for estimating depression risk Validation of nomogram models Analysis of the clinical practicability and rationality of the prediction model

Discussion

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