IPSS quality of life question: a possible indicator of depression among patients with lower urinary tract symptoms

Introduction: Depression and benign prostatic hyperplasia (BPH) are prevalent, especially in older patient populations. Emerging data suggest potential interactions between depression and BPH. We sought to assess whether the questions of the International Prostate Symptom Score (IPSS), specifically the quality of life (QoL) question, predict depression. Materials and methods: We asked 541 consecutive male patients over the age of 40 in a tertiary care clinic to self-administer the IPSS QoL score and the Geriatric Depression Scale (GDS), a validated screening tool for depression. Receiver operating characteristics (ROC) curves were depicted and used to determine the area under the curve (AUC) and relative sensitivity and specificity of the individual questions of the IPSS relative to the GDS. Results: Of the cohort, 17.2 percent screened positive for depression. More than half (54.7%) of nondepressed patients had a QoL score of 0-2, while a similar number of depressed patients (50.8%) had a QoL score of 5 or 6. The QoL question of the IPSS exhibited an AUC (95% CI, p value) of 0.735 (0.669-0.800, p < 0.001). A cut-off of QoL scores > 5 exhibited the highest specificity (93.1%)while a cut off of QoL scores > 1 exhibited a sensitivity of 90.0%. Conclusions: Future studies should validate these findings and shed further light on this tool's clinical utility. Pending this future validation, patients with a score of 6 could be considered for further mental health evaluation.