Association between benign prostatic hyperplasia and depression and anxiety: a cross-sectional and prospective cohort study based on the UK biobank

Benign prostatic hyperplasia (BPH) commonly affects ageing men, with unclear long-term psychiatric effects. We examined these associations using cross-sectional, longitudinal and genetic data from the UK Biobank. Our analysis of 229,001 UK Biobank individuals examined cross-sectional and prospective relationships between BPH and mental health. Logistic regression models investigated baseline associations, while 51,805 individuals followed for seven years and 171,228 following for 14.9 years assessed prospective hazards. To determine causality, Mendelian Randomisation (MR) was used. At baseline, BPH is associated with higher odds of depression (OR: 1.42, 95% CI: 1.34–1.51) and anxiety (OR 1.44, 1.36–1.53). Prospectively, BPH predicted incident depression (OR 1.41, 1.12–1.79) and anxiety (OR 1.48, 1.09–2.01) at seven years and increased depression and anxiety risk over 14.9 years (HR 1.38, 1.24–1.53) and 1.45, 1.30–1.61). Subgroup analysis indicates that BPH significantly raises depression and anxiety risk, particularly in those aged <60, employed, high income or less active. BPH causes depression (OR 1.003, 1.000–1.006), but not anxiety, while bidirectional MR showed that anxiety slightly protects against BPH risk (OR 0.998, 0.997–1.000). BPH is associated with elevated risks of depression and anxiety, with genetic evidence supporting a causal link to depression. KeypointsBenign prostatic hyperplasia (BPH) is associated with increased long-term risks of depression and anxiety.Genetic evidence supports a causal relationship from BPH to depression, but not anxiety, highlighting differing mechanisms.Younger, employed, higher-income, and physically inactive men are especially vulnerable, suggesting targeted interventions are necessary.Future research should focus on developing interdisciplinary strategies for screening and supporting mental health in men with BPH Benign prostatic hyperplasia (BPH) is associated with increased long-term risks of depression and anxiety. Genetic evidence supports a causal relationship from BPH to depression, but not anxiety, highlighting differing mechanisms. Younger, employed, higher-income, and physically inactive men are especially vulnerable, suggesting targeted interventions are necessary. Future research should focus on developing interdisciplinary strategies for screening and supporting mental health in men with BPH