Association of depression and urolithiasis

Objectives: To study the hypothesis that patients with urolithiasis would have a higher prevalence of depression compared to the general population. Urolithiasis is associated with frequent recurrences. Patients with urolithiasis may develop a chronic condition associated with poor quality of life and depression. The frequency and severity of stones episodes would relate to depression. Methods: In an institutional review boardapproved study; we prospectively recruited 115 patients who were evaluated for urolithiasis. Patients completed an Emory stone questionnaire covering demographics and a validated CES-D depression questionnaire. Depression scores were compared with U.S. norms. Demographics and clinical variables were analyzed. Results: On the CES-D depression questionnaire 30.4% of patients scored <16, a "significant level of physiological distress." The U.S. lifetime prevalence of depression was 16.5%. Determinants of depression included the following: family history of urolithiasis (OR = 3.49, CI = 1.51; 8.07), stone episode within the last 12 months (OR = 2.77, CI = 1.18; 6.53), and >1 emergency room visits for stone disease (OR = 2.61, CI = 1.14; 5.99). Patients with Charlson comorbidity indexes of ≤ 1 were more likely to be depressed than those scoring >1 (OR 2.89, CI = 1.20; 6.95). There were no significant associations with age at first stone, number of lifetime stones, number of surgeries, number of workdays missed, and need for dietary modifications or medications for stone prevention. Conclusions: The prevalence of depression in our patient cohort with urolithiasis was substantially greater than societal norms. Multiple stone-related factors were associated with significant psychological distress. Appreciation of this issue may allow better patient care.