Association between nocturia frequency and depression in adults: evidence from NHANES 2021-2023 and a Chinese exploratory cohort.
- 1Department of Urology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China.
- 2Department of Cardiology, Xiantao First People's Hospital, Xiantao, Hubei, China.
Abstract
Background
Nocturia and depression commonly coexist and may share underlying pathways. We examined the cross-sectional association between nocturia frequency and clinically relevant depressive symptoms.Methods
We analyzed 4,162 adults from the National Health and Nutrition Examination Survey (NHANES) 2021-2023. Nocturia was categorized as 0, 1, 2, or ≥3 voids/night; a Patient Health Questionnaire-9 (PHQ-9) score ≥10 defined clinically relevant depressive symptoms. Survey-weighted logistic regression, an ordinal trend test, and subgroup analyses were conducted. A Chinese cohort (n = 255) was used for exploratory sleep-pathway analyses. A sensitivity analysis used a modified Pittsburgh Sleep Quality Index (PSQI) score excluding the sleep-disturbance component, which includes the nocturnal bathroom-use item.Results
In the fully adjusted complex survey model, two voids/night (OR: 1.42; 95% CI: 1.05-1.92; p = 0.026) and ≥3 voids/night (OR: 1.83; 95% CI: 1.40-2.40; p < 0.001) were associated with higher odds of clinically relevant depressive symptoms, with an ordinal trend (p < 0.001). An exploratory age interaction was observed (Wald p for interaction = 0.043). In the Chinese exploratory cohort, the unstandardized indirect effect through total PSQI score was 0.244 (bootstrap 95% CI 0.094-0.426), whereas the total and direct effects were non-significant. A sensitivity analysis excluding the PSQI sleep-disturbance component yielded a smaller but still positive indirect effect (0.181; bootstrap 95% CI 0.053-0.342).Conclusions
Frequent nocturia was cross-sectionally associated with clinically relevant depressive symptoms. The Chinese exploratory outpatient cohort provided exploratory support for a sleep-related statistical pathway, which was attenuated but remained positive after excluding the PSQI sleep-disturbance component. These findings highlight nocturia as a clinically relevant symptom linking urinary, sleep, and mental health, while longitudinal studies are needed to clarify temporal and causal relationships.
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BibTeX
@article{cheng2026association,
title = {{Association between nocturia frequency and depression in adults: evidence from NHANES 2021-2023 and a Chinese exploratory cohort.}},
author = {Cong Cheng and Yichi Yang and Tao Yang and Jinmin Zeng and Youji Yan and Yixiang Liao},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1801592},
url = {https://europepmc.org/article/MED/42908671},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between nocturia frequency and depression in adults: evidence from NHANES 2021-2023 and a Chinese exploratory cohort.
AU - Cong Cheng
AU - Yichi Yang
AU - Tao Yang
AU - Jinmin Zeng
AU - Youji Yan
AU - Yixiang Liao
PY - 2026
DA - 2026/10/07
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1801592
UR - https://europepmc.org/article/MED/42908671
AB - Background Nocturia and depression commonly coexist and may share underlying pathways. We examined the cross-sectional association between nocturia frequency and clinically relevant depressive symptoms.Methods We analyzed 4,162 adults from the National Health and Nutrition Examination Survey (NHANES) 2021-2023. Nocturia was categorized as 0, 1, 2, or ≥3 voids/night; a Patient Health Questionnaire-9 (PHQ-9) score ≥10 defined clinically relevant depressive symptoms. Survey-weighted logistic regression, an ordinal trend test, and subgroup analyses were conducted. A Chinese cohort (n = 255) was used for exploratory sleep-pathway analyses. A sensitivity analysis used a modified Pittsburgh Sleep Quality Index (PSQI) score excluding the sleep-disturbance component, which includes the nocturnal bathroom-use item.Results In the fully adjusted complex survey model, two voids/night (OR: 1.42; 95% CI: 1.05-1.92; p = 0.026) and ≥3 voids/night (OR: 1.83; 95% CI: 1.40-2.40; p < 0.001) were associated with higher odds of clinically relevant depressive symptoms, with an ordinal trend (p < 0.001). An exploratory age interaction was observed (Wald p for interaction = 0.043). In the Chinese exploratory cohort, the unstandardized indirect effect through total PSQI score was 0.244 (bootstrap 95% CI 0.094-0.426), whereas the total and direct effects were non-significant. A sensitivity analysis excluding the PSQI sleep-disturbance component yielded a smaller but still positive indirect effect (0.181; bootstrap 95% CI 0.053-0.342).Conclusions Frequent nocturia was cross-sectionally associated with clinically relevant depressive symptoms. The Chinese exploratory outpatient cohort provided exploratory support for a sleep-related statistical pathway, which was attenuated but remained positive after excluding the PSQI sleep-disturbance component. These findings highlight nocturia as a clinically relevant symptom linking urinary, sleep, and mental health, while longitudinal studies are needed to clarify temporal and causal relationships.
SN - 2296-2565
ER -