Cross-sectional and prospective associations between multidimensional psychological distress and urogenital disorders: findings from the UK biobank

Psychological distress is a major public health issue with multisystemic effects, yet its multidimensional nature and specific links to urogenital disorders remain inadequately characterized due to methodological limitations of prior studies. This large-scale study utilized data from the UK Biobank ( N = 501,988) to investigate both cross-sectional and prospective associations between six validated psychometric instruments including emotional distress (MHS-20), neuroticism (N-12), somatic symptoms (RDS-4), depression (PHQ-9), and anxiety (GAD-7) and eight non-infectious urogenital conditions. Multivariable-adjusted logistic and Cox proportional hazards models were employed, controlling for demographic, socioeconomic, lifestyle, and clinical confounders. Multiplicative interaction analyses were introduced to evaluate effect modification by age, sex, and menopausal status. Higher scores across all psychological scales were associated with increased incidence of urogenital diseases, with the strongest associations observed for RDS-4 with urgency urinary incontinence (HR = 1.48, 95% CI: 1.39–1.58), IC/BPS (HR = 1.49, 95% CI: 1.25–1.78), and pelvic pain (HR = 1.49, 95% CI: 1.35–1.64). Interaction analyses indicated significant effect modifications by age, sex, and menopausal status for specific bladder and pelvic floor disorders. For sex-specific patterns, females exhibited stronger associations for IC/BPS and other bladder disorders, whereas pelvic floor dysfunction showed stronger associations in males. Associations for pelvic myalgia remained consistent across sexes, indicating no significant effect modification. Chronic prostatitis showed limited to no prospective associations with psychological distress. Multidimensional psychological distress represents a risk factor for urogenital disorders, with notable demographic variations. These findings support the incorporation of structured psychological assessments into urological practice to facilitate a more integrated, biopsychosocial approach to patient management.