Electronic Theses and Dissertations




Ransome Eke



Date of Award


Document Type


Degree Name

Doctor of Philosophy



Committee Chair

Xinhua Yu

Committee Member

Vikki Nolan

Committee Member

Hongmei Zhang

Committee Member

Edwards Dismuke


Depression is a common cause of disability and mortality in the elderly population. Benign prostatic hyperplasia (BPH), a benign enlargement of prostate gland, may be related to depression in men, as reported in previous studies. This dissertation explored the co-occurrence of depression and BPH in elderly men, the transition probabilities of depression status as its relations to varying BPH transition status, and the effect of socioeconomic disadvantage on depression in men with BPH. The data were drawn from the Medicare Current Beneficiary Survey (MCBS) and Medicare claims data from 2005 through 2009. The study population comprised of community dwelling elderly male Medicare beneficiaries aged 65 years or above (N=10, 067). Depression and BPH were defined using both self-report and diagnostic codes. Two transition processes for depression and BPH were constructed based on two follow-up years. The Markov process for depression and BPH states progression and their probabilities were determined. The transition rates were assessed using generalized linear mixed models with covariance matrix estimated by generalized estimating equations to explain the variations between repeated measures. Survey weights and multilevel cluster effect was considered in all our analysis. We adjusted for age, race, marital status, education level, income levels, insurance coverage, and comorbidities including cancer, diabetes, heart diseases, arthritis, and other mental health conditions. We found an overall prevalence of 13% for depression and about 41% for BPH. The adjusted risk ratio (ARR) of depression in men with BPH compared with no BPH was 1.16 (95% CI, 1.04-1.30). Compared to those who remained with no-BPH, there was about 50% more chances of transiting from depression to no depression state in men who progressed from BPH to no-BPH status, (Adjusted transition rate, 1.49; 95% CI, 1.05-2.12;p-values= 0.021). The probability of transition from no-depression to depression in elderly men with two or more comorbidity was about two-folds higher compared with no comorbidity. Heterogeneity in socioeconomic context is a significant determinant of depression risk in elderly men with BPH. In conclusion, a significant impact of BPH on depression was reported. There is need to sensitize healthcare professionals on the importance of carefully depression evaluation among elderly men.


Data is provided by the student.

Library Comment

dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.