Elsevier

Obstetrics & Gynecology

Volume 101, Issue 1, January 2003, Pages 149-156
Obstetrics & Gynecology

Regular paper
Urinary incontinence and depression in middle-aged United States women

https://doi.org/10.1016/S0029-7844(02)02519-XGet rights and content

Abstract

Objective

To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression.

Methods

This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50–69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders.

Results

Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates.

Conclusion

Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.

Section snippets

Materials and methods

The study population is drawn from participants in the Health and Retirement Survey, a large prospective population-based study36 funded by the National Institute of Aging and coordinated by the Institute for Social Research at the University of Michigan. The Health and Retirement Survey was designed to provide in-depth information about health, economic, and sociological issues surrounding retirement. At inception, target subjects ranged in age from 51 to 61 years; spouses of any age were also

Results

There were 5701 women in this sample. Nine hundred five women (15.9%) reported incontinence and 4796 did not. Of the total, 249 (4.4%) had severe incontinence, whereas 591 (10.5%) had mild-moderate incontinence. Sixty-five women did not respond to the frequency of incontinence question and could not be categorized. These 65 women are not included in subsequent logistic regression analyses.

Approximately one in ten women (9.8%) endorsed six or more symptoms on the revised Center for Epidemiologic

Discussion

Using data from a large population-based survey, we found that depression (assessed by the Diagnostic and Statistical Manual of Mental Disorders–based depression tool) was significantly associated with the prevalence of urinary incontinence. After adjusting for covariates, women with severe incontinence were 80% more likely to be depressed, whereas for women with mild incontinence, the risk of depression was 40% higher than for women without incontinence. However, the association did not hold

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