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Incontinence Severity and Major Depression in Incontinent Women

From the ¹Departments of Obstetrics and Gynecology and ²Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; and ³Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.

Objective: Research has shown an association between urinary incontinence and depression. Studies that use community-based samples and major depressive disorder diagnostic criteria are needed. The objective of this study was to estimate the prevalence of and factors associated with major depression in women with urinary incontinence.

Methods: We conducted an age-stratified postal survey of 6,000 women aged 30–90 years. Subjects were randomly selected from enrollees in a large health maintenance organization in Washington state. Main outcome measures were prevalence of current major depression and adjusted odds ratios for factors associated with major depression in women with urinary incontinence.

Results: The response rate was 64% (n = 3,536) after applying exclusion criteria. The prevalence of urinary incontinence was 42% (n = 1,458). The prevalence of major depression was 3.7% (n = 129), with 2.2% in those without incontinence versus 6.1% in those with incontinence. Among women with incontinence, major depression prevalence rates differed by incontinence severity (2.1% in mild, 5.7% in moderate, and 8.3% in severe) and incontinence type (4.7% in stress, 6.6% in urge/mixed). Obesity (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3–4.0), current smoking (OR 2.7, 95% CI 1.5–4.9), lower educational attainment (OR 2.0, 95% CI 1.2–3.3), moderate incontinence (OR 2.7, 95% CI 1.1–6.6), and severe incontinence (OR 3.8, 95% CI 1.6–9.1) were each associated with increased odds of major depression in women with urinary incontinence, controlling for age and medical comorbidity. Compared with women with incontinence alone, women with comorbid incontinence and major depression had significantly greater decrements in quality of life and functional status and increased incontinence symptom burden.

Conclusion: Women with moderate-to-severe urinary incontinence should be screened for comorbid major depression and offered treatment if depression is present.

Level of Evidence: II-2

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