Association of depression and anxiety in underserved women with and without urinary incontinence

Depression and anxiety are found in increasing rates in those with lower urinary tract disease. The manner in which this association further impacts underserved women has not been fully evaluated.

For this study, 429 patients were included from general gynecology and female pelvic medicine and reconstructive surgery clinics between the ages 18 and 80 years at a Los Angeles County teaching hospital. Patients who met the study criteria completed the following questionnaires: the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory, Pelvic Floor Distress Inventory Short From, Pelvic Floor Impact Questionnaire Short Form, and the SF-12 Health Survey. Data analyses included descriptive statistics, tests of mean difference, correlations, and regression models to compare with categories of incontinent and continent women.

Of the 429 patients, 71.8% were Hispanic with a mean age of 46.6 years (range, 18-80 years) and median parity of 2.83 (0-17). Among the patients with incontinence, 34.1% reported mild, moderate, or severe depression on the BDI-II compared with 21% patients without incontinence (P = 0.003). In addition, 20.4% of the incontinent group had severe depression (BDI-II, >20), whereas only 8.2% in the continent group had severe depression (P = 0.001). The higher Urinary Distress Inventory scores did correlate with the worsening Patient Health Questionnaire (r = 0.263; P = 0.0001), BDI-II (r = 0.209; P = 0.002), and SF-12 Health Survey mental scores (r = -0.140; P = 0.04).

Current findings show that approximately one third of the women reporting incontinence in our sample had depression. Underserved patients seeking medical care for incontinence in publically funded hospitals may have depression and anxiety at rates higher than those reported in the general population.