Initiation and Utilization of Psychotherapy in Women With Overactive Bladder

The incidence of and factors associated with psychotherapy use in women with overactive bladder are unknown.

The primary objectives of this study were to determine the incidence of psychotherapy initiation after overactive bladder diagnosis in female Medicare beneficiaries and to analyze clinical and sociodemographic factors associated with initiation of psychotherapy within 3 years from OAB diagnosis.

This was a retrospective cohort study of women diagnosed with OAB between the years 2011 and 2021 using the Medicare 5% Limited Data Set (LDS). ICD codes were used to identify women with OAB, and from that cohort, CPT codes were used to identify incident use of psychotherapy within 5 years from OAB diagnosis. Cox proportional hazards models were used to evaluate clinical and sociodemographic factors associated with use of psychotherapy. Logistic regression was used to evaluate clinical and sociodemographic factors associated with high (≥10 sessions) versus low (<10 sessions) utilization of psychotherapy.

There were 374,918 women who met the inclusion criteria for OAB diagnosis; of these, 28,571 (8.7%) attended at least 1 psychotherapy session within 5 years. Factors associated with increased use of psychotherapy included dual Medicaid/Medicare status (aOR 1.26 [1.21, 1.31]), living in the Northeast (vs South) (aOR 1.26 [1.21, 1.31]), being diagnosed with anxiety or depression (aOR 5.14 [5.01, 5.26]), alcohol or drug abuse (aOR 1.66 [1.57, 1.75]), and increasing Charlson comorbidity score (aOR 1.03 [1.03, 1.04]).

Psychotherapy use in older women with OAB is not rare. Demographic factors and psychiatric comorbidities affect the likelihood of psychotherapy use in this population.