Incontinence linked to depression in nearly half of women

Depression and incontinence appear to be associated in women, but the statistical strength of that association depends on the instrument used to classify depression, according to this population-based, cross-sectional study. Investigators used data on 5,701 women aged 50 to 69 years collected during interviews conducted for the Health and Retirement Study. Approximately 16% of the women reported either mild-moderate or severe urinary incontinence. The diagnosis of depression was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders and the revised Center for Epidemiologic Studies Depression Scale. Women with mild-moderate incontinence were significantly more likely to suffer from depression than a matched population without incontinence. Those with mild-moderate incontinence had a 40% greater risk (95% CI, 1.06-1.87); women with severe incontinence had an 82% greater risk (95% CI, 1.26-2.63). However, the association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjustment for covariates.
Level II-2 evidenceComment. This study supports previous reports on the association of urinary incontinence and depression by Melville et al (Am J Obstet Gynecol 2002), Dugan et al (J Am Geriatr Soc 2000), and Zorn et al (J Urol 1999). This study is powerful in numbers and depression instruments, but it is limited by self-reporting of urinary incontinence and the lack of specific urinary incontinence diagnoses. Nonetheless, the association was still significant. Nygaard's study, like Melville's, was carefully designed and used validated psychiatric diagnostic instruments to reveal the association, which has limited previous studies findings. The symptom severity measures used in this study did not reveal the association, highlighting the point that depression may go undiagnosed when only symptom screening instruments, rather than diagnostic instruments, are used. Multiple studies have now shown an association between depression and urinary incontinence. This study reinforces the need to screen this at-risk population.

Gretchen M. Lentz, MD
Associate Professor of Obstetrics and Gynecology
Associate Director of the Women's Health Care Center
University of Washington
Seattle, WAComment. The statistical strength of the association between depression and self-reported incontinence in this study depended on the instrument used to identify and diagnose the depression. Approximately 16% of the 5,701 women reported mild to moderate or severe urinary incontinence, although the exact type of problems were not further identified (menopause was not identified as a covariable). The importance of this study is to consider that depression may accompany incontinence and should be diagnosed and treated accordingly.

Miriam Rosenthal, MD

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