Urinary Incontinence After Stress Incontinence Surgery: A Risk Factor for Depression

• Published in: Urology (Ridgewood, N.J.) N.J.), 2009, Vol.73 (1), p.41-46
• Main Authors: Stoffel, John T, Morgan, Daniel, Dunn, Rodney, Hsu, Yvonne, Fenner, Dee, DeLancey, John, McGuire, Edward J, Wei, John T
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; Cross-Sectional Studies; Depression; Depression - etiology; Female; Humans; Medical sciences; Middle Aged; Mood disorders; Nephrology. Urinary tract diseases; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Severity of Illness Index; Surveys and Questionnaires; Treatment Failure; Urinary Incontinence - complications; Urinary Incontinence, Stress - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.08.478

Objectives To determine whether urinary incontinence after stress incontinence surgery is a risk factor for concomitant symptoms of depression. Methods Women who underwent stress urinary incontinence surgery from 1993 to 2002 were given 2 validated quality-of-life questionnaires, the Incontinence Symptom Index and the Patient Health Questionnaire, to assess the severity of urinary incontinence symptoms after surgery and to identify moderate-to-severe depressive symptoms, respectively. Bivariate and multivariate statistical models were then constructed to determine the independent parameters associated with the reporting of moderate-to-severe depressive symptoms in this group of women. Results Of the 687 identified women, 437 (64%) returned completed questionnaires. The average patient age was 59 years, with a median follow-up after the index surgery of 2.9 years (range 0.4-10.1). Urinary incontinence after stress incontinence surgery was found to be an independent risk factor for associated moderate-to-severe depressive symptoms. Each 10-point increase in the Incontinence Symptom Index total symptom severity score resulted in a near doubling of the odds of having concomitant depressive symptoms (odds ratio 1.93, 95% confidence interval 1.41-2.65). Additional comorbid conditions (odds ratio 1.46, 95% confidence interval 1.23-1.73), additional postoperative vaginal prolapse surgery (odds ratio 3.20, 95% confidence interval 1.30-7.89), and perimenopausal status (odds ratio 3.79, 95% confidence interval 1.60-8.95) were also significantly associated with depressive symptoms. Conclusions Urinary incontinence after stress incontinence surgery is strongly associated with moderate-to-severe postoperative depression symptoms, even years after the index surgery. Additional studies are necessary to examine the causal relationships between incontinence and depression.