URINARY incontinence

(UI) & Depression

Current Research and Implications for
Future Investigation and Intervention

Natasha Kumar, MS4

June 26, 2016

introduction
Urinary incontinence: involuntary leakage of
urine, urge vs. stress vs. mixed
Minassian et al, 2008: 49.2% (any UI), 23.7%
(stress), 9.9% (urge), 14.5% (mixed)
Markland et al, 2011: 51.1% of women

Major depression: >2 weeks with 5/9

SIGECAPS
NIMH: 15.7 million adults in 2014 (6.7% of
population)
Women: 8.1% had an episode of MDD in 2013

AGENDA
1. Is depression a concern when assessing
or treating patients with UI?
a. Correlation of depression with UI
b. The clinical impact of depression on UI

2. Should urogynecologists screen

patients presenting with a chief
complaint of UI for depression?
a. Health disparities / access to healthcare as a
cofounder
b. Unanswered questions

THE Link between

depression and UI
Melville et al 2005, Archives of Internal
Medicine

Melville et al 2005, Obstetrics &

Gynecology

 Goode et al 2008, The Journal of Urology

Depression & Clinical

outcomes IN UI
Melville et al 2005, Obstetrics &
Gynecology

Siff et al 2016, AJOG [in press]

Should
urogynecologists screen
patients presenting
with a chief complaint
of UI for depression?

health disparities:
confounding factor?

Future directions
Unanswered research question: What is the prevalence
of undertreated or undiagnosed depression in
patients presenting to a urogynecology clinic for
evaluation and treatment of UI?
PHQ-2 or PHQ-9 assessing depressive symptoms
Chart review of H&Ps to identify pre-existing diagnosis
and/or treatment (well managed, undertreated or
undiagnosed MDD)

Potential future intervention: Screening for depression

in urogynecology clinic + linkage to psychiatric
follow-up change in clinical outcomes for UI
(QOL/functional status)?
Confounding factor: concurrent UI and depression treatment

Take home points

Depression is correlated with urinary
incontinence, but none of the data proves a
causal relationship between the two diseases.
Depression impacts subjective experiences like
QOL and functional status, but its impact on
treatment effect (e.g. MUS slings) is less clear.
We need to better understand the
diagnosis/treatment status of MDD in patients
with UI to determine whether intervention (i.e.
screening) would be useful.

Bibliography
Danforth, K.N., et al. (2006). Risk factors for urinary incontinence among
middle-aged women. American Journal of Obstetrics and Gynecology
194(2): 339-345.
Duralde, E.R., et al. (2016). Bridging the gap: determinants of undiagnosed
or untreated urinary incontinence in women. American Journal of Obstetrics
and Gynecology 214(2): 266-e1.
Goode, P.S., et al. (2008). Population based study of incidence and
predictors of urinary incontinence in black and white older adults. The
Journal of Urology 179(4): 1449-1454.
Markland, A.D., et al. (2011). Prevalence and trends of urinary
incontinence in adults in the United States, 2001 to 2008. The Journal of
Urology 186(2): 589-593.
Melville, J.L., et al. (2005). Urinary incontinence in US women: a population
based study. Archives of Internal Medicine 165(5): 537-542.
Melville, J.L.et al. (2005). Incontinence severity and major depression in
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Minassian, V.A., et al. (2008). Urinary incontinence in women: variation in
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1): 324-331.
Siff, L.N., et al. (2016). The effect of major depression on quality of life after
surgery for stress urinary incontinence: a secondary analysis of the Trial of
Midurethral Slings. American Journal of Obstetrics & Gynecology . [in press]