Advertisement

Urinary incontinence, depression and posttraumatic stress disorder in women veterans

Published:April 18, 2012DOI:https://doi.org/10.1016/j.ajog.2012.04.016

      Objective

      To study associations between urinary incontinence (UI) symptoms, depression, and posttraumatic stress disorder in women veterans.

      Study Design

      This cross-sectional study enrolled women 20 to 52 years of age registered at 2 midwestern US Veterans Affairs Medical Centers or outlying clinics within 5 years preceding study interview. Participants completed a computer-assisted telephone interview assessing urogynecologic, medical, and mental health. Multivariable analyses studied independent associations between stress and urgency UI and depression and posttraumatic stress disorder.

      Results

      Nine hundred sixty-eight women mean aged 38.7 ± 8.7 years were included. Of these, 191 (19.7%) reported urgency/mixed UI and 183 (18.9%) stress UI. Posttraumatic stress disorder (odds ratio, 1.8; 95% confidence interval, 1.0–3.1) but not depression (odds ratio, 1.2; 95% confidence interval, 0.73–2.0) was associated with urgency/mixed UI. Stress UI was not associated with posttraumatic stress disorder or depression.

      Conclusion

      In women veterans, urgency/mixed UI was associated with posttraumatic stress disorder but not depression.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zorn B.H.
        • Montgomery H.
        • Pieper K.
        • Gray M.
        • Steers W.D.
        Urinary incontinence and depression.
        J Urol. 1999; 162: 82-84
        • Lagro-Janssen A.L.
        • Debruyne F.M.
        • Van Weel C.
        Psychological aspects of female urinary incontinence in general practice.
        Br J Urol. 1992; 70: 499-502
        • Nygaard I.
        • Turvey C.
        • Burns T.L.
        • Crischilles E.
        • Wallace R.
        Urinary incontinence and depression in middle-aged United States women.
        Obstet Gynecol. 2003; 101: 149-156
        • Perry S.
        • McGrother C.W.
        • Turner K.
        An investigation of the relationship between anxiety and depression and urge incontinence in women: development of a psychological model.
        Br J Health Psychol. 2006; 11: 463-482
        • Klausner A.P.
        • Steers W.D.
        Corticotropin releasing factor: a mediator of emotional influences on bladder function.
        J Urol. 2004; 172: 2570-2573
        • Melville J.L.
        • Fan M.-Y.
        • Rau H.
        • Nygaard I.E.
        • Katon W.J.
        Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample.
        Am J Obstet Gynecol. 2009; 201: 490.e1-490.e7
        • Milliken C.S.
        • Auchterlonie J.L.
        • Hoge C.W.
        Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war.
        JAMA. 2007; 298: 2141-2148
        • Bogner H.R.
        • Gallo J.J.
        • Swartz K.L.
        • Ford D.E.
        Anxiety disorders and disability secondary to urinary incontinence among adults over age 50.
        Int J Psychiatry Med. 2002; 32: 141-154
        • Sadler A.G.
        • Mengeling M.A.
        • Syrop C.H.
        • Torner J.C.
        • Booth B.M.
        Lifetime sexual assault and cervical cytologic abnormalities among military women.
        J Women's Health. 2011; 20: 1693-1701
        • Sandvik H.
        • Hunskaar S.
        • Vanvik A.
        • Bratt H.
        • Seim A.
        • Hermstad R.
        Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.
        J Clin Epidemiol. 1995; 48: 339-343
        • Hannestad Y.S.
        • Rortveit G.
        • Sandvik H.
        • Hunskaar S.
        A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study.
        J Clin Epidemiol. 2000; 53: 1150-1157
        • Brown J.S.
        • Vittinghoff E.
        • Lin F.
        • Nyberg L.M.
        • Kusek J.W.
        • Kanaya A.M.
        Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002.
        Diabetes Care. 2006; 29: 1307-1312
        • Kessler R.
        • Andrews G.
        • Mroczek D.
        • Ustun B.
        • Wittchen H.U.
        The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF).
        Int J Methods Psychiatric Res. 1998; 7: 171-185
        • Foa E.B.
        • Riggs D.S.
        • Dancu C.V.
        • Rothbaum B.O.
        Reliability and validity of a brief instrument for assessing post-traumatic stress disorder.
        J Trauma Stress. 1993; 6: 459-473
        • Brewin C.R.
        • Andrews B.
        • Rose S.
        • Kirk M.
        Acute stress disorder and posttraumatic stress disorder in victims of violent crime.
        Am J Psychiatry. 1999; 156: 360-366
        • Patten S.B.
        Major depression prevalence in Calgary.
        Can J Psychiatry. 2000; 45: 923
        • Resnick H.S.
        • Kilpatrick D.G.
        • Dansky B.S.
        • Saunders B.E.
        • Best C.L.
        Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women.
        J Consult Clin Psychol. 1993; 61: 984-991
        • Kilpatrick D.G.
        • Ruggeiro K.J.
        Rape In Iowa: a report to the state.
        National Violence Against Women Prevention Research Center, 2004
        • American College of Obstetricians and Gynecologists
        Educational bulletin: sexual assault.
        ACOG Educ Bull. 1997; 242: 756-762
        • Ware Jr, J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Women's Research and Education Institute
        (Accessed Oct. 24, 2011)
        • Milsom I.
        • Abrams P.
        • Cardozo L.
        • Roberts R.G.
        • Thuroff J.
        • Wein A.J.
        How widespread are the symptoms of an overactive bladder and how are they managed?.
        BJU Int. 2001; 87: 760-766
        • Bogner H.R.
        • Gallo J.J.
        • Sammel M.D.
        • Ford D.E.
        • Armenian H.K.
        • Eaton W.W.
        Urinary incontinence and psychological distress in community-dwelling older adults.
        J Am Geriatr Soc. 2002; 50: 489-495
        • van der Vaart C.H.
        • Roovers J.P.
        • de Leeuw J.R.
        • Heintz A.P.
        Association between urogenital symptoms and depression in community-dwelling women aged 20 to 70 years.
        Urology. 2007; 69: 691-696
        • Bogner H.R.
        • Gallo J.J.
        Urinary incontinence, condition-specific functional loss, and psychological distress.
        J Am Geriatr Soc. 2002; 50: 1311
        • Seal K.H.
        • Bertenthal D.
        • Miner C.R.
        • Sen S.
        • Marmar C.
        Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.
        Arch Intern Med. 2007; 167: 476-482
        • Fontana A.
        • Rosenheck R.
        Duty-related and sexual stress in the etiology of PTSD among women veterans who seek treatment.
        Psychiatr Serv. 1998; 49: 658-662
        • Hankin C.S.
        • Skinner K.M.
        • Sullivan L.M.
        • Miller D.R.
        • Frayne S.
        • Tripp T.J.
        Prevalence of depressive and alcohol abuse symptoms among women VA outpatients who report experiencing sexual assault while in the military.
        J Trauma Stress. 1999; 12: 601-612
        • Sadler A.G.
        • Booth B.M.
        • Nielson D.
        • Doebbeling B.N.
        Health-related consequences of physical and sexual violence: women in the military.
        Obstet Gynecol. 2000; 96: 473-480
        • Davila G.W.
        • Bernier F.
        • Franco J.
        • Kopka S.L.
        Bladder dysfunction in sexual abuse survivors.
        J Urology. 2003; 170: 476-479
        • Jundt K.
        • Scheer I.
        • Schiessl B.
        • Pohl K.
        • Haertl K.
        • Peschers U.M.
        Physical and sexual abuse in patients with overactive bladder: is there an association?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 449-453
        • Link C.L.
        • Lutfey K.E.
        • Steers W.D.
        • McKinlay J.B.
        Is abuse causally related to urologic symptoms?.
        Eur Urol. 2007; 52: 397-406
        • Klausner A.P.
        • Ibanez D.
        • King A.B.
        • et al.
        The influence of psychiatric comorbidities and sexual trauma on lower urinary tract symptoms in female veterans.
        J Urol. 2009; 182: 2785
        • Mariappan P.
        • Alhasso A.
        • Ballantyne Z.
        • Grant A.
        • N'Dow J.
        Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review.
        Eur Urol. 2007; 51: 67
        • Steers W.D.
        • Herschorn S.
        • Kreder K.J.
        • et al.
        Duloxetine compared with placebo for treating women with symptoms of overactive bladder.
        BJU Int. 2007; 100: 337-345
        • Thor K.B.
        • Kirby M.
        • Viktrup L.
        Serotonin and noradrenaline involvement in urinary incontinence, depression and pain: scientific basis for overlapping clinical efficacy from a single drug, duloxetine.
        Int J Clin Pract. 2007; 61: 1349-1355
        • Arborelius L.
        • Owens M.J.
        • Plotsky P.M.
        • Nemeroff C.B.
        The role of corticotropin-releasing factor in depression and anxiety disorders.
        J Endocrinol. 1999; 160: 1-12
        • Klausner A.P.
        • Streng T.
        • Na Y.G.
        • et al.
        The role of corticotropin releasing factor and its antagonist, astressin, on micturition in the rat.
        Auton Neurosci. 2005; 123: 26-35
        • Southwick S.
        • Rasmusson A.
        • Barron J.
        • Arnsten A.
        Neurobiological and neurocognitive alterations in PTSD.
        in: Vasterling J. Brewin C. Neuropsychology of PTSD: biological, cognitive and clinical perspectives. The Guilford Press, New York2005: 27-58
        • Schnurr P.P.
        • Green B.L.
        Trauma and health: physical health consequences of exposure to extreme stress.
        American Psychological Association, Washington, DC2004