Is there an association between depressive and uri

Authors: G van de Pol H J van Brummen H W Bruinse A P M Heintz C H van der Vaart

Publish Date: 2007/04/03

Volume: 18, Issue: 12, Pages: 1409-1415

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Abstract

Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy In the general population an association is reported between urinary symptoms and depressive symptoms The association of depressive and urinary symptoms has not yet been assessed in pregnancy In this study we assessed 1 the prevalence of depressive symptoms overactive bladder OAB syndrome urge urinary incontinence UUI and stress urinary incontinence SUI during and after pregnancy using the Center for Epidemiologic Studies Depression Scale CESD and the Urogenital Distress Inventory UDI and 2 the association of depressive symptoms with urinary incontinence and overactive bladder syndrome during and after pregnancy controlling for confounding socioeconomic psychosocial behavioural and biomedical factors in a cohort of healthy nulliparous women Our data show a significant increase in prevalence of depressive symptoms UUI SUI and OAB during pregnancy and a significant reduction in prevalence of depressive symptoms SUI and OAB after childbirth UUI prevalence did not significantly decrease after childbirth In univariate analysis urinary incontinence and the OAB syndrome were significantly associated with a CESD score indicative of a possible clinical depression at 36 weeks gestation However after adjusting for possible confounding factors only the OAB syndrome remained significantly associated OR 44 18–105 No association was found between depressive and urinary symptoms at 1 year postpartum Only OAB was independently associated with depressive symptoms during pregnancy Possible explanations for this association are discussedThe lifetime risk of depressive symptoms in women 59–213 is about twice that in men and symptoms often start in the childbearing years 1 2 3 Prevalence rates of 10–25 during pregnancy 4 5 6 7 8 9 and of 6–16 postpartum are reported 5 6 8 10 11 12 Prevalence rates vary because of the diversity of populations and diagnostic methodology Most researchers found higher rates during pregnancy than after childbirth 5 6 8 Urogenital symptoms are also more prevalent in pregnancy than in the general population Prevalence rates of 9–50 have been reported for urinary incontinence UI during first pregnancy and 34–95 for frequency and urgency symptoms overactive bladder OAB syndrome 13 14 Strong associations are found between depressive symptoms urinary incontinence and overactive bladder syndrome in nonpregnant women 15 16 17 18 19 Whilst the relationship of depressive symptoms and urinary symptoms has not yet been explored in pregnancy several factors have been found to be associated with depressive symptoms in a general pregnant and postpartum population These factors include biomedical factors such as obesity age chronic pain like back pain previous depressive symptoms 12 20 21 behavioural factors like excessive use of alcohol smoking lack of leisure time physical exercise and socioeconomic factors like unemployment and low job satisfaction 5 7 22 Psychosocial factors such as poorer social support stressful life events and personality features have also been found related to depressive symptoms 11 22 23 24 25The aim of this study was to 1 analyse the prevalence of depressive symptoms and urinary symptoms during and after pregnancy and 2 assess the association of urinary symptoms with depressive symptoms controlling for psychosocial behavioural socioeconomic and biomedical factors during and after pregnancyBetween January 2002 and July 2003 1366 nulliparous pregnant women from 10 urban midwifery practices in the center of The Netherlands were approached to take part in a prospective longitudinal cohort study assessing pelvic floor problems sexuality and back pain during first pregnancy until 1 year after delivery All nulliparous pregnant women received information about the study from the midwives After 1 week the women were approached by phone and asked if they wanted to participate in the study Inclusion criteria were a singleton low risk pregnancy and sufficient knowledge of the Dutch languageOne hundred and twentytwo women were excluded due to having a twin pregnancy n = 2 miscarriage n = 13 or insufficient knowledge of the Dutch language 107 Thus 1244 women met the inclusion criteria Of these 672 54 decided to participate in the study The most common reasons for refusal were lack of time and the intensity and intrusiveness of the questions The present study is a separate analysis of data collected from the larger study The Medical Ethics Committee of the University Medical Center Utrecht approved the study All participants signed an informed consent formTo assess the prevalence rates at different points in time of depressive symptoms stress urinary incontinence SUI urge urinary incontinence UUI and overactive bladder OAB syndrome we used data obtained from all respondents of questionnaires sent at 12 and 36 weeks gestation and 3 and 12 months postpartum In addition we analysed data obtained from the questionnaires sent at 36 weeks gestation and 12 months after delivery to assess the possible association between urinary symptoms and depression We did so because the prevalence of urinary symptoms peak in the third trimester and because pelvic floor symptoms occurring in pregnancy and persisting 1 year after delivery may be associated with depression at this time 26Depressive symptoms were investigated using the Center for Epidemiologic Studies Depression Scale CESD This scale is developed for use in nonpsychiatric populations and gives an impression of depressive symptoms 27 28 The total score ranges from 0 to 60 a higher score corresponds with more depressive symptoms A cutoff score of 16 is frequently used as an indication of a possible clinical depression We refer in this study to women who scored B16 on the CESD as having depressive symptomsUrinary symptoms were assessed with the Urogenital Distress Inventory UDI 29 30 The UDI is a validated standardised questionnaire translated in Dutch This questionnaire consists of 19 questions about urogenital symptoms and the experienced discomfort of these symptoms We looked specifically at selfreported urge and stress urinary incontinence and overactive bladder syndrome Although the UDI also consists of questions on prolapse obstructive micturition and pain and heaviness in the pelvic area these symptoms have not been linked to depression in current literature Therefore these questions were not used in the present study We followed the definitions of the International Continence Society ICS 31 Urge incontinence was determined by a positive answer to the question “Do you experience urine leakage related to the feeling of urgency” Stress incontinence was determined by a positive answer to the question “Do you experience urine leakage related to physical activity coughing or sneezing” Overactive bladder syndrome was determined when both of the following questions were answered positively “Do you experience frequent urination” and “Do you experience a strong feeling of urgency to empty your bladder”

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