Depression and its association with the psychosocial factors of urinary incontinence

Abstract

Urinary Incontinence has been associated with psychological distress, depression and anxiety. However, research exploring these psychological effects has been minimal, mostly concentrating on older people, women or samples of convenience. Only a few studies have examined quality of life, management and coping behaviours, social connectedness, and beliefs and knowledge of the condition, focussing more upon risk factors such as gender, age, cognitive impairment and physical health. The research question for this thesis is whether the depression experienced by people with urinary incontinence is associated with psychosocial factors related to incontinence. The group of studies that contribute to the project “Depression and its Association with the Psychosocial Factors of Urinary Incontinence” include a population study examining incontinence, depression and quality of life in both men and women; another population study looking at perceptions of seriousness and severity of incontinence in women; a review of the literature; and a qualitative study examining women’s experience of urinary incontinence and depression. A review of the literature found that incontinence and psychological wellbeing are intertwined. Enquiring about the mental health status of those with incontinence should include an assessment of psychosocial factors to help reduce the burden of incontinence. I found that depression and incontinence both reduce health related quality of life (HRQoL). When they occur together there appears to be an additive effect which affects both physical and mental health. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall HRQoL. I also found that severity and limitations to lifestyle were predictors of women perceiving that their incontinence was moderate to very serious. Help-seeking for incontinence improves if education and information target women who use continence management aids, have difficulty being involved in activities or who use other management strategies. Finally, an exploration of how women experience incontinence in relation to their depression status was undertaken. Women who are older and highly resilient experience less depression and can manage their depression better. Women who do not exhibit resilience are more likely to experience depression, and their incontinence has a greater impact on their lives. Age and resilience-focused interventions in women newly diagnosed with incontinence may lessen the impact of depression on these women. Those who experience incontinence and are affected by depression in their day to day lives experience a reduced quality of life. We can also gauge the impact of incontinence on the lives of women by examining their limitations and perceptions about the seriousness of their condition, and we can target interventions towards those who experience limitations and use management strategies. We can also design targeted interventions for specific age groups that can increase resilience, so that the burden, including depression, is eased and quality of life is increased in women experiencing incontinence.