Background:A number of studies have reported an association between urinary incontinence and depression. However, validated self reported Quality of Life instruments (QOL) have not been utilized to determine if postoperative urinary incontinence is associated with major depressive symptoms in women surgically treated for stress urinary incontinence.
Methods:A cross sectional health related QOL survey of 444 women who underwent surgery for stress urinary incontinence between 1993 and 2003 was performed. Each subject completed a battery of validated instruments including the Incontinence Severity Index (ISI) and the Patient Health Questionnaire (PHQ). Generalized linear models were used to evaluate the significance of severity of urinary incontinence symptoms on the severity of depression.
Results:Average patient age was 59 years and median follow-up after surgery was 2.9 years (range 0.4-10.1 years). In a multivarible statistical model, the severity of total incontinence symptoms was significantly associated with moderate-major depressive symptoms (OR 1.93, 95% CI [1.41, 2.65]). The number of additional comorbid conditions (OR 1.46, 95% CI [1.23,1.73]), post operative vaginal prolapse surgery (OR 3.20, 95% CI [1.30, 7.89]), and transition to menopause (OR 3.79, 95% CI [1.60, 8.95]) were also associated with depressive symptoms. Age was found to be protective (OR 0.61, 95% CI [0.46, 0.81]).
Conclusions:A greater degree of urinary incontinence as measured by the ISI was significantly associated with moderate-severe post operative depression symptoms even years after primary anti-incontinence surgery. Further studies will be necessary to examine the causal relationships between incontinence and depression.

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