Depressive symptoms and treatment of women with urgency urinary incontinence
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Introduction and hypothesis
Depression is more common in patients with urinary incontinence (UI). Drug or rehabilitation therapy have been shown to be effective in reducing urgency UI (UUI) symptoms, but whether these treatments can ameliorate the negative impact of UUI on the psychological aspects of quality of life is unclear.
A secondary analysis of an assessor-blinded randomized controlled trial was performed. The number of depressive symptoms was the primary outcome as measured by the Center for Epidemiologic Studies Depression scale (CES-D).
Thirty-six (22 %) subjects had a CES-D score >16 at baseline, the cutoff for having depressive symptoms. A significant association was found between having a CES-D score >16 and lower quality of life related to UI at baseline. The mean CES-D score among those with depressive symptoms at baseline was significantly reduced throughout the study, with a mean of 23.7 at baseline, to 18.3 and 15.2 at the 3-month and 1-year follow-up (p < 0.001), respectively. The number of participants who had depressive symptoms decreased during the study period only in the physical therapy groups, from 31 at baseline to 28 and 25, at 3 and 12 months, respectively, while there was no such change in the drug group.
Patients with UUI who had depressive symptoms showed significant improvement in their depressive symptoms with treatment over 1 year. This improvement occurred regardless of the type of treatment. This study emphasizes the increasingly recognized problem of undiagnosed depression among middle-aged women with UUI.
KeywordsCenter for Epidemiologic Studies Depression scale (CES-D) Depressive symptoms Drug therapy Pelvic floor physical therapy Pelvic floor muscle training Urgency urinary incontinence
Center for Epidemiologic Studies Depression scale
Combined pelvic floor rehabilitation
Pelvic floor muscle training
Quality of life related to urgency urinary incontinence
Urgency urinary incontinence
We thank the physical therapists of Maccabi Healthcare Services who specialize in pelvic floor rehabilitation and their clinic directors for participating in the study and managing the data collection process. We thank the managers of the Maccabi ‘Ramot’ clinic and their team and the management of Shefela – Jerusalem District for their support of this project. We also thank the gynecology and urogynecology physicians who referred patients to our study and managed the drug therapy group. A special acknowledgment is dedicated to Dr. Yossi Azuri, M.D., MHA, head of the Clinical Studies Unit in Maccabi Healthcare Services and his staff. We thank Daniel Deutscher, Ph.D. PT, Director of Research and Development, Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel. This study was funded by Maccabbi Healthcare services in Israel.
Conflicts of interest
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