International Urogynecology Journal

, Volume 24, Issue 11, pp 1953–1959 | Cite as

Depressive symptoms and treatment of women with urgency urinary incontinence

  • Rachel Kafri
  • Arad Kodesh
  • Jeffrey Shames
  • Jacob Golomb
  • Itshak Melzer
Original Article


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.


Center for Epidemiologic Studies Depression scale (CES-D) Depressive symptoms Drug therapy Pelvic floor physical therapy Pelvic floor muscle training Urgency urinary incontinence 



Drug therapy


Bladder training


Center for Epidemiologic Studies Depression scale


Combined pelvic floor rehabilitation


Depressive symptom


Pelvic floor muscle training


Quality of life related to urgency urinary incontinence


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



  1. 1.
    Wyman J, Harkins S, Choi S, Taylor J, Fantl J (1987) Psychosocial impact of urinary incontinence in women. Obstet Gynecol 70:378–381PubMedGoogle Scholar
  2. 2.
    Melville JL, Delaney K, Newton K, Katon W (2005) Incontinence severity and major depression in incontinent women. Obstet Gynecol 106:585–592PubMedCrossRefGoogle Scholar
  3. 3.
    Geulayov G, Lipsitz J, Sabar R, Gross R (2007) Depression in primary care in Israel. Isr Med Assoc J 9:571–578PubMedGoogle Scholar
  4. 4.
    Levinson D, Paltiel A, Nir M, Makovki T (2007) The Israel National Health Survey: issues and methods. Isr J Psychiatry Relat Sci 44:85–93PubMedGoogle Scholar
  5. 5.
    Steers W, Lee K (2001) Depression and incontinence. World J Urol 19:351–357PubMedCrossRefGoogle Scholar
  6. 6.
    Sung V, West D, Hernandez A, Wheeler T, Myers D, Subak L et al (2009) Association between urinary incontinence and depressive symptoms in overweight and obese women. Am J Obstet Gynecol 200:555.e1–555.e5CrossRefGoogle Scholar
  7. 7.
    Felde G, Bjelland I, Hunskaar S (2012) Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study. Int Urogynecol J 23:299–306PubMedCrossRefGoogle Scholar
  8. 8.
    Burgio K, Locher J, Roth D, Goode P (2001) Psychological improvements associated with behavioral and drug treatment of urge incontinence in older women. J Gerontol B Psychol Sci Soc Sci 56:P46–P51PubMedCrossRefGoogle Scholar
  9. 9.
    Kafri R, Deutscher D, Shames J, Golomb J, Melzer I (2012) Randomized trial of a comparison of rehabilitation or drug therapy for urgency urinary incontinence: 1-year follow-up. Int Urogynecol J. doi:10.1007/s00192-012-1992-8 PubMedGoogle Scholar
  10. 10.
    Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26PubMedCrossRefGoogle Scholar
  11. 11.
    Amir M, Lewin-Epstein N, Becker G, Buskila D (2002) Psychometric properties of the SF-12 (Hebrew version) in a primary care population in Israel. Med Care 40:918–928PubMedCrossRefGoogle Scholar
  12. 12.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  13. 13.
    Moore K, Hu TW, Subak L, Wagner T, Deutekom M (2009) Economics of urinary and fecal incontinence and prolapse, Committee 22. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence: 4th International Consultation on Incontinence, Paris, July 5–8, 2008. Plymbridge Distributors Ltd, Plymouth, pp 1687–1712Google Scholar
  14. 14.
    Burgio K, Locher JL, Goode PS, Hardin M, McDowell BJ, Dombrowski M et al (1998) Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 280:1995–2000PubMedCrossRefGoogle Scholar
  15. 15.
    Ströhle A (2009) Physical activity, exercise, depression and anxiety disorders. J Neural Transm 116:777–784PubMedCrossRefGoogle Scholar
  16. 16.
    Tadic SD, Zdaniuk B, Griffiths D, Rosenberg L, Schäfer W, Resnick N (2007) Effect of biofeedback on psychological burden and symptoms in older women with urge urinary incontinence. J Am Geriatr Soc 55:2010–2015PubMedCrossRefGoogle Scholar
  17. 17.
    Innerkofler P, Guenther V, Rehder P, Kopp M, Nguyen-Van-Tam D, Giesinger J et al (2008) Improvement of quality of life, anxiety and depression after surgery in patients with stress urinary incontinence: results of a longitudinal short-term follow-up. Health Qual Life Outcomes 6:72PubMedCrossRefGoogle Scholar
  18. 18.
    Khullar V (2012) Patient-reported outcomes and different approaches to urinary parameters in overactive bladder: what should we measure? Int Urogynecol J 23:179–192PubMedCrossRefGoogle Scholar
  19. 19.
    Hay Smith J, Berghmans B, Burgio K, Dumoulin C, Hagen S, Moore K et al (2009) Adult conservative management, Committee 12. In: Abrams A, Cardozo L, Khoury S, Wein A (eds) Incontinence: 4th International Consultation on Incontinence, Paris, July 5–8, 2008. Plymbridge Distributors Ltd, Plymouth, pp 1025–1120Google Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Rachel Kafri
    • 1
    • 4
  • Arad Kodesh
    • 2
    • 3
  • Jeffrey Shames
    • 4
  • Jacob Golomb
    • 5
  • Itshak Melzer
    • 1
  1. 1.Department of Physical Therapy, Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health ScienceBen-Gurion University of NegevBeer-ShevaIsrael
  2. 2.Psychiatric Department, Shfela DistrictMaccabi Healthcare Services, ‘Ramot’Rishon LezionIsrael
  3. 3.Department of Community Mental HealthHaifa UniversityHaifaIsrael
  4. 4.Department of Physical Therapy and Rehabilitation UnitMaccabi Healthcare Services, ‘Ramot’Rishon LezionIsrael
  5. 5.Department of UrologySheba Medical CenterTel HaShomerIsrael

Personalised recommendations