Journal of Cancer Survivorship

, Volume 8, Issue 3, pp 497–507 | Cite as

Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer

  • Alexandra J. WhiteEmail author
  • Bryce B. Reeve
  • Ronald C. Chen
  • Angela M. Stover
  • Debra E. Irwin



This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL).


The prevalence of MDD risk among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the Surveillance, Epidemiology and End Results Program-Medicare Health Outcomes Survey (SEER-MHOS) linked database (n = 9,282 with cancer/n = 289,744 without cancer). Risk for MDD was measured using three items from the Diagnostic Interview Schedule, and HRQOL was measured by the SF-36. UI was defined as self-reported leakage of urine causing a problem in previous 6 months. Factors associated with MDD were investigated using logistic regression, and the impact of co-occurring MDD and UI on HRQOL scores was determined using linear regression.


The prevalence of MDD risk ranged from 19.2 % for prostate to 34.1 % for lung. Lung cancer diagnosis was associated with risk of MDD. Being ≥5 years from diagnosis was associated with decreased risk of MDD (prevalence odds ratio (POR) = 0.82, 95 % confidence interval (95 % CI) 0.71, 0.95). The coexistence of both UI and MDD was associated with a decrease across HRQOL subscales; including 40 points on role-emotional (RE) score.


Cancer survivors reporting co-occurrence of UI and MDD experienced significant decrements in HRQOL.

Implications of Cancer Survivors

Understanding the combined effect of UI and MDD may help clinicians to better recognize and alleviate their effects on cancer survivors’ HRQOL.


Urinary incontinence Major depressive disorder Health-related quality of life Cancer Survivor 



This study is supported in part by grant ES07018 from the National Institute of Environmental Health Sciences and by the UNC Lineberger Cancer Control Education Program (R25 CA57726).

Conflict of interest

The authors have no conflicts of interest or financial disclosures.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Alexandra J. White
    • 1
    Email author
  • Bryce B. Reeve
    • 2
    • 3
  • Ronald C. Chen
    • 2
    • 4
  • Angela M. Stover
    • 2
    • 5
  • Debra E. Irwin
    • 1
    • 2
  1. 1.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  3. 3.Department of Health Policy and ManagementUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Radiation OncologyUniversity of North CarolinaChapel HillUSA
  5. 5.Department of Health BehaviorUniversity of North CarolinaChapel HillUSA

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