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Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study

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Introduction and hypothesis

Several studies have indicated depression and anxiety to be associated with urinary incontinence (UI), however, the strength of the associations varies widely. The objective of this study was to determine these associations in a large survey.


In a cross-sectional population-based survey study, we analysed questionnaire data on UI, depression and anxiety from 5,321 women between 40 and 44 years. A multivariate logistic regression model was used to predict the odds of having high levels of anxiety and depression among women with UI of different types and severities.


Among women with UI, the adjusted OR for depression was 1.64 (95% CI, 1.32–2.04) and for anxiety 1.59 (95% CI, 1.36–1.86) compared with women without UI.


UI was associated with both anxiety and depression in middle-aged women, with the strongest associations for mixed and urgency UI.

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  1. Hunskaar S, Lose G, Sykes D, Voss S (2004) The prevalence of urinary incontinence in women in four European countries. BJU Int 93:324–330

    Article  PubMed  CAS  Google Scholar 

  2. Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT (2000) Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 11:301–319

    Article  PubMed  CAS  Google Scholar 

  3. AHCPR Urinary Incontinence in Adults Guideline Update Panel (1996) Managing acute and chronic urinary incontinence. Am Fam Physician 54:1661–1672

    Google Scholar 

  4. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  5. Narrow WE, Rae DS, Robins LN, Regier DA (2002) Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. Arch Gen Psychiatry 59:115–123

    Article  PubMed  Google Scholar 

  6. Monz B, Chartier-Kastler E, Hampel C et al (2007) Patient characteristics associated with quality of life in European women seeking treatment for urinary incontinence: results from PURE. Eur Urol 51:1073–1081

    Article  PubMed  Google Scholar 

  7. Hunskaar S, Vinsnes A (1991) The quality of life in women with urinary incontinence as measured by the sickness impact profile. J Am Geriatr Soc 39:378–382

    PubMed  CAS  Google Scholar 

  8. Murray CJ, Lopez AD (1997) Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349:1436–1442

    Article  PubMed  CAS  Google Scholar 

  9. Mykletun A, Bjerkeset O, Overland S, Prince M, Dewey M, Stewart R (2009) Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry 195:118–125

    Article  PubMed  Google Scholar 

  10. Melville JL, Walker E, Katon W, Lentz G, Miller J, Fenner D (2002) Prevalence of comorbid psychiatric illness and its impact on symptom perception, quality of life, and functional status in women with urinary incontinence. Am J Obstet Gynecol 187:80–87

    Article  PubMed  Google Scholar 

  11. Melville JL, Delaney K, Newton K, Katon W (2005) Incontinence severity and major depression in incontinent women. Obstet Gynecol 106:585–592

    Article  PubMed  Google Scholar 

  12. Vigod SN, Stewart DE (2006) Major depression in female urinary incontinence. Psychosomatics 47:147–151

    Article  PubMed  Google Scholar 

  13. Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD (1999) Urinary incontinence and depression. J Urol 162:82–84

    Article  PubMed  CAS  Google Scholar 

  14. van der Vaart CH, Roovers JP, de Leeuw JR, Heintz AP (2007) Association between urogenital symptoms and depression in community-dwelling women aged 20 to 70 years. Urology 69:691–696

    Article  PubMed  Google Scholar 

  15. Perry S, McGrother CW, Turner K (2006) An investigation of the relationship between anxiety and depression and urge incontinence in women: development of a psychological model. Br J Health Psychol 11:463–482

    Article  PubMed  Google Scholar 

  16. Watson AJ, Currie I, Curran S, Jarvis GJ (2000) A prospective study examining the association between the symptoms of anxiety and depression and severity of urinary incontinence. Eur J Obstet Gynecol Reprod Biol 88:7–9

    Article  PubMed  CAS  Google Scholar 

  17. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol 53:1150–1157

    Article  PubMed  CAS  Google Scholar 

  18. Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29:4–20

    PubMed  Google Scholar 

  19. Sandvik H, Seim A, Vanvik A, Hunskaar S (2000) A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn 19:137–145

    Article  PubMed  CAS  Google Scholar 

  20. Sandvik H, Espuna M, Hunskaar S (2006) Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J Pelvic Floor Dysfunct 17:520–524

    Article  PubMed  Google Scholar 

  21. Nortvedt MW, Riise T, Sanne B (2006) Are men more depressed than women in Norway? Validity of the Hospital Anxiety and Depression Scale. J Psychosom Res 60:195–198

    Article  PubMed  Google Scholar 

  22. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  23. Bjelland I, Tell GS, Vollset SE, Konstantinova S, Ueland PM (2009) Choline in anxiety and depression: the Hordaland Health Study. Am J Clin Nutr 90:1056–1060

    Article  PubMed  CAS  Google Scholar 

  24. Klokk M, Gotestam KG, Mykletun A (2010) Factors accounting for the association between anxiety and depression, and eczema: the Hordaland health study (HUSK). BMC Dermatol 10:3

    Article  PubMed  Google Scholar 

  25. Hampel C, Wienhold D, Benken N, Eggersmann C, Thuroff JW (1997) Prevalence and natural history of female incontinence. Eur Urol 32(Suppl 2):3–12

    PubMed  Google Scholar 

  26. Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R (2003) Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 101:149–156

    Article  PubMed  Google Scholar 

  27. Mehta KM, Simonsick EM, Penninx BW et al (2003) Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study. J Am Geriatr Soc 51:499–504

    Article  PubMed  Google Scholar 

  28. Coyne KS, Wein AJ, Tubaro A et al (2009) The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int 103(Suppl 3):4–11

    Article  PubMed  Google Scholar 

  29. Thor KB, Kirby M, Viktrup L (2007) Serotonin and noradrenalin involvement in urinary incontinence, depression and pain: scientific basis for overlapping clinical efficacy from a single drug, duloxetine. Int J Clin Pract 61:1349–1355

    Article  PubMed  CAS  Google Scholar 

  30. Melville JL, Fan MY, Rau H, Nygaard IE, Katon WJ (2009) Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample. Am J Obstet Gynecol 201:491–497

    Article  Google Scholar 

  31. Bogner HR, O'Donnell AJ, de Vries HF, Northington GM, Joo JH (2011) The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults. J Anxiety Disord 25(2):203–208

    Article  PubMed  Google Scholar 

  32. Bogner HR, Gallo JJ, Swartz KL, Ford DE (2002) Anxiety disorders and disability secondary to urinary incontinence among adults over age 50. Int J Psychiatry Med 32:141–154

    Article  PubMed  Google Scholar 

  33. O'Donnell M, Lose G, Sykes D, Voss S, Hunskaar S (2005) Help-seeking behaviour and associated factors among women with urinary incontinence in France, Germany, Spain and the United Kingdom. Eur Urol 47:385–392

    Article  PubMed  Google Scholar 

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The data collection was conducted as part of HUSK (the Hordaland Health Study ´97-´99) in collaboration with the Norwegian National Screening Service.


The study is funded by Norwegian Medical Association´Fund for Research in General Practice.

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Correspondence to Gunhild Felde.

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Felde, G., Bjelland, I. & Hunskaar, S. Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study. Int Urogynecol J 23, 299–306 (2012).

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