Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;84(5):463-470.
doi: 10.1016/j.eururo.2023.05.013. Epub 2023 May 27.

Continence Problems and Mental Health in Adolescents from a UK Cohort

Katie Gordon  1 , Naomi Warne  1 , Jon Heron  1 , Alexander von Gontard  2 , Carol Joinson  3
Affiliations

Continence Problems and Mental Health in Adolescents from a UK Cohort

Katie Gordon et al. Eur Urol. 2023 Nov.

Abstract

Background: Adolescents with continence problems experience unique threats to their psychological well-being, but long-term mental health sequelae are unknown.

Objective: To examine prospective relationships between incontinence/lower urinary tract symptoms (LUTS) and mental health problems in young people.

Design, setting, and participants: A prospective cohort study of young people (n = 7332: 3639 males and 3693 females) from a population-based sample was conducted.

Outcome measurements and statistical analysis: We estimated the association between incontinence/LUTS and mental health outcomes using multivariable regression models adjusted for sex, socioeconomic position, developmental level, intelligence quotient, stressful life events, maternal psychopathology, body mass index, and emotional/behavioural problems.

Results and limitations: Daytime wetting and voiding postponement showed the greatest number of associations with mental health problems. All incontinence subtypes/LUTS were associated with increased odds of generalised anxiety disorder (eg, odds ratio for daytime wetting = 3.01, 95% confidence interval [1.78, 5.09], p < 0.001) and/or higher anxiety scores. There was also evidence of associations with common mental disorder (eg, voiding postponement: 1.88 [1.46, 2.41], p < 0.001), depression (eg, urgency: 1.94 [1.19, 3.14], p = 0.008), depressive symptoms (eg, daytime wetting: 1.70 [1.13, 2.56], p = 0.01), self-harm thoughts (eg, voiding postponement: 1.52 [1.16, 1.99], p = 0.003), and disordered eating (eg, nocturia 1.72 [1.27, 2.34], p = 0.001). We are unable to generalise our results to minority ethnic groups, less affluent populations, and non-UK samples.

Conclusions: Young people with incontinence/LUTS are at an increased risk of mental health problems. Further research is needed to establish the direction of causality.

Patient summary: We looked at the association between continence problems and mental health outcomes in young people from a large population-based cohort. Young people with continence problems at the age of 14 yr were more likely to suffer from a range of mental health problems at the age of 18 yr, including common mental disorder, depression, anxiety, self-harm thoughts, and disordered eating. Paediatric continence clinics should address the mental health needs of young people and provide clear and effective care pathways to child and adolescent mental health services.

Keywords: Adolescence; Avon Longitudinal Study of Parents and Children; Incontinence; Lower Urinary Tract Symptoms; Mental health; Prospective cohort.

PubMed Disclaimer

Conflict of interest statement

Financial disclosures: Carol Joinson certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Figures

Fig. 1
Fig. 1. Sample derivation and attrition in ALSPAC.
ALSPAC = Avon Longitudinal Study of Parents and Children; IQ = intelligent quotient; WISC = Wechsler Intelligence Scale for Children.
See this image and copyright information in PMC

References

    1. Whale K, Cramer H, Wright A, Sanders C, Joinson C. ‘What does that mean?’: a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK. BMJ Open. 2017;7:e015544. doi: 10.1136/bmjopen-2016-015544. - DOI - PMC - PubMed
    1. Heron J, Grzeda MT, von Gontard A, Wright A, Joinson C. Trajectories of urinary incontinence in childhood and bladder and bowel symptoms in adolescence: prospective cohort study. BMJ Open. 2017;7:e014238. doi: 10.1136/bmjopen-2016-014238. - DOI - PMC - PubMed
    1. von Gontard A, Cardozo L, Rantell A, Djurhuus JC. Adolescents with nocturnal enuresis and daytime urinary incontinence—how can pediatric and adult care be improved—ICI-RS 2015? Neurourol Urodyn. 2017;36:843–9. - PubMed
    1. Whale K, Cramer H, Joinson C. Left behind and left out: the impact of the school environment on young people with continence problems. Br J Health Psychol. 2018;23:253–77. doi: 10.1111/bjhp.12284. - DOI - PMC - PubMed
    1. Platt B, Cohen Kadosh K, Lau JY. The role of peer rejection in adolescent depression. Depress Anxiety. 2013;30:809–21. - PubMed

Publication types