Association of Urinary Incontinence and Depression: Findings From the National Health and Nutrition Examination Survey

Abstract

Objective: To evaluate the association between urinary incontinence and depression. An estimated 21 million adults in the United States (U.S.) reported at least one major depressive episode. Urinary incontinence has a well-described negative impact on quality of life.

Methods: We included respondents aged ≥20 who participated in the 2017 - March 2020 National Health and Nutrition Examination Survey cycles. Our dichotomous outcomes were depression and clinical depression. The predictor variable urinary incontinence was assessed using the validated incontinence severity index. We fitted an adjusted multivariable logistic regression and performed interaction analysis for urinary incontinence and our variable of interest.

Results: Among a weighted sample of 233.5 million people (unweighted 8256), 19.9 million (8.5%) reported depression (P < .001). The weighted population was 48.6% male, 55.2% married, and 63.4% non-Hispanic White (all P < .001). Moderate and severe urinary incontinence was associated with depression (adjusted odds ratio [aOR] 2.3; 95%CI [1.5-3.3]; aOR 3.8; 95%CI [2.5-3.3]; P < .001). No association was observed between urinary incontinence and clinical depression. Interaction analysis showed that men (aOR 3.62; 95%CI [2.13-6.15]; P_int<.001) and participants at the lowest socioeconomic status (aOR 2.2; 95%CI [1.3-3.71]; P_int=.005) with moderate/severe urinary incontinence had higher odds of depression than their continent counterparts.

Conclusion: We report that urinary incontinence is an independent predictor of depression in a nationally representative survey for men and those in the lowest socioeconomic tier. The association is most prominent among men and the socioeconomically disadvantaged population. This suggests that treatment for urinary incontinence may be important tool to reduce depression in the general population.