Psychiatric problems have been identified as risk factors for, and outcomes of, lower urinary tract symptoms (LUTS) in women including, urgency, frequency, nocturia and incontinence. However, studies of the association between psychosocial and emotional factors and LUTS in women are limited. Although there is a growing body of evidence suggesting that LUTS are associated with increased risk of anxiety and depression, few studies have estimated these associations in a large population-representative sample of women. In a population based study including results from more than 3,000 women, Litman et al (2007) found that only depressive symptoms correlated with LUTS, but this was based on a cross-sectional design. In another cross sectional study conducted via the internet, LUTS were associated with increased levels of anxiety and depressive symptoms (Coyne et al. 2009). However, the response rate to the study was only 59%, so selection bias may have affected the findings (e.g. individuals with higher levels of depression and anxiety symptoms may have been more likely to the respond to the study). There is also evidence from small clinic-based studies for an association between LUTS and psychiatric co-morbidities (Klausner et al. 2009; Maccaulay et al. 1991; Stone & Judd, 1978; Zorn et al. 1999; Bodden-Heidrich et al. 1999).

Limitations of earlier research should be taken into account when interpreting the findings. In addition to cross-sectional design and small clinic-based samples, few studies have adjusted for confounding factors that are associated with both LUTS and depression/anxiety symptoms. These include smoking, overweight, parity, birth complications, diabetes, and menstrual symptoms. Few studies have examined the specific association of individual LUTS on depression and anxiety, and few have examined whether having an increased number of LUTS is associated with greater risk for depressive and anxiety symptoms.

The psychiatric morbidity associated with LUTS needs further assessment in a longitudinal study. The proposed study will examine the association between maternally reported LUTS and mental health domains in a population-representative sample.

References

Bodden-Heidrich R, Beckmann MW, Libera B, Rechenberger I, Bender HG. Psychosomatic aspects of urinary incontinence. Arch Gynecol Obstet. 1999;262(3-4):151-8.

Coyne KS, Wein AJ, Tubaro A, Sexton CC, Thompson CL, Kopp ZS, Aiyer LP. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009 Apr;103 Suppl 3:4-11.

Klausner AP, Ibanez D, King AB, Willis D, Herrick B, Wolfe L, Grob BM. The influence of psychiatric comorbidities and sexual trauma on lower urinary tract symptoms in female veterans. J Urol. 2009 Dec;182(6):2785-90.

Litman HJ, Steers WD, Wei JT, Kupelian V, Link CL, McKinlay JB; Boston Area Community Health Survey Investigators. Relationship of lifestyle and clinical factors to lower urinary tract symptoms: results from Boston Area Community Health survey.Urology. 2007 Nov;70(5):916-21. Epub 2007 Oct 24.

Macaulay AJ, Stern RS, Stanton SL.Psychological aspects of 211 female patients attending a urodynamic unit.J Psychosom Res. 1991;35(1):1-10.

Stone CB, Judd GE. Psychogenic aspects of urinary incontinence in women. Clin Obstet Gynecol. 1978 Sep;21(3):807-15.

Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD. Urinary incontinence and depression.J Urol. 1999 Jul;162(1):82-4.