Urinary Incontinence, Depression, and Economic Outcomes in a Cohort of Women Between the Ages of 54 and 65 Years

Hung, Kristin J. MD; Awtrey, Christopher S. MD; Tsai, Alexander C. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000186
Contents: Original Research

OBJECTIVE: To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit.

METHODS: The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54–65 years of age. Women were followed-up with biennial interviews until 2010–2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest.

RESULTS: At baseline, 727 participants (survey-weighted prevalence, 16.6%; 95% confidence interval [CI] 15.4–18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2%; 95% CI 25.4–33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6%; 95% CI 19.8–23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95% CI 1.27–1.62) and work disability (adjusted hazard ratio, 1.21; 95% CI 1.01–1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95% CI 0.93–1.21).

CONCLUSION: In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits.


In Brief

Urinary incontinence is associated with onset of probable depression and work disability among women between the ages of 54 and 65 in the United States.

Author Information

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, the Division of Global Psychiatry, Department of Psychiatry, and the Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, and the Mbarara University for Science and Technology, Mbarara Uganda.

Corresponding author: Kristin J. Hung, MD, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, East Campus, Kirstein 317, Boston, MA 02215; e-mail: khung@bidmc.harvard.edu.

Financial Disclosure Dr. Tsai receives salary support from NIH K23MH096620 and the Robert Wood Johnson Foundation Health and Society Scholars Program. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.