Urinary incontinence after stress incontinence surgery: a risk factor for depression.

Objectives: To determine whether urinary incontinence after stress incontinence surgery is a risk factor for concomitant symptoms of depression.

Methods: Women who underwent stress urinary incontinence surgery from 1993 to 2002 were given 2 validated quality-of-life questionnaires, the Incontinence Symptom Index and the Patient Health Questionnaire, to assess the severity of urinary incontinence symptoms after surgery and to identify moderate-to-severe depressive symptoms, respectively. Bivariate and multivariate statistical models were then constructed to determine the independent parameters associated with the reporting of moderate-to-severe depressive symptoms in this group of women.

Results: Of the 687 identified women, 437 (64%) returned completed questionnaires. The average patient age was 59 years, with a median follow-up after the index surgery of 2.9 years (range 0.4-10.1). Urinary incontinence after stress incontinence surgery was found to be an independent risk factor for associated moderate-to-severe depressive symptoms. Each 10-point increase in the Incontinence Symptom Index total symptom severity score resulted in a near doubling of the odds of having concomitant depressive symptoms (odds ratio 1.93, 95% confidence interval 1.41-2.65). Additional comorbid conditions (odds ratio 1.46, 95% confidence interval 1.23-1.73), additional postoperative vaginal prolapse surgery (odds ratio 3.20, 95% confidence interval 1.30-7.89), and perimenopausal status (odds ratio 3.79, 95% confidence interval 1.60-8.95) were also significantly associated with depressive symptoms.

Conclusions: Urinary incontinence after stress incontinence surgery is strongly associated with moderate-to-severe postoperative depression symptoms, even years after the index surgery. Additional studies are necessary to examine the causal relationships between incontinence and depression.