An investigation of the relationship between anxiety and depression and urge incontinence in women: development of a psychological model.

Objectives. The study investigated the association between anxiety and depression and urge incontinence and the direction of causal pathways between these variables. Design. A prospective longitudinal postal survey. Method. A random sample of women aged 40 years or more, registered with a general practitioner in Leicestershire or Rutland, was mailed a postal questionnaire. The questionnaire included questions on general health, urinary symptoms and the Hospital Anxiety and Depression Scale (HADS). In total, 12,568 women responded to the baseline postal survey (65.3% response rate) and 9,596 to the first annual follow-up (79.8% response rate). The prevalence and one-year incident rates of these symptoms were compared and contrasted, whilst controlling for confounding variables. Results. A significant proportion of women with urge incontinence reported symptoms of anxiety (56.6%) and depression (37.6%). Anxiety and depression were associated with a number of urinary symptoms and were not exclusive to urge incontinence. Incident cases of anxiety and depression were predicted by the presence of urge incontinence at baseline. Incident cases of urge incontinence were predicted by anxiety at baseline, but not depression. Anxiety, urge incontinence and frequency appeared to interact and exacerbate each other. Conclusions. The findings demonstrated the relevance of emotional factors in the development and maintenance of urge incontinence. Currently, assessment and treatment protocols for urge incontinence concentrate on physical symptoms and toilet behaviours. A more integrated psychological model of urge incontinence is proposed.