title: Urinary incontinence and psychological distress in community-dwelling older adults.
abstract: OBJECTIVE
  To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress.
  
  
  METHODS
  A population-based longitudinal survey.
  
  
  METHODS
  Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981.
  
  
  METHODS
  Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available.
  
  
  METHODS
  Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up.
  
  
  RESULTS
  Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12).
  
  
  CONCLUSIONS
  Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.
authors.affiliation: Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. bogner@mail.med.upenn.edu
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Haroutune K
authors.initials: HK
authors.lastname: Armenian
authors.forename: William W
authors.initials: WW
authors.lastname: Eaton
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014549:Urinary Incontinence / Q000453:epidemiology / Q000523:psychology*