title: Urinary incontinence and depression in middle-aged United States women.
abstract: OBJECTIVE
  To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression.
  
  
  METHODS
  This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders.
  
  
  RESULTS
  Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates.
  
  
  CONCLUSIONS
  Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nygaard
authors.forename: Carolyn
authors.initials: C
authors.lastname: Turvey
authors.forename: Trudy L
authors.initials: TL
authors.lastname: Burns
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crischilles
authors.forename: Robert
authors.initials: R
authors.lastname: Wallace
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology*