title: Affective symptoms and the overactive bladder - a systematic review.
abstract: BACKGROUND
  Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented.
  
  
  OBJECTIVE
  Systematically review the literature on the association of affective conditions with OAB.
  
  
  METHODS
  Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664).
  
  
  RESULTS
  Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1.
  
  
  CONCLUSIONS
  To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
authors.affiliation: Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: desiree.vrijens@mumc.nl.
authors.forename: Desiree
authors.initials: D
authors.lastname: Vrijens
authors.affiliation: Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: jamie.drossaerts@mumc.nl.
authors.forename: Jamie
authors.initials: J
authors.lastname: Drossaerts
authors.affiliation: Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: g.van.koeveringe@mumc.nl.
authors.forename: Gommert
authors.initials: G
authors.lastname: van Koeveringe
authors.affiliation: Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: p.vankerrebroeck@mumc.nl.
authors.forename: Philip
authors.initials: P
authors.lastname: Van Kerrebroeck
authors.affiliation: Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom. Electronic address: j.vanos@maastrichtuniversity.nl.
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.affiliation: Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: c.leue@mumc.nl.
authors.forename: Carsten
authors.initials: C
authors.lastname: Leue
mesh_terms: D000342:Affective Symptoms / Q000150:complications*; D001007:Anxiety / Q000150:complications*; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D053201:Urinary Bladder, Overactive / Q000523:psychology*; D053202:Urinary Incontinence, Urge / Q000523:psychology*
keywords: Affective symptoms; Anxiety; Depression; Depressive symptoms; Overactive bladder syndrome; Urgency urinary incontinence