title: Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting.
abstract: Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA. sarah.wilson@duke.edu.|Duke Global Health Institute, Durham, NC, USA. sarah.wilson@duke.edu.
authors.forename: Sarah M
authors.identifier: http://orcid.org/0000-0002-1028-6028
authors.initials: SM
authors.lastname: Wilson
authors.affiliation: Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA.|Duke Global Health Institute, Durham, NC, USA.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Gileard G
authors.initials: GG
authors.lastname: Masenga
authors.affiliation: Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Mary V
authors.initials: MV
authors.lastname: Mosha
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003863:Depression; D005260:Female; D005402:Fistula / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008603:Mental Health; D007744:Obstetric Labor Complications / Q000523:psychology / Q000601:surgery*; D011203:Poverty; D011247:Pregnancy; D011788:Quality of Life / Q000523:psychology*; D012918:Social Alienation; D057545:Social Stigma; D013636:Tanzania
keywords: Maternal health; Maternal morbidity; Mental health; Obstetric fistula; Tanzania; Vesico-vaginal fistula (VVF)