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26-05-2013 | Gynaecology | Article

Call for depression awareness in urge urinary incontinence


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medwireNews: Both physical and drug therapy significantly reduce depressive symptoms in women with urge urinary incontinence (UUI), research shows.

However, the study, published in the International Urogynecology Journal, found that 22% of women had depressive symptoms that had not been clinically diagnosed.

"This study emphasized the increasingly recognized problem of undiagnosed depression among middle-aged women with UUI," say authors Itshak Melzer (Ben-Gurion University of Negev, Beer-Sheva, Israel) and colleagues.

The study involved the secondary analysis of a randomized trial including 164 women aged 45 to 75 years with UUI. The women were randomly assigned to receive antimuscarinic drug therapy (tolterodine SR, 4 mg), bladder training, pelvic floor muscle training, or combined pelvic floor rehabilitation for 3 months.

Women with clinically diagnosed depression were excluded from the study, but 36 (22%) patients scored greater than 16 on the Center for Epidemiologic Studies Depression scale (CES-D), indicating depressive symptoms.

At baseline, women with depressive symptoms had significantly lower scores on the Quality of life related to UI measure compared with women without, with a mean score of 63.7 versus 73.7. Health status, as measured by the EuroQol visual analog scale, was also significantly lower at 62.7 versus 78.7.

After 3 months' treatment, the mean CES-D score among women with depressive symptoms fell from 23.7 to 18.3. And, at 1-year follow-up, it had fallen to 15.2 - below the threshold for depressive symptoms. Conversely, women initially without depressive symptoms showed a slight but significant increase in CES-D scores, from 5.6 at baseline to 7.3 at 1 year.

An analysis of the interaction effects between groups and time also showed that women with depressive symptoms at baseline experienced greater improvements in depressive symptoms and UUI-related symptoms with therapy than women without depressive symptoms at baseline.

There was no significant change in the proportion of women with depressive symptoms over the study period among those who received physical therapy and those who received drug therapy.

Nevertheless, the authors conclude that the significant proportion of women with undiagnosed depression and the clinically meaningful impact of treatment observed in their study "reflect the importance of enhancing the awareness of clinicians about the depressive component of UUI treatment."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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