According to these studies:
* Urinary incontinence is increasingly widespread in later life, especially among women.
* The condition is closely linked to depression.
* Pharmacologic treatment of depression can favorably affect both disorders.
During their lifetimes, nearly half of all women suffer from some degree of urinary incontinence, categorized as either stress incontinence, the leaking of a small amount of urine when coughing or on lifting a heavy object, or urge incontinence, in which the sudden urge to void is irresistible, rendering it difficult to reach the toilet in time. Some women experience a combination of the two types. The widespread availability of products for incontinence is indicative of its prevalence, which can entail serious impairment of functioning, such as loss of libido, fear of exercising, or fear of leaving the home.
A study published in Obstetrics and Gynecology adds to the growing body of evidence that links depression and urinary incontinence. A detailed 15-page questionnaire mailed to 6,000 randomly selected female subscribers to a Washington state health maintenance organization probed for the presence and type of urinary incontinence, while incorporating screening criteria for major depression; the responses to further questions allowed the researchers to adjust for possible causes of both problems-depression has been associated with medical comorbidity, obesity, smoking, and lower levels of education, while incontinence has been linked to diabetes. Even after allowing for the possibility that some depressed women may not have returned the questionnaire, the prevalence of depression was shown to be three times greater in respondents with incontinence.
In an earlier study conducted in 2001 by a group of nurse researchers at Columbia Presbyterian Medical Center in New York City, it also was discovered that depression is approximately three times more prevalent among incontinent women than it is among continent women, and it was concluded that it often can be difficult to determine which condition came first. Impairment in the performance of daily activities and a change in self-esteem attributable to the leakage of urine can have emotional consequences culminating in anger and depression, but there also seems to be the possibility that incontinence can be caused by biochemical factors that can also engender depression. Complex serotonergic neuronal pathways govern voiding, for example, and in a study published in the Journal of Urology, diminished serotonergic function was associated with both some forms of depression and urge incontinence, with the authors suggesting that the treatment of the serotonergic dysfunction with serotonergic antidepressants exerts a favorable effect on the incontinence.
Depression is a remediable mental disorder. The symptoms can be subtle and are not always readily recognizable to the patient, but mood disorders can greatly degrade the quality of life, interfere with self-care (including adherence to a medication regimen), and cause heightened sensitivity to somatic symptoms such as pain and fatigue. They can also adversely affect disease processes. Nurses providing care to incontinent patients in clinical settings should be aware of the easily used tools for screening for depression and refer patients to nurse practitioners or physicians, as appropriate.
CC