Urinary Incontinence has been associated with psychological distress, lower quality of life, depression and anxiety.  However, few studies have concentrated on the psychological issues relating to incontinence such as the impact on quality of life, management and coping behaviours, social connectedness, and beliefs and knowledge of the condition, focussing more upon risk factors such as gender, age, cognitive impairment and physical health.  such as those influenced by resilience. The overarching aim of this program of work was “Is the depression experienced by people with urinary incontinence is associated with psychosocial factors related to incontinence such as quality of life?” Contributions to this project included population studies over time (1,2), literature reviews and a qualitative study examining women’s experience of urinary incontinence and depression (3). Resilience features when describing this relationship particularly the psychosocial aspects, such as support structures, self-esteem, physical and mental health, coping, resourcefulness, and self-discipline, which are all constructs of this concept. There has been much discussion about what defines resilience; this makes measuring resilience difficult because it has been described both as a continuum and an aggregate of a number of different resources.

A group of mixed method studies contributed to an investigation into whether the depression experienced by people with urinary incontinence is associated with psychosocial factors related to incontinence. These included a number of population studies over the last 2 decades using the Health Omnibus Survey (n= 3000) (1998, 2001, 2004, 2015), examining incontinence, depression and quality of life; and perceptions of seriousness and severity of incontinence; a review of the literature, as well as a qualitative study examining women’s experience of urinary incontinence and depression. Ethical approval was obtained from the relevant Human Research Ethics Committee and all participants gave informed consent to be involved in the studies.

Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health. A review of the literature has also found that incontinence and psychological wellbeing are intertwined. Enquiring about the mental health status of those with incontinence should include an assessment of psychosocial factors to help reduce the burden of incontinence. Further, severity and limitations to lifestyle were found to be predictors of women perceiving that their incontinence was moderate to very serious.  Help-seeking for incontinence improve if education and information target women who use continence management aids, have difficulty being involved in activities or who use other management strategies. Finally, an exploration of how women experience incontinence in relation to their depression status has been undertaken. We have also been able to ascertain the prevalence of urinary incontinence in female respondents over time, with UI reported by n=546/1546 (35.3%) of females in 1998, n=579/1549 (37.4%) in 2001, and 624/1527 (40.8%) in 2015, showing an upward trajectory over time.

Women who are older and highly resilient, experience less depression and can manage their depression better (3).  Women who do not exhibit resilience are more likely to experience depression, and their incontinence has a greater impact on their lives (3). This is increasingly important considering the increase in the prevalence of urinary incontinence over time. We can gauge the impact of incontinence on the lives of women by examining their limitations from and perceptions about the seriousness of their condition, and we can target interventions towards those who experience limitations and use management strategies. Targeted interventions can be designed for specific age groups, that can increase resilience, so that the burden, including depression, is eased and the quality of life is increased in women experiencing incontinence.

Those who experience incontinence and are affected by depression in their day to day lives experience a reduced quality of life. If we can identify and manage comorbid depression in women with incontinence we may improve overall quality of life. It is important to assess psychosocial factors in women with incontinence, and design age and resilience focus interventions to lessen the impact of depression and improve quality of life.

Avery JC, Stocks NP, Duggan P, Mayer AJ, Taylor AW, Goldney RD and MacLennan AH.  Identifying the quality of life effects of urinary incontinence with depression in an Australian population.  BMC Urology. 2013; 13(11).
Avery J, Stocks N, Taylor AW. Gill TK. Perceptions and prevalence of urinary incontinence in the Australian population. Australian and New Zealand Continence Journal. 2014; 20(1): 7-13.
Avery JC, Braunack-Mayer AJ, Duggan PM, Taylor AW, Stocks NP.  “It’s our lot”; how resilience influences the experience of depression in women with urinary incontinence.  Health Sociology Review 2015. 24(1) 94–108