The Causal Effect of Different Depression Subtype on Interstitial Cystitis/Painful Bladder Syndrome: A Nationwide Retrospective Cohort Study

Chang K1, Lee M2, Wu S3, Lin H4, Wu H5

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes

Abstract 528
Assessment and Pathophysiology
Scientific Podium Short Oral Session 35
On-Demand
Painful Bladder Syndrome/Interstitial Cystitis (IC) Pain, Pelvic/Perineal Quality of Life (QoL)
1. Department of Obstetrics and Gynecology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan. Dept. of Management Info. Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, 2. Department of Urology, Miao-Li General Hospital, Ministry of Health and Welfare, Miaoli City Taiwan, 3. School of Medicine, Griffith University, Gold Coast, Australi, 4. Dept. of Management Info. Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, 5. Department of Urology, Mialoi General Hospital, Ministry of Health and Welfare, Taichung, Taiwan,
Presenter
Links

Abstract

Hypothesis / aims of study
Interstitial cystitis/painful bladder syndrome (IC/PBS) and depression are two diseases of chronic, unknown etiology and often occur concomitantly without a reasonable reason. Past studies have suggested that the prevalence of depression in IC/PBS patients ranges from 5 % to above 50 %. Some diseases have interaction with each other and therefore be co-existed. Similarly, there may also have interaction or causal effect between depression and IC/PBS. There are many different subtypes of depression with different severity or mechanism. The effect of comorbidity and interaction may therefore different among these subtypes. We hypothesized that depression is a risk factor of IC/PBS, and the effect was related to different type of depression. This study used a nationwide database with retrospective cohort study, and aimed to investigate the causal effect of different depression subtypes on IC/PBS.
Study design, materials and methods
Two types of newly diagnosed depression between 2002 and 2013 were identified from a nationwide database as the depression cohorts. Subjects which diagnosed of IC/PBS before depression were excluded. All depression patients were divided into two subgroups according to ICD-9 coding as Major depressive disorder, recurrent episode; and Major depressive disorder, single episode. These subjects were further matched one to one by confounding factors (including age, and other 12 comorbidities) with propensity scores as matched cohorts. All subjects were followed up during the study period to detect the event of IC/PBS. The hazard ratio (HR) of IC/PBS between depression and non-depression cohort in each type of depression was applied before and after matched by propensity scores. The duration of IC/PBS as consequence of depression and incidence density were calculated.
Results
There were 21,646 depression and 607,535 depression subjects, respectively, including11,290 and 10,281 patients in recurrent type subgroup and single episode type subgroup, respectively. Each subgroup was matched one to one using propensity score for confounding factors and yielded 11,179, 10,220 depression and non-depression cohorts among two subgroups. Demographics, including age, sex and 12 comorbidities, were similar between two cohorts of the same subgroup. Subgroup with recurrent type of major depressive disorder had significant higher incidence density and shorter duration of developing IC/PBS than matched control. (6.929 per 10,000 person-years and 4.67±2.65 years). After adjusted, the risk of IC/PBS remained significantly increased in recurrent type of major depressive disorder, HR=1.54 (95% CI, 1.039-2.269; p=0.031).
Interpretation of results
After controlling the confounding factors in our cohort study, the risk of IC/PBS was significantly increased in patients with recurrent or severe depressive disorder. A cross-talk pathophysiology of depression and IC/BPS is possible. Further study to investigate the effects of other types of depression was suggested. This finding could imply valuable cues to a urological approach, and preventive measures for holistic care in depressive disorder patients. Early identification and treatment of depressive disorder were important for prevention of BPS/IC in these numerous and disabled patients.
Concluding message
The risk of IC/PBS was significantly increased in patients with recurrent or severe depressive disorder. Early identification and treatment of depressive disorder were  important for prevention of BPS/IC in these numerous and disabled patients.
Figure 1 Table 1. Comparison on confounders between the depression and non-depression cohorts of three sub-groups
Figure 2 Table 2. Hazard ratio of IC/BPS in the depression cohort compared with the non-depression cohort of two sub-groups , Table 3. Incidence density of IC/PBS between the depression cohort and non-depression cohort in two sub-groups
Disclosures
Funding No Clinical Trial No Subjects Human Ethics Committee The Institutional Review Board of the Feng Yuan Hospital, Ministry of Health and Welfare, Republic of China, specifically (project/IRB no. 108009) Helsinki Yes Informed Consent No
10/07/2025 09:11:09