According to the World Health Organization (WHO), one in eight people globally lives with a mental disorder. Specifically, women face a lifetime prevalence of 17% for anxiety and 29% for depression. Many women, especially older women, suffer from urological dysfunction. Women with urological diseases experience various negative impacts on their quality of life, including physical, social, and psychological factors. While various studies have separately reported the psychological impact of individual urological conditions, direct comparisons of the mental health burden across multiple female urological diseases remain scarce.
This study aimed to evaluate and compare the prevalence of anxiety and depression among patients with urinary incontinence (UI), pelvic organ prolapse (POP), and interstitial cystitis/ bladder pain syndrome (IC/BPS) attending a female urology department in Japan.

After approval was obtained from the relevant ethics committee, written informed consent was obtained from patients at their first consultation. All patients underwent a diagnostic work-up involving their medical history and a physical examination (including transvaginal examination). This study included 422 patients with UI, 361 with symptomatic POP (>2 in the pelvic organ prolapse quantification [POP-Q] scale), and 132 with IC or BPS. The UI group completed the International Consultation of Incontinence Questionnaire-Short Form and the Overactive bladder symptom score, the POP group completed the POP-Q scale and Prolapse-QOL, and the IC / BPS group completed the Interstitial Cystitis Symptom Index and Problem Index. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression in all patients. Comparisons of proportions among the three groups were performed using the chi-square test. When a significant difference was identified, post-hoc pairwise comparisons were conducted with Bonferroni correction to adjust for multiple testing. A p-values < 0.05 was considered statistically significant.

The average age was 63±14.5 years in the UI patients, 70.8±9.6 years in the POP patients, and 69.5 ±16.6 years in the IC/BPS patients. The prevalence of psychological distress was extremely high across all urological conditions. In the general Japanese female population, the prevalence of anxiety and depression is 2.6% and 7.5%, respectively. Anxiety was observed in 28.0% of UI patients, 25.4% of POP patients, and a striking 72.2% of IC/BPS patients. Similarly, depression was reported in 25.2% of UI patients, 24.6% of POP patients, and reached an extraordinary 87.0% in the IC/PBS patients. The prevalence of both anxiety and depression in patients with IC/BPS was significantly higher than those in patients with UI and POP (p < 0.001).

Compared to the general Japanese female population, the risk of anxiety was approximately 10 times higher for UI or POP and 27 times higher for IC/BPS patients. Regarding depression, the risk was 3 times higher for UI/POP and 11 times higher for IC/BPS patients.

Compared with the general Japanese population, female urological diseases, particularly those with IC/BPS, exhibit an extremely high prevalence of mental health comorbidities. Comprehensive mental health screening and integrated care are essential in the management of these patients.