The Effect of Long-Term Treatment of Overactive Bladder on Self Esteem and Depression; Results from a One Year Prospective Study


Introduction and Objectives: The loss of self-esteem and depressive symptoms have been previously reported in women with urinary incontinence. Low self-esteem and depression can have a profound effect on quality of life. The incidence of depression in the United Kingdom is estimated between 20 to 25% of women. Self-esteem, defined as the "belief and confidence in one’s own ability and value" is distinct from well being, confidence, and depression. Self-esteem and depression influence health-seeking and coping behaviours and perception of illness and treatment compliance, which are important factors in the successful management of lower urinary tract dysfunction. The objective of this study was to determine whether or not treatment of overactive bladder (OAB) was associated with improvement in self-esteem and depression in women, using validated questionnaires.

Methods: Women referred from primary care with symptoms of OAB participating in a 1-year prospective follow-up study of conservative treatment for OAB were recruited from 2 urogynaecology tertiary referral centers. Treatment included information about lifestyle modification, bladder retraining, pelvic floor exercises, and antimuscarinic medication. Patients were assessed at baseline and 12 months. Participants were asked to complete a series of validated questionnaires at both visits; the Hospital Anxiety and Depression Scale (HADS), the Rosenberg Self-esteem Scale (SES), and the Kings Health Questionnaire (KHQ). The HADS is a 14-item screening questionnaire for clinical anxiety and depression. The SES is a 10-item questionnaire scored on a 4-point Likert scale. The SES is marked on a continuous scale whereby a greater score indicates greater self-esteem. The KHQ is a 9-domain quality of life questionnaire that has been used extensively for the assessment of lower urinary tract dysfunction. Statistical analysis was performed using paired t test calculations on SPSS version 15. This study was granted ethical approval by the local research and ethics committee, and all patients gave written informed consent.

Results: Ninety patients took part in the study and completed 12 months of follow-up. The mean age of participants was 54 years (range: 22 to 86). Seven patients reported a history of mental health illness at baseline. Treatment of OAB was associated with improvement in all KHQ domains for all patients. Improvement in the incontinence impact, role limitations, physical limitations, emotions, severity measures, and personal relationships domains was statistically significant (P < 0.05). At baseline, 43 patients (48%) screened positive for anxiety and 31 patients (34%) screened positive for depression on the HADS screening questionnaire. At the end of the study, 25 (28%) and 21 (23%) patients screened positive for anxiety and depression, respectively. There was a statistically significant reduction in the number of patients who screened positive for clinical anxiety from baseline to 12-month follow-up; the reduction in the number of patients who screened positive for depression at the end of the study did not reach statistical significance. Comparison of baseline and 12-month follow-up scores showed a significant improvement in mean SES scores from baseline to 12-month follow-up (P < 0.05) in patients who did not screen positive for anxiety or depression on the HADS screening questionnaire.

Conclusions: Treatment of OAB in women is associated with improvements in lower urinary tract symptoms and self-esteem, and a reduction in the incidence of clinical anxiety and depression.

KEYWORDS: Overactive bladder, self-esteem, anxiety, depression