One in five recently deployed U.S. women veterans report overactive bladder symptoms. Mental health conditions such as depression and anxiety commonly co-occur in women with overactive bladder, but temporal relationships between these outcomes have not been well-studied, and the mechanism behind this association is unknown. The Women Veterans Urinary Health Study, a nationwide longitudinal study in recently deployed women veterans, was designed to better understand relationships between overactive bladder and mental health conditions.
To estimate the 1-year incidence and remission of overactive bladder and to identify the impact of depression, anxiety, posttraumatic stress disorder and prior sexual assault on 1-year overactive bladder incidence and remission rates.
Participants of this 1-year prospective cohort study were female veterans separated from military service who had returned from Iraq or Afghanistan deployment within the previous 2 years. Eligible women were identified through the Defense Manpower Data Center and recruited by mail and telephone. Telephone screening confirmed participants were ambulatory, community-dwelling veterans and excluded those with urinary tract fistula, congenital abnormality or cancer; pelvic radiation; spinal cord injury; multiple sclerosis; Parkinson's disease; stroke or current/recent pregnancy. Data collection included computer-assisted telephone interviews performed at enrollment and 1 year later. The interview assessed demographic and military service characteristics; urinary symptoms and treatment; depression, anxiety and posttraumatic stress disorder symptoms and treatment; and a lifetime history of sexual assault. Overactive bladder was identified if at least moderately bothersome urgency urinary incontinence and/or urinary frequency symptoms were reported on Urogenital Distress Inventory items. Exposures included depression, anxiety, posttraumatic stress disorder and lifetime sexual assault, assessed at baseline using validated questionnaires (including the Patient Health Questionnaire and Posttraumatic Stress Disorder Checklist). Associations between exposures and overactive bladder incidence and remission were estimated using propensity-score adjusted logistic regression models.
1107 (88.0%) of 1258 eligible participants completed 1-year interviews. Median age was 29 years (range 20-67) and 53% were nulliparous. Overactive bladder was identified at baseline in 242 (22%), and 102 (9.2%), 218 (19.7%), 188 (17.0%) and 287 (25.9%) met criteria for baseline depression, anxiety, posttraumatic stress disorder and lifetime sexual assault, respectively. At 1-year, overactive bladder incidence was 10.5% (95%CI, 8.6%-12.8%), and remission of overactive bladder was 36.9% (95%CI, 30.8-43.4%). New overactive bladder occurred more often in women with baseline anxiety (21% vs. 9%), posttraumatic stress disorder (19% vs. 9%) and lifetime sexual assault (16% vs. 9%) (all: p<0.01). After adjustment, anxiety (OR = 2.4; 95%CI, 1.4-4.1) and lifetime sexual assault (OR = 1.7; 95%CI, 1.0-2.8) predicted 1-year incident overactive bladder. Overactive bladder remission occurred less often in those with baseline depression (19% vs. 41%, p<0.01) and anxiety (29% vs. 42%, p=0.03). After adjustment, depression decreased 1-year overactive bladder remission risk (OR = 0.37; 95%CI, 0.16-0.83). Overactive bladder treatment was uncommon and not associated with remission.
Anxiety, depression and prior sexual assault, common post-deployment problems for women veterans, influence the natural history of overactive bladder. Providers should screen for mental health conditions and sexual assault in women with newly diagnosed or persistent overactive bladder.
American journal of obstetrics and gynecology. 2017 Jun 20 [Epub ahead of print]
Catherine S Bradley, Ingrid E Nygaard, Stephen L Hillis, James C Torner, Anne G Sadler
Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA; Departments of Obstetrics and Gynecology and Urology, University of Iowa Carver College of Medicine, and Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA. Electronic address: ., Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT., Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA; Department of Radiology, University of Iowa Carver College of Medicine and Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA., Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA., Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA.