A prospective study examining the association between the symptoms of anxiety and depression and severity of urinary incontinence

Objective: To investigate the association of the presence or absence of the symptoms of anxiety and depression compared with the 48 h pad test as an objective measure of incontinence. Design: Prospective study. Setting: Urodynamics clinic in a large teaching hospital. Subjects: All patients with urinary incontinence attending for urodynamic assessment from 23.4.96 to 29.10.96. Interventions: 48 h pad test, Hospital Anxiety and Depression scale (HAD scale). Main outcome measures: Urodynamic diagnosis of cause of incontinence. Urinary loss over 48 h as measured by weight change in pads. Presence of symptoms of anxiety or depression as defined by HAD scale score of 8 or more. Results: Urodynamic investigation was performed for incontinence on 133 patients. Of these 127 (95.4%) completed the HAD scale questionnaire. Of the 43 patients (32.2%) who returned the pads 18 (41.8%) patients were found to have symptoms of anxiety and six patients (13.9%) had symptoms of depression. Patients with symptoms of anxiety had lower mean measured urinary loss over a 48 h period compared to women with no symptoms of anxiety (median loss 44.2 ml range 6.8– 622.4 versus 97.1 ml range 8.2–4384.4 ml) (P=0.05). There was no significant association between symptoms of depression and pad test results. Conclusions: Patients presenting with incontinence who have symptoms of anxiety are on average less incontinent compared to than those without symptoms of anxiety. It suggests that anxious patients present with a lesser degree of incontinence than nonanxious patients.