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Obstet Gynecol. 2014 Apr;123(4):822-7. doi: 10.1097/AOG.0000000000000186.

Urinary incontinence, depression, and economic outcomes in a cohort of women between the ages of 54 and 65 years.

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Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, the Division of Global Psychiatry, Department of Psychiatry, and the Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, and the Mbarara University for Science and Technology, Mbarara Uganda.



To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit.


The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54-65 years of age. Women were followed-up with biennial interviews until 2010-2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest.


At baseline, 727 participants (survey-weighted prevalence, 16.6%; 95% confidence interval [CI] 15.4-18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2%; 95% CI 25.4-33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6%; 95% CI 19.8-23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95% CI 1.27-1.62) and work disability (adjusted hazard ratio, 1.21; 95% CI 1.01-1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95% CI 0.93-1.21).


In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits.

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