Overactive bladder, mental illness prevalent in young female war veterans

By Joanna Lyford, Senior medwireNews Reporter

Overactive bladder (OAB) symptoms are present in nearly one in four female veterans returning from overseas military service, US researchers say.

Their longitudinal analysis of participants in the Women Veterans Urinary Health Study also found an association between OAB and mental health issues such as depression and post-traumatic stress disorder (PTSD).

“Given these findings, OAB screening in patients with mental health conditions and vice versa may increase opportunities for the diagnosis and treatment of both sets of bothersome conditions”, write Catherine Bradley (University of Iowa Hospitals & Clinics, Iowa City, USA) and colleagues in the Journal of Urology.

The study enrolled 1702 women who in the previous 2 years had returned from deployment in Iraq and Afghanistan. The women were interviewed by telephone.

The women’s mean age was just 31.1 years and they were of diverse race/ethnicity: 59.1% were White, 21.2% were Black, 11.5% were Hispanic and 4.5% were Asian. Most women had served in the army and 17% were officers.

The overall prevalence of bothersome OAB symptoms was 22%, which is around twice the rate that would be expected in an age- and gender-matched general population, say the study authors.

Women with OAB were significantly older, weighed more and were more likely to be Black than women without this symptom, the researchers report. They also had higher parity and were significantly less likely to describe themselves as being in “excellent” or “very good” general health.

The overall prevalence of PTSD, depression and anxiety was 19%, 10% and 21%, respectively, while 27% reported a history of sexual assault.

Interestingly, all four of these factors were significantly more frequent in women with OAB than in those without; rates were 37.8% versus 13.8% for PTSD, 20.5% versus 7.0% for depression, 40.6% versus 16.0% for anxiety, and 37.0% versus 24.4% for sexual assault.

Each of the psychiatric diagnoses remained significantly associated with OAB after adjusting for covariates, with odds ratios of 2.7, 2.7, 2.5 and 1.4 for PTSD, depression, anxiety, and sexual assault, respectively.

The presence of mental health symptoms was also associated with a greater severity of urinary symptom bother on the Urogenital Distress Inventory and functional impact on the Incontinence IIQ-7 (Impact Questionnaire Short Form).

Bradley’s team says that there are several putative functional, social and biological mechanisms that may underlie the association between mental ill health and OAB. Dysfunction in serotonergic and pituitary–adrenal systems have been proposed as possible pathophysiological mechanisms; alternatively, low-grade inflammation may be a common underlying cause.

The team concludes: “Screening and evaluation for bothersome urinary symptoms and mental health problems appear warranted in female veterans presenting for primary and urological care after deployment.”

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