Urinary Incontinence and Psychological Distress in Community‐Dwelling Older African Americans and Whites

Abstract

OBJECTIVES-To compare the association between urinary incontinence (UI) and psychological distress in older African Americans and whites. DESIGN-A population-based longitudinal survey.SETTING-Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS-AfricanAmericans and whites aged 50 and older at follow-up interviews performed between 1993 and 1996 for whom complete data were available (n = 747).MEASUREMENTS-Participants were classified as incontinent if any uncontrolled urine loss within the 12 months before the interview was reported. Psychological distress was assessed using the General Health Questionnaire (GHQ). RESULTS-AfricanAmericans with UI were more likely to experience psychological distress as measured using the GHQ than were African Americans without UI (unadjusted odds ratio = 4.22, 95% confidence interval = 1. 72-10.39). In multivariate models that controlled for age, sex, education, functional status, cognitive status, and chronic medical conditions, this association remained statistically significant. The association between UI and psychological distress did not achieve statistical significance in whites.CONCLUSION-The effect of UI on emotional well-being may be greater for African Americans than for whites.Keywords urinary incontinence; race; psychological distress; depression Urinary incontinence (UI) is a common condition in older adults. Although sampling and methodological differences account for variability in estimates from surveys, 1 the prevalence of UI in community-dwelling older adults has been reported to be about 10% for men and 20% for women.2 , 3 African-American women appear to be less likely to experience UI than white women.4 ,5 In a large study of an ethnically diverse sample of women, the prevalence of UI was lowest in African American women, 6 Despite the lower prevalence of UI in certain ethnic groups, there may be ethnic differences in the effect of UI on daily life. Overall, the evidence for the negative emotional consequences of UI has been conflicting. Some studies have suggested an association between UI and symptoms of depression as well as anxiety. [8][9][10][11][12][13][14][15] Other studies found no association between UI and depression 16 or that UI was only weakly related to psychological well-being. 17,18 One study found incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were slightly more likely to report psychological distress. Psychological distress associated with UI was not more likely in ethnic minorities, but fewer than 10% of individuals with UI in that sample were African American. 18 However, a study with an ethnically diverse sample found that Hispanic and African-American women experienced a greater level of effect on daily life with increasing severity of UI than white women. 19 Another study on a convenience sample of collegeeducated African-American women who reported UI...

Urinary incontinence among Taiwanese women: an outpatient study of prevalence, comorbidity, risk factors, and quality of life

“…For peptic ulcer disease, no report in the literature shows a correlation between peptic ulcer and urinary incontinence. However, since there is an association between urge incontinence (UI) and psychological distress [38], and psychological distress is a potential risk factor for peptic ulcer [39], we suspect that urinary incontinence may indirectly induce peptic ulcer through psychological distress. The significant association of cardiac disease with incontinence cannot be well explained at this point.…”

Palliative Care for the Older Adult

“…UI can be a troublesome symptom that impacts quality of life with significant psychological consequences including social withdrawal, body image distortion, and depression. [102][103][104] UI has been noted to substantially increase caregiver burden, and it is an independent predictor of nursing home placement. [105][106][107] Unfortunately, data describing the evaluation and treatment of incontinence in palliative care settings are limited.…”

Gender Differences in Healthcare-Seeking Behavior for Urinary Incontinence and the Impact of Socioeconomic Status

“…1 For both genders, UI is associated with increased risk of morbidities, such as pressure sores and urinary tract infections, 1 and can have detrimental impacts on social and psychologic well-being. [1][2][3] A wide range of treatments of UI are available, and incontinence can be substantially improved or even cured. 1 However, a large percent of incontinent elders do not seek professional advice or treatment, 4 -7 because of misconceptions that UI is a normal consequence of aging or childbirth, embarrassment about urine leakage, or fear of needing an operation.…”