Abstract General Information

Title

MENTAL DISORDERS AND CONTINENCE PROBLEMS: A PROSPECTIVE STUDY OF BIDIRECTIONAL RELATIONSHIPS

Introduction and objective

Comorbidity between mental disorders and incontinence is well-established but the direction of the association is unclear. It is often assumed that the comorbidity is due to adverse consequences of continence problems on quality of life. It is also suggested that mental disorders could increase the risk of incontinence. The objectives of this study are to examine (i) if childhood mental disorders are associated with new onset urinary incontinence and (ii) if lower urinary tract symptoms in adolescence are associated with an increased risk of mental disorders.

Method

This study is based on data from over 6000 participants in the UK Avon Longitudinal Study of Parents and Children. We used multivariable logistic regression to examine (i) if mental disorders in children who were dry at age 7 are associated with new onset urinary incontinence (bedwetting and/or daytime wetting) at age 9 and (ii) if lower urinary tract symptoms (e.g. daytime wetting, bedwetting, voiding postponement, urgency, nocturia) at age 14 are associated with an increased risk of mental disorders at age 18.

Results

We found strong evidence that separation anxiety at age 7 is associated with new onset incontinence at age 9 (odds ratio (95% confidence interval) = 2.08 (1.39, 3.13), p<0.001). Social anxiety, attention deficit hyperactivity disorder and oppositional defiant disorder were also associated with new onset incontinence, but these associations attenuated following adjustment for developmental level and earlier emotional/behaviour problems. All subtypes of lower urinary tract symptoms in adolescents were associated with increased odds of anxiety [e.g. daytime wetting= 3.01 (1.78, 5.09), p<0.001]. There was also evidence of associations with common mental disorder [e.g., voiding postponement: 1.88 (1.46, 2.41), p<0.001], depression [e.g., urgency: 1.94 (1.19, 3.14), p=0.008], depressive symptoms [e.g., daytime wetting: 1.70 (1.13, 2.56), p=0.01], self-harm thoughts [e.g., voiding postponement: 1.52 (1.16, 1.99), p=0.003], and disordered eating [e.g., nocturia 1.72 (1.27, 2.34), p=0.001]. Daytime wetting and voiding postponement showed the greatest number of associations with mental disorders, but there was only weak evidence that bedwetting was associated with increased mental disorders.

Conclusion

We found evidence that (i) separation anxiety is associated with an increased risk of new onset urinary incontinence in children who were previously dry and (ii) young people with lower urinary tract symptoms are at increased risk of mental disorders in late adolescence. Paediatric continence clinics should address the mental health needs of children and young people and provide clear and effective care pathways to child and adolescent mental health services.