Prevalence of Anxiety and Depression in Women with Overactive Bladder in an Underserved Area

Objectives: Overactive bladder (OAB) symptoms in women can significantly lower quality of life and increase risk of associated anxiety and/or depression. Most treatment methods may fail to address this emotional burden directly due to lack of early screening among OAB patients. Health disparities research indicates these challenges may be augmented in minority populations and medically underserved communities. This study aims to estimate the prevalence of anxiety and/or depression in a cohort of predominately Hispanic patients with OAB in an underserved area.

Methods: This retrospective cross-sectional study included patients from a single institutional Urogynecology clinic in a medically underserved area. Charts were reviewed for patients presenting with symptoms of OAB (urinary frequency, urgency, nocturia and/or urgency urinary incontinence) as identified via ICD-10 codes from 2016-2020. Pregnant or recent postpartum patients and patients with active gynecologic malignancy were excluded. Patient demographics, main presenting symptoms, prior treatments/surgery for pelvic floor disorders, medical comorbidities, and physical exam findings from the initial office visit were collected. Charts were cross-referenced for a history of anxiety and/or depression using ICD-10 codes, physician notes, current care under a psychiatrist, and relevant medications to estimate the prevalence of anxiety and/or depression. Data is reported using summary statistics using means/standard deviations and frequencies/percentages. Logistic regression analysis were used to identify factors associated with an increased prevalence of anxiety/depression in patients with OAB. A P-value of 0.05 was considered statistically significant.

Results: Six hundred-seventy one charts for patients with ICD-10 codes for OAB symptoms were included in the final analysis. Most patients were Hispanic (89.3%) with an average age of 63.3 years (standard deviation 13.65). A total of 217 (32.3%) had a history of anxiety and/or depression (21.2% anxiety only, 42.9% depression only, and 35.9% both symptoms). This was reported via associated ICD-10 codes (73.3%), physician documentation (94.5%), current care with psychiatry (11.5%), or current relevant medication usage (52.5%). Of the patients with anxiety and/or depression, 54.1% had OAB as the main presenting complaint.Forty-one percent were taking medications for OAB. Only three patients (1.4%) were referred to psychiatry for anxiety and/or depression. On adjusted logistic regression analysis, as compared to prolapse, patients with OAB (OR 2.0 95% CI 1.29-3.10) and patients with any comorbidities were more likely to have anxiety and/or depression (OR 1.61 95% CI 1.05-2.46).

Conclusions: Anxiety and depression were prevalent in OAB patients in this medically underserved, predominately Hispanic population. Referral to psychiatry for these symptoms was low, which may indicate under-screening in these patients. Lack of other comorbidities was protective against having anxiety/depression. This study highlights the importance of developing a multidisciplinary, collaborative approach to treating patients with combined OAB and anxiety/depression.