Kafri Rachel, Kodesh Arad, Shames Jeffrey, Golomb Jacob, Melzer Itshak
Department of Physical Therapy, Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health Science, Ben-Gurion University of Negev, PO Box 653, Beer-Sheva, 84105, Israel.
Int Urogynecol J. 2013 Nov;24(11):1953-9. doi: 10.1007/s00192-013-2116-9. Epub 2013 May 15.
Depression is more common in patients with urinary incontinence (UI). Drug or rehabilitation therapy have been shown to be effective in reducing urgency UI (UUI) symptoms, but whether these treatments can ameliorate the negative impact of UUI on the psychological aspects of quality of life is unclear.
A secondary analysis of an assessor-blinded randomized controlled trial was performed. The number of depressive symptoms was the primary outcome as measured by the Center for Epidemiologic Studies Depression scale (CES-D).
Thirty-six (22%) subjects had a CES-D score >16 at baseline, the cutoff for having depressive symptoms. A significant association was found between having a CES-D score >16 and lower quality of life related to UI at baseline. The mean CES-D score among those with depressive symptoms at baseline was significantly reduced throughout the study, with a mean of 23.7 at baseline, to 18.3 and 15.2 at the 3-month and 1-year follow-up (p < 0.001), respectively. The number of participants who had depressive symptoms decreased during the study period only in the physical therapy groups, from 31 at baseline to 28 and 25, at 3 and 12 months, respectively, while there was no such change in the drug group.
Patients with UUI who had depressive symptoms showed significant improvement in their depressive symptoms with treatment over 1 year. This improvement occurred regardless of the type of treatment. This study emphasizes the increasingly recognized problem of undiagnosed depression among middle-aged women with UUI.
抑郁症在尿失禁（UI）患者中更为常见。药物或康复治疗已被证明对减轻急迫性尿失禁（UUI）症状有效，但这些治疗能否改善UUI对生活质量心理方面的负面影响尚不清楚。
对一项评估者盲法随机对照试验进行二次分析。抑郁症状数量是主要结局，通过流行病学研究中心抑郁量表（CES-D）进行测量。
36名（22%）受试者在基线时CES-D评分>16，这是存在抑郁症状的临界值。在基线时，发现CES-D评分>16与较低的与UI相关的生活质量之间存在显著关联。在整个研究过程中，基线时有抑郁症状者的平均CES-D评分显著降低，基线时平均为23.7，在3个月和1年随访时分别降至18.3和15.2（p<0.001）。在研究期间，只有物理治疗组有抑郁症状的参与者数量减少，从基线时的31人分别降至3个月和12个月时的28人和25人，而药物组没有这种变化。
有抑郁症状的UUI患者在1年的治疗后抑郁症状有显著改善。无论治疗类型如何，这种改善都会出现。本研究强调了UUI中年女性中未被诊断出的抑郁症这一日益受到认可的问题。
