Li Kun, Yan Xiao, Zhang Meng, He Yang, Luo Chengjun
Department of Urology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China.
Int Urogynecol J. 2025 Apr 28. doi: 10.1007/s00192-025-06140-y.
Urinary incontinence (UI) is associated with body mass index (BMI) and may be influenced by depressive symptoms. This study was aimed at assessing the relationship between BMI and UI risk and frequency in adult women, with a focus on depressive symptoms, measured by Patient Health Questionnaire-9 (PHQ-9) score, as a potential mediator.
Data from 6107 adult women in the National Health and Nutrition Examination Survey from 2005 to 2018 were analyzed. Weighted multivariable-adjusted regression analysis determined odds ratios (ORs) and 95% confidence intervals (CIs) for BMI-UI associations. Restricted cubic spline (RCS) analysis evaluated nonlinear relationships, and causal mediation analysis examined the mediating role of depressive symptoms. Subgroup analyses were stratified by PHQ-9 score.
Higher BMI was associated with increased UI risk and frequency. When BMI was categorized into quartiles, UI risk progressively increased from Q2 to Q4. In the fully adjusted model, OR for UI risk in Q4 vs Q1 was 2.53 (95% CI 1.83, 3.52; p < 0.001), with a significant trend across quartiles. RCS analysis indicated a nonlinear relationship, with increased UI risk, particularly at BMI levels above 30. Depressive symptoms were independently associated with higher UI risk and frequency, with significant mediation effects. Mediation analysis revealed that PHQ-9 score accounted for approximately 6.8% of the effect of the BMI on UI risk and 6.5% on UI frequency (both p < 0.001).
Elevated BMI and depressive symptoms are independently associated with increased UI risk and frequency among adult women. The mediation effect of depressive symptoms underscores the importance of addressing mental health and weight management to reduce UI risk. These findings advocate a holistic approach to UI prevention and treatment, integrating physical and mental health strategies.
尿失禁（UI）与体重指数（BMI）相关，且可能受抑郁症状影响。本研究旨在评估成年女性中BMI与UI风险及频率之间的关系，重点关注通过患者健康问卷-9（PHQ-9）评分测量的抑郁症状作为潜在中介因素的作用。
分析了2005年至2018年国家健康与营养检查调查中6107名成年女性的数据。加权多变量调整回归分析确定了BMI与UI关联的比值比（OR）和95%置信区间（CI）。受限立方样条（RCS）分析评估非线性关系，因果中介分析检验抑郁症状的中介作用。亚组分析按PHQ-9评分分层。
较高的BMI与UI风险和频率增加相关。当BMI分为四分位数时，UI风险从第二四分位数到第四四分位数逐渐增加。在完全调整模型中，第四四分位数与第一四分位数相比，UI风险的OR为2.53（95%CI 1.83，3.52；p<0.001），四分位数间有显著趋势。RCS分析表明存在非线性关系，UI风险增加，尤其是在BMI水平高于30时。抑郁症状与较高的UI风险和频率独立相关，具有显著的中介作用。中介分析显示，PHQ-9评分约占BMI对UI风险影响的6.8%，对UI频率影响的6.5%（均p<0.001）。
BMI升高和抑郁症状与成年女性UI风险和频率增加独立相关。抑郁症状的中介作用强调了关注心理健康和体重管理以降低UI风险的重要性。这些发现提倡采用综合身心健康策略的整体方法来预防和治疗UI。
