Affective Symptoms and Health-Related Quality of Life Among Women with Stress Urinary Incontinence: Cross-Sectional Study

Figures & data

Table 1 Sociodemographic and Clinical Characteristics (Uro-Gynaecological History) Among Women with SUI and the Controls

	Women with SUI (n=80)	Controls (n=97)	P
Age, mean (SD), years	51.5 (11)	49 (7)	p=0.104
Marital status, n (%)			χ^2=21.0 p<0.001
Single	13 (16.3)	47 (48.5)
With partner	67 (83.7)	50 (51.5)
Education, n (%)			χ^2=10.4 p<0.006
Secondary school, <12 years	27 (33.8)	13 (13.4)
Upper secondary	29 (36.3)	47 (48.5)
University/faculty	24 (30)	37 (38.1)
Clinical characteristics
Comorbid chronic illness, n (%)	30 (37.5)	32 (33.0)	χ^2=0.392 p=0.531
BMI mean (SD), kg/m^2	28.8 (6.5)	26.3 (4.1)	0.002
Obesity, n (%)	27 (33.8)	14 (14.4)	0.002
Gynaecological history
Menopause, n (%)	41 (51.3)	37 (38.1)	0.08
Type of delivery, n (%)
Vaginal delivery	78 (97.5)	77 (79.4)	0.002
Parity, n (%)			p=0.001
0	0 (0)	12 (12.4)
1	15 (18.8)	31 (32)
2	49 (61.3)	43 (44.3)
3+	16 (20)	11 (11.3)
Urinary symptoms, mean (SD)
No. of daytime voids^a	1.8 (0.4)	1.4 (0.5)	<0.001
No. of nighttime voids^b	1.4 (0.5)	1.6 (0.6)	<0.001
Urinary leakage with physical activity^c	2.99 (0.1)	0.08 (0.4)	<0.001
Amount of leakage (elimination), n (%)			<0.001
Droplet	2 (2.5)	4 (4.1)
Squirt	56 (70)	0
All vesicle	22 (27.5)	0
leakage	0	93 (95.9)

Notes: P-values are obtained using two-sample t-tests for continuous variables and chi-square tests of independence for categorical variables; p<0.05 in bold. Based on the categories of response: ^aDiurnal frequency (episodes per day): 1 = 1 to 5 times; 2 = 6 to 9 times; 3 = 10 or more times. ^bNocturia frequency (episodes per night): 0=never; 1=one time; 2=two or more times. ^cUrinary leakage with physical activity: 0=question not applicable; 1=coughing; 2=sneezing.

Table 2 The Comparison of Self-Reported Anxiety and Depression Symptoms on HADS Scores and Health- Related QoL in the KHQ Scores Among Women with SUI and the Controls

Domains	Women with SUI, n=80 Mean (SD)	Controls n=97 Mean (SD)	Mann–Whitney^a
			P
HADS-D, score	5.4 (3.3)	2.4 (2.1)	<0.001
HADS-A, score	7.2 (3.6)	3.8 (3.0)	<0.001
HADS-D >7, n (%)	23 (28.8)	3 (3.1)	<0.001
HADS-A >7, n (%)	40 (50.0)	11 (11.3)	<0.001
HADS-D ≥11, n (%)	5 (6.3)	0 (0)	0.012
HADS-A ≥11, n (%)	14 (17.5)	3 (3.1)	0.001
KHQ domain scores
1 - General health perceptions (GH)	36.1 (22.1)	26.3 (15.5)	<0.001
2 - Incontinence impact (II)	62.5 (22.10)	8.25 (20.43)	<0.001
3 - Role limitations (RL)	74.79 (21.37)	1.03 (5.27)	<0.001
4 - Physical limitations (PL)	79.17 (20.9)	1.89 (6.75)	<0.001
5 - Social limitations (SL)	69.17 (20.7)	0	<0.001
6 - Personal relationships (PR)	62.28 (27.30)	0	<0.001
7 - Emotions (EM)	65.97 (22.80)	0.23 (1.59)	<0.001
8 - Sleep/energy (SE)	25.21 (17.38)	2.75 (7.08)	<0.001
9 - Severity measures (SEV)	70.92 (12.74)	6.39 (11.42)	<0.001
Part 1^b	101.5 (39.2)	34.5 (28.4)	<0.001
Part 2^b	447.5 (105.6)	12.3 (26.2)	<0.001

Notes: Data are presented as mean (SD) or n (%). ^aMann–Whitney test statistics provide the U statistic, as well as the asymptotic significance (2-tailed) p-value. ^bPart 1 – sum of domains 1 and 2 of the KHQ; Part 2 – sum of domains 3 to 9 of the KHQ.

Table 3 Comparison Between the HADS and KHQ Scores Among Women with SUI According to Age Groups

Domains	<55 Years Old (n=47) Mean (SD)	≥55 Years Old (n=33) Mean (SD)	Mann–Whitney^a
HADS-A, score	6.4 (3.8)	8.4 (3.2)	0.008
HADS-D, score	3.9 (3.0)	7.5 (2.5)	<0.001
HADS-A >7, n (%)	19 (40.4%)	21 (63.6%)	0.041
HADS-D >7, n (%)	8 (17%)	15 (45%)	0.006
HADS-A ≥11, n (%)	5 (10.6)	9 (27.3)	0.054
HADS-D ≥11, n (%)	–	5 (15.2)	0.006
BMI, kg/m^2	27.5 (5.4)	30.7 (7.6)	0.046
Duration of SUI, median (IQR), years	7 (4–10)	10 (6.5–15.5)	0.007
1 - General health perceptions (GH)	30.8 (20.9)	50.7 (18.2)	<0.001
2 - Incontinence Impact (II)	55.3 (22.2)	72.7 (17.6)	<0.001
3 - Role limitations (RL)	70.9 (21.2)	80.3 (20.6)	0.023
4 - Physical limitations (PL)	74.1 (22.4)	86.4 (16.4)	0.013
5 - Social limitations (SL)	67.1 (20.2)	72.1 (21.5)	0.208
6 - Personal relationships (PR)	68.8 (22.7)	53.0 (30.7)	0.028
7 - Emotions (EM)	61.5 (22.9)	72.4 (21.3)	0.023
8 - Sleep/energy (SE)	21.6 (19.0)	30.3 (13.4)	0.003
9 - Severity measures (SEV)	69.9 (12.0)	72.3 (13.8)	0.242
Part 1^b	86.1 (36.9)	123.5 (31.5)	<0.001
Part 2^b	433.9 (109)	466 (99)	0.174

Notes: Data are presented as mean (SD) or n (%). ^aMann–Whitney test statistics provide the U statistic, as well as the asymptotic significance (2-tailed) p-value. ^bPart 1 – sum of domains 1 and 2 of the KHQ; Part 2 – sum of domains 3 to 9 of the KHQ.

Table 4 Cross-Sectional Predictors of Anxiety and Depression in Women with SUI (n=80)

	OR (95% CI)	p
Depression (HADS-D>7)
Model 1
Duration of SUI	0.81 (0.69–0.94)	0.006
Amount of urine	3.59 (1.04–12.4)	0.043
Age ≥55 vs <55 years old	5.82 (1.47–23.1)	0.012
BMI, kg/m^2	1.13 (1.01–1.27)	0.027
Nagelkerke R^2= 0.424
Model 2
Duration of SUI	0.81 (0.69–0.94)	0.004
Age ≥55 vs <55 years old	5.74 (1.44–23.1)	0.013
BMI, kg/m^2	1.14 (1.02–1.28)	0.017
KHQ: Emotions (EM)	1.06 (1.02–1.09)	0.005
Nagelkerke R^2= 0.459
Anxiety (HADS-A>7)
Model 1
Amount of urine	4.60 (1.35–15.68)	0.015
Comorbid chronic illness, Yes vs No	10.4 (3.2–33.9)	<0.001
Nagelkerke R^2= 0.411
Model 2
Parity	0.05 (0.01–0.37)	0.003
Duration of SUI	0.83 (0.69–0.99)	0.044
Comorbid chronic illness, Yes vs No	0.03 (0.003–0.20	0.002
KHQ Personal relationships (PR)	1.13 (1.04–1.21)	0.003
KHQ Emotions (EM)	1.05 (0.997–1.11)	0.063
Nagelkerke R^2= 0.749

Notes: Model 1: adjusted for age, categorical age ≥55 (No, Yes), spouse status, education, BMI, menopausal status, parity, comorbidities, and UI symptoms, including duration of SUI, amount of urine, number of daytime voids and number of nighttime voids; Model 2: all variables in model 1 and all the KHQ domains.

Table 5 Predictors of Disease-Specific Quality of Life in Both Middle-Aged (<55 Years) and Older (≥55 Years) Women with SUI (n=80)

Dependent Variable^a	Independent Variable	Standardized ß	P value	Adjusted R^2	F	P value
<55 years old
KHQ: Part 1	HADS-A score	0.430	0.001	0.544	19.29	<0.001
	Comorbid chronic illness (No, Yes)	0.314	0.009
	No. of daytime voids^b	0.244	0.025
KHQ: Part 2	HADS-A score	0.723	<0.001	0.667	47.1	<0.001
	No. of daytime voids	0.243	0.008
≥55 years old
KHQ: Part 1	HADS-D score	0.411	0.010	0.340	9.26	0.001
	BMI, kg/m^2	0.359	0.023
KHQ: Part 2	HADS-D score	0.460	0.003	0.397	8.02	<0.001
	Education	–0.408	0.007
	Spouse status (0=Single; 1=With partner)	0.321	0.030

Notes: ^aPart 1 – sum of domains 1 and 2 of the KHQ; Part 2 – sum of domains 3 to 9 of the KHQ. ^bDiurnal frequency (episodes per day): 1 = 1 to 5 times; 2 = 6 to 9 times; 3 = 10 or more times. Part 1 contains general health perception and incontinence impact (one item each). Part 2 contains role limitations, physical limitations, social limitations (two items each), personal relationships, emotions (three items each) and sleep/energy (two items) and severity measures (four items).