Female urinary incontinence and wellbeing: results from a multi-national survey

Historically, research on wellbeing has mainly been conducted within two traditions: hedonic wellbeing and eudaimonic wellbeing. The hedonic approach to wellbeing measures subjective wellbeing which is comprised of life satisfaction, positive affect, and an absence of negative affect. Specifically, focusing on happiness from the perspective of pleasure versus pain including both cognitive evaluation (life satisfaction) and affect (with positive and negative affect comprising separate dimensions). In contrast, the eudaimonic approach to wellbeing is not simply interested in subjective happiness, but in the realisation of human potential. Within this view, wellbeing is linked to a person living in a way which is congruent with their deeply held values: a meaningful life characterised by personal growth, as opposed to a pleasurable life characterised by hedonic enjoyment. There is now international interest in wellbeing and its role in all aspects of life. This interest can be seen at a population level and in specific contexts such as work. In addition, wellbeing is now an outcome of interest in many health-related areas. Wellbeing scales such as the Warwick-Edinburgh Wellbeing Scale (WEMWBS;) [14] measure both hedonic and eudaimonic wellbeing and are correlated with general health, positive and negative affect, life satisfaction and mental ill-health. UI has been shown to negatively impact on these outcomes and it is important to investigate whether wellbeing scores are related to UI as at the moment there is little information on this topic.

There have been a number of studies which have investigated associations between incontinence and mental health [15‐17]. These generally confirm that UI is associated with an increased risk of depression [15], and show that treatment of the depression associated with UI may be an effective way of reducing the burden of UI [16]. Indeed, interventions aimed at increasing resilience may lessen the impact of depression on those with UI [17].

Two Australian studies have investigated associations between UI and wellbeing [18, 19]. The first study [18] showed that UI was associated with reduced wellbeing but that the relationship between different types of UI and wellbeing was different. The second study [19] investigated associations between UI and wellbeing in young nulligravid women. The results confirmed that women with UI reported lower wellbeing that women without UI. It is now important to replicate and extend these findings using multi-national samples of women of working age and recently developed measures of wellbeing.

The primary aim was to conduct secondary analyses of our previous study [13] which focused on UI in women of working age to provide a detailed profile of female UI and wellbeing. This involved comparison of the wellbeing of those with UI with those with no symptoms. Examination of the individual items of the WEMWBS was carried out to determine whether effects are global or restricted/greatest in specific domains. Further analyses examined whether the associations between UI and wellbeing (and effects on wellbeing of those without UI) varied as a function of demographics and lifestyle (frequency of exercise and sex). Our previous paper from this survey [13] focused on associations between UI severity, HRQoL and WEMBS. UI symptoms were associated with lower HRQoL, which then impacts negatively on wellbeing. In the analyses reported here sub-sets of the UI group (based on indicators of severity - e.g., frequency of wearing pads; interference with activities) were also compared. The general hypothesis being tested was that even relatively mild UI would be associated with reduced wellbeing (compared to those without UI) and that such effects would be global rather than restricted to specific domains or sub-groups. Additionally, the analyses examined whether there was variation within the UI group as a function of the impact of UI on different activities and outcomes. These secondary analyses extend the initial aims of the protocol and address issues that are of practical relevance to women of working age with UI.

UI categorisation was defined by the answer to the ICIQ-UI Short Form question “how often do you leak urine?; those answering “Never” were classed as without UI while all other answers were classed as having UI. UI severity was based on the response to “How much urine do you usually leak?” [20] with a small amount being classified as “light UI”, a moderate amount as “medium UI” and a large amount as “severe UI”. Those reporting UI completed questions measuring UI symptoms (ICIQ-UI short form) [21] and UI quality of life (ICIQ-LUTSqol) [20]. Both UI and non-UI participants completed the WEMWBS [14] which has 14 items and a Likert scale of 1–5 giving a maximum score of 70.

Demographic factors (e.g., age; marital status) were recorded as were frequency of exercise and sex. Other questions examined the impact of UI on aspects of life. Outcomes of UI were also recorded (degree of embarrassment; frequency of wearing pads). The complete set of questions are given in supplementary information with our previous publication from the study [13].

The first set of analyses compared those reporting UI with those who did not. Analyses were carried out on the individual items of the wellbeing scale to determine whether any specific domains were more impaired than others. Sub-groups based on demographic factors were also compared. The initial analyses involved a MANOVA to determine whether effects were apparent across all items of the wellbeing scale. Most studies use the WEMWBS total score but analysis of the individual items provided an opportunity to examine the generality of effects. Subsequent analyses examined whether effects were apparent in sub-groups of patients (based on demographics, frequency of exercise and sex) and used univariate ANOVAs followed by multiple regression. Factor analyses were carried out to identify categories of outcomes associated with UI. ANOVAs were then carried out to examine changes in wellbeing as a function of the severity of these different types of problem. A similar approach was used to examine the effects of factors leading to leakage on wellbeing. The analyses were carried out using the IBM SPSS Statistics 20 package.