The association between depressive symptoms and lower urinary tract symptoms and impact among women: Investigating behavioural, cognitive and physiological pathways

Objective: Mechanistic studies are needed to understand why depressive symptoms are associated with poorer physical health. The objective of this study was to examine whether behavioural, cognitive and physiological factors mediated an association between depressive symptoms, measured in early adulthood, and lower urinary tract symptoms (LUTS) and their impact, a composite variable measured in mid-life adulthood, among women in the Coronary Artery Risk Development in Young Adults study, conducted in four regions of the United States. Design: Prospective cohort study. Methods: Data were examined for 871 women. Depressive symptoms were measured and averaged across Years 5, 10 and 15. Year 20 health behaviour combined information about smoking, physical activity and diet. Year 25 cognitive function combined performance on different cognitive tests. Year 25 metabolic syndrome combined standard risk criteria for waist circumference, triglycerides, high-density lipoprotein, blood pressure and glucose. A cluster analysis of urinary incontinence, other LUTS and impact data—collected two years after Year 25—was used to group women into one of four categories: no or very mild symptoms with no impact (bladder health) versus mild, moderate or severe symptoms/impact. Results: Structural equation modelling showed a statistically significant direct path between depressive symptoms and LUTS/impact. Tests of indirect paths showed that health behaviours, cognitive function and metabolic syndrome did not mediate the association between depressive symptoms and LUTS/impact. Conclusions: Depressive symptoms in early adulthood appear to be associated with LUTS and their impact in mid-life adulthood over and above health behaviours, cognitive function and metabolic syndrome.