Abstract
BackgroundThe prevalence of depression is not well studied among women with pelvic floor disorders. Hence, this study aimed to determine the prevalence of depression and its associated factors among women with pelvic floor disorders.MethodsA cross-sectional study was conducted among 306 women with one or more of the advanced pelvic floor disorders who attended at the gynaecologic outpatient clinic of Gondar university referral hospital in the six months data collection period. Women who complained of urinary or faecal incontinence or protruding mass per vagina were assessed and staged accordingly. Eligible women i.e. those with advanced pelvic organ prolapse or obstetric fistula were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories for all consenting women. Interviews were done by a female midwife nurse. Depression measures were obtained using the Beck’s Depression Inventory (BDI) tool administered by the midwife nurse after intensive training. Data were entered into a computer using Epi Info version 3. 5.3, and then exported to SPSS version 20 for analysis. Multiple logistic regressions were fitted and Odds ratios with 95% confidence intervals were calculated to identify associated factors.ResultsOf the 306 women interviewed, 269 had advanced pelvic organ prolapse (stages 3 and 4), 37 had obstetric fistula. All four women (100%) with both faecal and urinary incontinence, 97.0% those with urinary incontinence due to obstetric fistula and 67.7% of those with advanced pelvic organ prolapse (stages 3 and 4) had symptoms of depression. Depression was significantly associated with age 50 years or older (P < 0.01), marital status (P < 0.05), history of divorce (p < 0.01), self perception of severe problem (P < 0.05), and having stage 3 pelvic organ prolapse (P < 0.01).ConclusionWomen with advanced pelvic organ prolapse, and obstetric fistula had high prevalence of depressive symptoms. A holistic management approach, including mental health care is recommended for women having such severe forms of pelvic floor disorders.
Highlights
The prevalence of depression is not well studied among women with pelvic floor disorders
The aged of participants ranged from 13–75 years and nearly two-third (63.7%) aged 50 or older (Table 1)
Younger than 18 years, marital status, history of divorce, self perception of severe disease, and stage 3 POP were significantly associated with depression (Table 3). To our knowledge, this is one of the few studies investigating depressive symptoms in women of developing countries with severe forms of pelvic floor disorders. We studied both women with advanced POP, and women with obstetric fistula and found out a 71.2% prevalence of depression altogether
Summary
The prevalence of depression is not well studied among women with pelvic floor disorders. This study aimed to determine the prevalence of depression and its associated factors among women with pelvic floor disorders. Many women with pelvic floor disorders do not seek medical advice [3,5,6] and this makes determining the incidence of gynecological conditions like prolapse and urinary incontinence very difficult. Such gynaecological conditions can impact on sexual well-being of women [7,8] and subsequently psychological problems. In areas where access to health care is often limited, women usually have to live with the consequences of fistula or prolapse for the rest of their lives [3] which can be a challenge, both physically and emotionally, as the symptoms can disrupt the woman’s day-to-day life [7,10]
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