Does Urinary Incontinence and Mode of Delivery Affect Postpartum Depression? A Nationwide Population-Based Cohort Study in Korea

Jin Young Nam,Eun-Cheol Park,Eun Cho

doi:10.3390/ijerph18020437

Abstract

We investigated the association between urinary incontinence and postpartum depression. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort and included women who delivered between 2004 and 2013. Postpartum depression was determined using diagnostic codes during the six-month postpartum period. Urinary incontinence was identified as having a prescription of incontinence drugs or a diagnosis. Cox proportional hazard models were used to calculate adjusted hazard ratios. Of the 83,066 women, 5393 (6.49%) had urinary incontinence and 691 (0.83%) had postpartum depression. Postpartum depression was higher among women with urinary incontinence, aged 15–19 years, ≥40 years old, the lowest income level, and who underwent cesarean section delivery. In the combined analysis, women with urinary incontinence and cesarean section had an approximately three times higher risk of postpartum depression compared with those without urinary incontinence and with spontaneous delivery. Women without urinary incontinence and cesarean section, and those with urinary incontinence and spontaneous delivery were at higher risk of postpartum depression compared with the reference group. Urinary incontinence and cesarean section delivery were significantly associated with postpartum depression during the first six months after childbirth. Therefore, further research should be conducted to evaluate whether urinary incontinence contributes to postpartum depression.

Highlights

Postpartum depression (PPD) is a common mental health problem among reproductiveaged women, occurring in approximately 13–19% of women during the first six months after delivery [1]
The total population was 83,066, the incidence of Urinary incontinence (UI) during the first three months was 5393 (6.49%), and PPD was noted in 691 women (0.83%) during the first six months after delivery
The results showed that both Spontaneous vaginal (SV) and cesarean section (CS) delivery women with UI and those without UI who had CS delivery had a significantly higher risk of PPD

Summary

Introduction

Postpartum depression (PPD) is a common mental health problem among reproductiveaged women, occurring in approximately 13–19% of women during the first six months after delivery [1]. Previous studies have demonstrated that risk factors for PPD include lower socioeconomic status and social support, childcare stress, a personal or family history of depression, cesarean section delivery, lack of breastfeeding, and adverse physical symptoms [1,5,6,7]. In a previous study, triggering of PPD was potentially explained as reproductive hormonal changes, especially reduction in estrogen and dysregulation of postsynaptic serotonin function, leading to the onset of clinical depression in a vulnerable subgroup of women [1,8]. This is not sufficient because of the presence of a number of other potential contributing factors of depression. It is difficult to identify which patients will develop depression, as well as the timing and

Methods

Discussion

Conclusion