Associations Between Psychological and Trauma-Related Factors and Urinary Incontinence Severity and Treatment Response among Women Veterans

BACKGROUND:Psychological and trauma-related factors (ie, stress, anxiety, post-traumatic stress disorder, and military sexual trauma) may induce physiological responses that contribute to urinary incontinence. Women veterans are disproportionately affected by psychological and trauma-related factors, which may influence urinary incontinence severity and response to behavioral urinary incontinence treatment. OBJECTIVE:We aimed to examine associations between psychological and trauma-related factors and both urinary incontinence severity and response to behavioral urinary incontinence treatment among women veterans. STUDY DESIGN:We conducted a secondary analysis of data from a randomized controlled trial that evaluated the effectiveness of 2 remote urinary incontinence behavioral treatment modalities in 3 southeastern Veterans Healthcare Administration systems from April 2020 to September 2023. Urinary incontinence severity was measured with International Consultation on Incontinence-Urinary Incontinence Short Form scores to reflect urinary incontinence frequency and amount leaked. Treatment response was defined as a 2.52-point reduction in International Consultation on Incontinence-Urinary Incontinence Short Form scores and modeled as a binary outcome. Stress was assessed with the Perceived Stress Scale-10. Military sexual trauma was determined based on 2 validated Veterans Health Administration screening items. Post-traumatic stress disorder and anxiety were assessed with self-reported items indicating whether participants were ever diagnosed with these conditions. We performed bivariate analyses to examine differences in sample characteristics by treatment response status. We used linear regression models to examine associations between each psychological and trauma-related factor and urinary incontinence severity at baseline and reported β coefficients. We used logistic regression models to estimate the odds of treatment response by each psychological and trauma-related factor. RESULTS:Among 200 women veterans (mean age=54 years, standard deviation=11), the most commonly reported psychological and trauma-related factors were anxiety (138/200, 69%), military sexual trauma (120/200, 60%), and post-traumatic stress disorder (101/200, 51%), and their mean perceived stress score was 17.9 (standard deviation=8.6) indicating moderate stress. Higher levels of perceived stress (β=0.18, 95% confidence interval [0.08, 0.27], P<.001), diagnosed anxiety (β=3.35, 95% confidence interval [1.73, 4.97], P<.001), post-traumatic stress disorder (β=1.96, 95% confidence interval [0.40, 3.51], P=.02), and reported military sexual trauma (β=1.80, 95% confidence interval [0.18, 3.41], P=.03) were significantly associated with greater urinary incontinence severity after adjusting for age, race, ethnicity, education level, body mass index, vaginal parity, menopausal status, medication for urinary incontinence, hysterectomy status, and randomization group. In total, 55% (109/200) of women veterans were classified as treatment responders. Higher levels of perceived stress were associated with lower odds of response to behavioral urinary incontinence treatment in the adjusted model (adjusted odds ratio=0.98, 95% confidence interval [0.97, 0.99], P=.01). CONCLUSION:Findings highlight the importance of understanding what psychological and trauma-related factors are associated with urinary incontinence among women and underscore the need for trauma-informed, interdisciplinary approaches to urinary incontinence care to improve health outcomes.