Mental health problems, stressful life events and relapse in urinary incontinence in primary school-age childhood: A prospective cohort study

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to relapses in urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent relapse in UI using multivariable logistic regression in a prospective UK cohort (n=6,408). Mothers provided information on their childs symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with UI relapse in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p<0.001). Social anxiety, attention deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with UI relapse, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p=0.065), such that females experiencing more stressful life events were at higher risk of UI relapse (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p=0.029) but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p=0.608). These results suggest that early treatment of separation anxiety and intervening to reduce the negative outcomes associated with stressful life events (in girls) may help to reduce risk of UI relapse.