Systematic review and meta-analysis identify significant relationships between clinical anxiety and lower urinary tract symptoms

Behrang Mahjani; Lotta Renström Koskela; Anita Batuure; Christina Gustavsson Mahjani; Magdalena Janecka; Christina M Hultman; Abraham Reichenberg; Joseph D Buxbaum; Olof Akre; Dorothy E Grice

doi:10.1002/brb3.2268

Systematic review and meta-analysis identify significant relationships between clinical anxiety and lower urinary tract symptoms

Brain Behav. 2021 Sep;11(9):e2268. doi: 10.1002/brb3.2268. Epub 2021 Aug 17.

Authors

Behrang Mahjani^{1

2

3

4}, Lotta Renström Koskela^{5

6}, Anita Batuure^{1

4}, Christina Gustavsson Mahjani^{1

2

3}, Magdalena Janecka^{1

2}, Christina M Hultman³, Abraham Reichenberg^{1

2}, Joseph D Buxbaum^{1

2

7

8

9

10}, Olof Akre^{5

6}, Dorothy E Grice^{1

9

4

10}

Affiliations

¹ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA.
² Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, USA.
³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁴ Division of Tics, OCD, and Related Disorders, Icahn School of Medicine at Mount Sinai, New York, USA.
⁵ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
⁷ Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
⁸ Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA.
⁹ The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
¹⁰ Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA.

Abstract

Background: Lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, and anxiety disorders are often comorbid conditions in patients. However, the existing evidence regarding the rates and nature of the co-occurrence of these conditions has not been systematically evaluated. The aim of this study was to examine these relationships.

Methods: We conducted a systematic review and meta-analysis to examine the relationship between LUTS and anxiety. We searched for articles published from January 1990 to July 2019 in PubMed, CENTRAL, PsycINFO, and Google Scholar. Outcomes were anxiety-related disorders and symptoms (clinically significant anxiety) and LUTS. We performed random-effects meta-analyses, inspected funnel plots, and applied the Egger's test to evaluate publication bias. We followed PRISMA guidelines and recorded our protocol on PROSPERO (ID = CRD42019118607).

Results: We identified 814 articles, of which 94 fulfilled inclusion criteria, and 23 had sufficient data for meta-analysis. The odds ratio (OR) for clinically significant anxiety among individuals with LUTS was 2.87 (95% CI: 2.38,3.46, p < .001). The OR for LUTS among individuals with clinically significant anxiety was 2.87 (95% CI: 1.07,7.74, p < .001), although very few studies examined this relationship. A large value of I² index suggests high heterogeneity between studies.

Conclusion: The results demonstrate a significant association between clinically significant anxiety and LUTS in both females and males. There were limited studies on younger individuals and on individuals ascertained for clinically significant anxiety, which should motivate further study in these areas. Understanding the co-occurrence of these conditions will lead to better prevention and interventions to ameliorate the progression of the symptoms and improve the quality of life. A thorough assessment of anxiety may provide more optimal care for LUTS patients.

Keywords: anxiety disorders; interstitial cystitis; lower urinary tract symptoms; obsessive-compulsive disorder; overactive bladder.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anxiety / epidemiology
Anxiety Disorders / epidemiology
Female
Humans
Lower Urinary Tract Symptoms* / epidemiology
Male
Quality of Life
Urinary Bladder, Overactive*