Depression, Abuse And Its Relationship To Interstitial Cystitis
The primary objective of this study is to examine the prevalence of depression and abuse (sexual and physical) among women with IC. The secondary objective of this study is to examine the use of different tools in extracting information regarding physical and sexual abuse.
All participants were asked to complete three questionnaires while waiting in the exam room to see their health care provider. All participants were asked to complete the questionnaires by themselves and in private. All other people in the exam room were asked to wait outside until the questionnaires were completed.
The prevalence of depression was measured using the BDI-II questionnaire. Prevalence of abuse was evaluated using the validated Drossman Questionnaire consisting of questions pertaining to physical and sexual abuse. The questionnaire defined both sexual abuse, child abuse, and physical abuse specifically, ensuring that the participant was unlikely to confuse their experiences.
In addition to the validated questionnaire, we asked the same participants directed questions as to whether they experienced sexual or physical abuse and whether this was as an adult or child. There were no definitions of abuse, adulthood, or childhood provided.
Ninety-eight (70%) subjects scored 14 or higher on the BDI-II, indicating depression. The mean score of the total sample was 14.6 (SD 9.2), representing mild depression. Of all of those that scored in the depression range (score of 14 or higher), the mean score was 22.4 (SD 6.4) representing moderate depression. The rates of abuse and depression are found in Table 1.
Table 1. Percentage of depression and abuse among IC sample
N (percentage) 98 (70%)
-- Sexual Abuse
N (percentage) 51 (36%)
-- Childhood Sexual Abuse
N (percentage) 30 (21%)
-- Physical Abuse
N (percentage) 44 (31%)
The prevalence of sexual abuse from the validated questionnaires was 36%. The prevalence of childhood sexual abuse among the sample was 21%. The prevalence of physical abuse among the sample was 31%. When asked if the individual was ever sexually abused (not validated questionnaire) in her lifetime the prevalence decreased to 28%. When asked if the individual was ever physically abused (not validated questionnaire) the prevalence dropped to 11%. These changes in prevalence rates were statistically significant. (Table 2)
Table 2. Directed questionnaire responses compared to validated questionnaire responses
-- Sexual Abuse
Directed Questionnaire 28%
Validated Questionnaire 36%
-- Physical Abuse
Directed Questionnaire 11%
Validated Questionnaire 31%
The inter-relationship between depression and chronic pain has been studied in multiple conditions chronic pain. The findings that IC subjects in this study have depression more often than the general public is not surprising. Examining the relationship between a history of abuse and IC is a very challenging endeavor. How sexual or physical abuse is defined and measured will alter the outcome of the results. Presently there is no gold standard definition or measuring tool that would allow for a more uniform reporting system. These issues have led to a variety of differing results in the literature.
The larger question to this study is whether abuse leads to the development of IC. This study does not answer the question. By discovering that IC patients report abuse more often then the general population does not mean that abuse is causally related to the development of IC. This study finds that there is an association between a history of abuse and depression and a diagnosis of IC. Whether this association is a direct relationship, where one factor leads to the development of the other, is unknown. The scope of this study does not prove a causal relationship. One of the limitations of this study is that there was no control group, queried at the same time, to provide a point of reference. This study adds to the growing body of information regarding the possible relationship between depression, abuse and IC.
Written by Howard Goldstein, DO, MPH, FACOG, as part of Beyond the Abstract on UroToday.com.
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