Mental health and incontinence

背景：人们普遍认为，尿失禁（不自觉的膀胱和/或肠道失控）只影响幼儿和老年人，但它影响所有年龄段的人。尿失禁会使生活质量下降，被描述为“不危及生命，但毁了生命”。尽管尿失禁的发病率高且有不良反应，但对尿失禁的原因、预防和治疗的研究却很少。有证据表明，始于童年的失禁问题往往会持续到青春期和成年期。我们之前的研究首次发现了强有力的证据，证明儿童早期的心理因素（包括情绪和行为问题、压力经历、母亲患有抑郁症或焦虑症）与小学年龄的失禁有关。临床医生认识到尿失禁与精神健康问题密切相关，但之前的研究无法确定精神健康状况不佳是尿失禁的原因还是后果。目的和目的：我们的目的是利用从儿童、青少年和成人队列研究（雅芳父母和儿童纵向研究- ALSPAC和UK Biobank）中收集的现有数据，确定心理健康与尿失禁之间关系的确切性质。ALSPAC，也被称为90后儿童，是一项正在进行的健康研究，旨在调查生物和环境对整个生命过程中健康和发展的影响。1991-1992年间，大约14000名孕妇加入了这项研究，从那以后，ALSPAC的孩子、母亲和伴侣一直在接受跟踪调查。ALSPAC提供广泛的数据，包括调查问卷、研究诊所、生物样本和与健康记录的联系。英国生物银行收集了2006-2010年招募的50多万成年人的数据，研究人员正在使用这些数据来改善各种疾病的预防、诊断和治疗。使用这些数据集，我们将采用新颖而稳健的统计方法来测试(i)心理健康问题（如抑郁、焦虑）和压力（如生活事件、童年逆境）是否会导致尿失禁，以及（ii）尿失禁是否会导致心理健康状况不佳。我们将研究一系列可能有助于解释失禁、心理健康和压力之间关系的因素，如养育子女、厕所焦虑、同伴受害、关系问题和社会参与。我们还将调查生物因素，如炎症（身体免疫反应的一部分）和心理应激反应（身体对压力反应的个体差异）是否能解释失禁和心理健康问题之间的联系。潜在的应用和益处：治疗尿失禁的临床医生认识到需要优先研究其与心理健康问题和压力的关系，因为这些知识将帮助他们更有效地管理他们的病人。患有失禁的人强烈地认为这与他们的心理健康有关，但治疗失禁的临床医生往往忽视或不充分评估心理健康问题。我们的研究将有助于临床医生开发预防干预和有效的治疗失禁。我们的工作也将有助于设计护理途径，将失禁患者的精神和身体保健相结合。这可以减少失禁患者出现精神健康问题的风险，并确保对这些患者存在的任何精神健康问题进行评估和治疗。了解儿童失禁的起源以及情绪/行为问题和压力的影响可以帮助防止失禁成为慢性疾病。最终，我们的研究可以改善失禁患者的生活，并帮助NHS更好地利用其资源。

Context:It is commonly believed that incontinence (involuntary loss of bladder and/or bowel control) affects only young children and the elderly, but it affects people of all ages. Incontinence can have debilitating effects on quality of life and has been described as "not life threatening, but life ruining". Despite the high prevalence and adverse effects of incontinence, research into the causes, prevention and treatment of incontinence is lacking. There is evidence that continence problems that originate in childhood can often persist into adolescence and adulthood. Our previous research was the first to find strong evidence that psychological factors in early childhood (including emotional and behaviour problems, stressful experiences, and having a mother with depression or anxiety) are associated with incontinence at primary school-age. Clinicians recognise that incontinence is strongly associated with mental health problems, but previous research has been unable to establish whether poor mental health is a cause or consequence of incontinence. Aims and objectives:We aim to determine the precise nature of the relationships between mental health and incontinence using existing data that has been collected from cohort studies of children, young people and adults (the Avon Longitudinal Study of Parents and Children- ALSPAC and UK Biobank). ALSPAC, also known as Children of the 90s, is an ongoing health research study that investigates biological and environmental influences on health and development across the life course. Around 14,000 pregnant women joined the study in 1991-1992 and ALSPAC children, mothers and partners have been followed up ever since. ALSPAC provides extensive data from questionnaires, research clinics, biological samples and linkage to health records. UK Biobank has collected data from over 500,000 adults recruited in 2006-2010 and this data is being used by researchers to improve the prevention, diagnosis and treatment of a wide range of illnesses. Using these datasets, we will apply novel and robust statistical methods to test whether (i) mental health problems (e.g. depression, anxiety) and stress (e.g. life events, childhood adversities) cause incontinence and if (ii) incontinence causes poor mental health. We will examine a range of factors that might help to explain the relationships between incontinence, mental health and stress such as parenting, toilet anxiety, peer victimisation, relationship problems, and social participation. We will also investigate whether biological factors such as inflammation (part of the body's immune response) and psychological stress reactivity (individual differences in the body's response to stress) explain the links between incontinence and mental health problems. Potential applications and benefits:Clinicians who treat incontinence recognise the need to prioritise research into its relationship with mental health problems and stress, because this knowledge will help them to manage their patients more effectively. People with incontinence feel strongly that there is a connection with their mental health, but mental health problems are often ignored or inadequately assessed by clinicians who treat incontinence. Our research will help clinicians to develop preventative interventions and effective therapies for incontinence. Our work will also contribute to the design of care pathways that integrate mental and physical healthcare for patients with incontinence. This could reduce the risk of patients with incontinence developing mental health problems and ensure that any existing mental health problems in these patients are assessed and treated. Understanding the origins of incontinence in childhood and the contribution of emotional/behaviour problems and stress could help to prevent it from becoming chronic. Ultimately, our research could improve the lives of people affected by incontinence and help the NHS make better use of its resources.