The effect of incontinence on depression among older adults: a longitudinal study in China

Objectives: Previous studies have found that incontinence was positively associated with depression among older adults in Western countries; however, the cross-sectional design of these studies constrains the ability to infer the impact of incontinence on depression. Moreover, few studies investigated the underlying mechanism linking incontinence and depression in Chinese context. This study aims to explore the effect of incontinence on depression and the underlying mechanism in China.Study design: This study used a longitudinal research design.Methods: The data used in this study were from the 2014 and 2018 waves of Chinese Longitudinal Healthy Longevity Survey. Among the sample, 1225 (49.04%) were females, and 1273 (50.96%) were males. The mean age was 88.146 years, and the standard deviation was 8.607. After eliminating samples with missing values, this study finally included 2498 samples. This study used Stata version 16.0 to conduct the statistical analysis. Based on Ordinary Least Squares (OLS) model, this study investigated the relationship between incontinence and depression. Using bootstrap method, this study tested the mediating effect of activity of daily living (ADL) on the above relationship.Results: Multivariate regression analysis revealed that incontinence was a significant risk factor for depression (coefficient = 2.261, P < 0.05). After heterogeneity analysis, this effect was significant for non -solo-living older adults (coefficient = 2.950, P < 0.05) and insignificant for solo-living older adults. Moreover, the mediation effect analysis suggested that ADL was a complete mediator between incon-tinence and depression (indirect effect = 1.083, 95% confidence interval [0.450, 1.716]). Notably, the indirect effect was quite large (47.92%).Conclusions: Incontinence was a significant risk factor associated with depression among older adults in China, especially for non-solo-living older adults. The effect of incontinence on depression was completely mediated by ADL. The research provided possible interventions for alleviating depression among older adults suffering from incontinence.(c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.