This project aims to examine bi-directional relationships between mental health problems and incontinence; to examine whether these relationships are causal, and to identify mechanisms that underlie these relationships in children, adolescents, and adults.

PI - Dr Carol Joinson.

Co-Is: University of Bristol - Dr Jon Heron, Dr Abigail Fraser, Professor Kate Tilling, Professor Marcus Drake, Dr Thomas Palmer, Dr Rosie Cornish

University of the West of England - Dr Nikki Cotterill

Evelina London Children’s Hospital - Dr Anne Wright

Bristol Royal Hospital for Sick Children - Dr Christine Spray

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.  We aim to determine the precise nature of the relationships between mental health problems and incontinence using existing data that has been collected from cohort studies of children, young people and adults. 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.

Our research will help clinicians to manage their patients with incontinence more effectively and inform the development of preventative interventions and effective therapies. Our work will also contribute to the design of care pathways that integrate mental and physical healthcare for patients with incontinence.