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Systematic Review and Meta-Analysis Identifies Significant Relationships Between Anxiety Disorders and Daytime Lower Urinary Tract Symptoms

By 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

Posted 01 Sep 2020
medRxiv DOI: 10.1101/2020.08.27.20183467

Background: Clinically, lower urinary tract symptoms (LUTS), such as voiding symptoms, overactive bladder, and interstitial cystitis, are associated with anxiety disorders. However, the existing evidence for the overlap of these conditions has not been systematically evaluated. The aim of this study was to examine this relationship. 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 "clinical anxiety") and subtypes of LUTS. We performed random-effect meta-analyses, and 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 for clinical anxiety among individuals with LUTS was 2.87 (95% CI: 2.38,3.46, P < 0.001). Very few studies looked at LUTS among individuals ascertained for clinical anxiety, but there appear to be significantly elevated odds ratio here as well. A large I2 value suggests high heterogeneity between studies. Conclusions: The results demonstrate a clinically significant association between clinical anxiety and LUTS. There were limited data on youth, which should motivate further study in this area. Understanding the co-occurrence of these conditions will lead to better prevention and interventions to ameliorate the progression of the symptoms and to improve quality of life.

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