Women with incontinence who require surgical intervention following a complication from midurethral mesh sling procedure are at significantly increased risk for depression and self-harm compared with women who did not need surgical intervention, according to a research letter published in JAMA Surgery.

A Canadian team of investigators conducted a population-based study to understand the effect of transvaginal mesh complications on the risk of depression or self-harm.

The primary outcome was presentation to a clinician for treatment of depression. The secondary outcome was evidence of self-harm defined as a suicide attempt or parasuicide behavior presented at the emergency department, or recent history of suicide attempt or parasuicide behavior that resulted in hospital admission.

A total of 57,611 women who underwent a midurethral mesh sling procedure over the 12-year study were eligible for participation. Of the cohort, 1586 women (average age, 52.5 y) underwent surgical correction for transvaginal mesh complication and 56,025 did not need any surgical correction.

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There was a statistically significant increase in risk of depression among women younger than 46 years who underwent surgical correction (absolute risk increase, 5.18%; adjusted hazard ratio [HR] 1.38). Similarly, an increased adjusted HR of 1.68 was reported for self-harm in women younger than 46 years; women between ages 46 and 66 years had an adjusted HR of 2.36.

“This age-dependent interaction is potentially a result of a stronger association between transvaginal mesh complications and intimacy among younger women,” the authors wrote. “When managing women with complications, surgeons should be aware of the potential serious psychologic implications of these complications.”

Reference

Welk B, Reid J, Kelly E, Wu YM. Association of transvaginal mesh complications with the risk of new-onset depression or self-harm in women with a midurethral sling [published January 9, 2019]. JAMA Surg. doi:10.1001/jamasurg.2018.4644