Women with complications after pelvic mesh implants at increased risk of depression and suicide

09/01/2019

Women who require more surgery for complications after a mesh-based sling procedure have an increased risk of depression and self-harm behavior, according to a new study by researchers at ICES.

Women with stress urinary incontinence leak urine when they cough, sneeze, laugh or are physically active. Mesh slings are made of synthetic polypropylene, a type of plastic, which are surgically implanted in the vaginal wall to treat urinary leakage. Mesh-based incontinence slings account for more than 90 per cent of incontinence procedures in women, and are associated with uncommon but potentially significant complications.

“There have been regulatory warnings and lawsuits related to significant transvaginal mesh complications. We wanted to quantify the serious psychological complications that can occur in women as a result of complications from transvaginal midurethral slings,” said Dr. Blayne Welk, senior author of the study and adjunct scientist at ICES Western, associate scientist at Lawson Health Research Institute and assistant professor at Western University’s Schulich School of Medicine & Dentistry.

To determine whether women who experience midurethral sling mesh complications requiring surgical intervention have an increased risk of depression or self-harm behaviour, Welk's team tracked the number of Ontario women who needed a follow-up surgery to remove or fix a mesh implant and if they received treatment for depression or self-harm. The study, which was published online January 9, 2019 in the journal JAMA Surgery, included almost 60,000 women who had the procedure January 2004 through December 2015.

The researchers found that 1586 (2.8 per cent) underwent a surgical procedure for a mesh complication. Of those women, 11 per cent (175 women) were treated for depression compared to eight per cent of women (4,470) who didn’t have corrective surgery. Of the women who needed corrective surgery, 2.77 per cent of women suffered from self-harm behaviour compared to only 1.15 per cent of women who did not need corrective surgery. These risks were highest in younger women.

“Younger women are the ones who are most at risk of these mental health complications, and we suspect that’s because of a stronger negative association between the complications and intimacy among this age group,” says Welk.

The researchers add that when women experience midurethral sling complications, both they and their surgeons should be aware of the potential serious psychological impact of these complications.

Author block: Blayne Welk, Jennifer Reid, Erin Kelly, You (Maria) Wu.

The article “Association of transvaginal mesh complications with the risk of new-onset depression or self-harm in women with a midurethral sling,” is published in the January 9, 2019 issue of JAMA Surgery.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

About Lawson Health Research Institute

As the research institute of London Health Sciences Centre and St. Joseph's Healthcare London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance healthcare around the world. www.lawsonresearch.ca

The Schulich School of Medicine & Dentistry at Western University is one of Canada’s preeminent medical and dental schools. Established in 1881, it was one of the founding schools of Western University and is known for being the birthplace of family medicine in Canada. For more than 130 years, the School has demonstrated a commitment to academic excellence and a passion for scientific discovery.