Women with transvaginal mesh complications requiring corrective surgery, particularly younger women, may be at significantly higher risk for experiencing depression and self-harm than women not requiring surgical correction, according to new study findings.
Of 57,611 women who underwent their first midurethral mesh sling procedure from 2004 to 2015, 1586 (2.8%) with a mean age of 52.5 years underwent a surgical correction for a transvaginal mesh complication, Blayne Welk, MD, MSc, of Western University in London, Ontario, Canada, and colleagues reported in JAMA Surgery. Compared with the patients who did not undergo surgical correction, those who did had a significant 21% increased risk of depression, in adjusted analyses.
Among patients younger than 46 years at the time of their sling procedure, those who underwent surgical correction had a 38% increased risk of depression compared with those who did not. For the age groups 46 to 66 years and older than 66 years, investigators found no significant differences in depression risk between those who underwent surgical correction and those who did not.
Overall, the surgical correction group had a significant 2-fold higher risk of self-harm than the no-surgical-correction group. Among patients younger than 46 and those aged 46 to 66 years, the surgical correction group had a 1.7-fold and 2.4-fold greater risk of self-harm, respectively. The investigators found no significant difference in self-harm risk between the groups among patients older than 66 years.
“This age-dependent interaction is potentially a result of a stronger association between transvaginal mesh complications and intimacy among younger women,” Dr Welk and the team stated. “When managing women with complications, surgeons should be aware of the potential serious psychological implications of these complications.”
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. JAMA Surg. 2019; published online ahead of print.