Association between pelvic floor dysfunction and depression and suicidal ideation in the U.S. women: Data from the National Health and Nutrition Examination Survey 2005 to 2018

Background Women are at increased risk for both pelvic floor dysfunction (PFD) and mental health issues, yet the association between PFD and psychological outcomes such as depression and suicidal ideation remains underexplored. PFD encompasses a spectrum of disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. Methods We analyzed data from 15,379 female participants aged ≥ 20 years from the NHANES 2005–2018 dataset. Weighted logistic regression and subgroup analyses were performed to examine the association between PFD and depression/suicidal ideation. Results In the 2005–2010 cohort, 10.8% of participants reported depression and 4.1% suicidal ideation. PFD was associated with a significantly higher prevalence of depression (14.9% vs. 7.5%) and suicidal ideation (6.0% vs. 2.5%) (p < 0.001). Fully adjusted models showed that PFD was independently associated with depression (OR = 2.076, 95% CI: 1.662–2.592) and suicidal ideation (OR = 2.884, 95% CI: 1.980–4.200). A dose-response relationship was observed, with participants reporting three pelvic floor symptoms having the highest risk (OR for depression = 5.700; OR for suicidal ideation = 4.321). Conclusion PFD (urinary incontinence, fecal incontinence, and pelvic organ prolapse) is independently associated with increased risks of depression and suicidal ideation in U.S. women. The psychological burden rises with the number of symptomatic disorders. Targeted mental health screening and intervention strategies are warranted in this population.