Women with pelvic mesh complications face higher depression risk

Women suffering from complications from surgically implanted pelvic mesheshave a slightly greaterrisk ofdepression than patients who experience a positive outcome from the procedure, a new study suggests.

The plastic slings are a common way to treat stress urinary incontinence. The condition causes women to leak urine when they cough, sneeze, laugh or are physically active. The medical device supports the urethra to help stop the leakage.

But worldwide reports of serious complications linked to the deviceshave resulted in several lawsuits and extensive media coverage, including a joint CBC News/Toronto Star investigation into the safety of all surgically implantable medical devices.

Seeing these women in clinic, they are often quite emotional and quite upset with these results of what's meant to be minimally invasive surgery.-Dr.BlayneWelk

In Canada and the U.S., thousands of womenreported that the plastic-covered mesh eroded inside them,causingintense pelvic pain and autoimmune symptoms.

Dr. Blayne Welk, associate professor of surgery at Western University, observed that some of his patients were suffering more than just physical pain.

"Seeing these women in clinic, they are often quite emotional and quite upset with these results of what's meant to be minimally invasive surgery," Welk said in an interview.

Welk is the senior author of a research letter published in this week's issue of the journal JAMA Surgerythat saysmesh complications areassociated with risk of depression or self-harm.

The researchers said that when women experiencephysical symptoms linked to the device, both they and their surgeons should also be aware of the potential for serious psychological impacts.

'My depression has increased'

Natasha Roach, 48, of Toronto was implanted with a sling in 2017. For more than a year, she's been going from doctor to doctor and in and out of emergency rooms, desperately trying to find a surgeon who will remove her device.

Roach is not only convinced the device is causing her frequent infections and severe pelvic pain, butthat the ordeal has also left her feeling depressed, powerless and emotionally exhausted.

"My depression has increased. I'll be open enough to say a couple weeks ago, I had a severe mental breakdown," Roach said in November 2018. "Now I'm at a loss just for everything and I'm extremely stressed out, too."

• Why many Canadians face long waits or big bills to have painful medical devices removed

Welk and his team at ICES, formerly the Institute for Clinical Evaluative Sciences,tracked women in Ontario who needed a followup surgery to remove or fix a mesh implant. They also checked to see if the women received treatment for depression or self-harm.

Over a 12-year period, the team found 57,611 women who had an initial sling procedure.

Roughly three per cent, nearly 1,600 women, experienced complications and required a second procedure.

Among women who had mesh complications, 11 per cent (175 women) were treated for depression compared to eight per cent of women (4,470) who didn't need corrective surgery.

According to the Ontario's Health Ministry, roughly a quarter of people will suffer from depression that's serious enough to need treatment at some point in their lifetime.

Younger women more at risk

Women under the age of 46 who suffered mesh complicationswere at greater risk of depression,the researchers found.

Welk thinks that's because younger women might be thinking about starting a family or having more childrenand are more likely to be juggling career responsibilities.

"[Younger women] tend to be a lot more affected by the complications and some of the effects it has on intimacy with their partner," Welk said. "That may be one of the driving forces forsome psychiatric diagnoses."

Painful intercourse is a commoncomplication of the sling procedure thatcan affect relationships, he said.

Welks also found that over the study period, 44 women showed evidence of self-harm, such as a suicide attempt or having suicidal thoughts that resulted in an admission to a psychiatric hospital or emergency department visit.

"When managing women with complications, surgeons should be aware of the potential serious psychological implications of these complications," the study's authors wrote.

The authors weren't able to determine whetherthe physical problems linked to mesh devices caused the cases of depression andself-harm.

'I have no hotline'

Nonie Wideman of Fort St. John, B.C., is convinced her mesh implantcaused her distress.

The 63-year-oldhad a plastic mesh surgically implanted in 2008 to treat herurinary stress incontinence. After suffering debilitating health problems, Wideman flew to Vancouver three years laterto have the device removed.

• Health Canada aims to improve safety of medical devices

She's been a driving force in the campaign to make clinical trial data for medical devices publicly available. She also helps other women enduring the same physical ordeal she experienced.

"I have no emotional support," Wideman said last month, after Health Canada announced new measures to regulate implants, including an advisory panel on medical devices that will hear from female patients.

"I have no hotline. I have nobody to talk to other than, you know, other people. And right now I've been a resource for so many women and I'm tired. This has been like 10 years and I would like to be able to put it behind me and know that women have a place to call."

Health Canada's "Action Plan on Medical Devices" includes hiring more inspectors, creating an expert committee on women's health and compelling manufacturers to report any safety alerts issued in other countries.

Where to get help:

Canada Suicide Prevention Service:1-833-456-4566 (Phone) |45645 (Text) |crisisservicescanada.ca(Chat)

In Quebec (French):Association qubcoise de prvention du suicide: 1-866-APPELLE (1-866-277-3553)

Kids Help Phone: 1-800-668-6868 (Phone), Live Chat counselling atwww.kidshelpphone.ca

Canadian Association for Suicide Prevention:Find a 24-hour crisis centre

If you're worried someone you know may be at risk of suicide, you should talk to them about it,says theCanadian Association forSuicide Prevention.Here aresomewarning signs:

Suicidal thoughts.
Substance abuse.
Purposelessness.
Anxiety.
Feeling trapped.
Hopelessness and helplessness.
Withdrawal.
Anger.
Recklessness.
Mood changes.