Suicide is death due to purposeful self-injury, and its incidence varies by factors such as gender and age (1). Globally, more than 700,000 people die by suicide each year. In the United States, more than 16 out of every 100,000 people die by suicide annually (2, 3). These numbers may be underestimated due to incomplete registration of deaths and inaccurate statistics (4). Suicide is not only a personal and family tragedy but also places a heavy burden on community and public health resources (5).

Suicidal ideation, the generation of thoughts about ending one’s life or committing suicide, is a precursor to suicide (6). Studies have shown that there is a strong correlation between suicide and suicidal ideation and that individuals with suicidal ideation face a significantly higher risk of suicide (6, 7). Of those with suicidal ideation, 60% will attempt suicide within a year (7). Suicidal ideation among young Americans increased significantly during the COVID-19 epidemic (8). Therefore, it is critical to explore risk factors for suicidal ideation clinically. One of the primary goals of suicide prevention is to identify at-risk populations (9). Suicidal thoughts are substantially common in individuals in general when mental health issues are present (10). Notably, feelings of sadness and anxiety are among the mental health conditions that overactive bladder illness sufferers are more prone to experience (11, 12). However, it is unclear whether overactive bladder disorder is associated with suicidal ideation. Understanding this relationship is important for effective suicide prevention and intervention.

Overactive bladder (OAB) is a urological disorder characterized by urinary urgency, accompanied by urinary frequency, nocturia, and sometimes urge incontinence, but without pathologic changes such as urinary tract infections (13). The prevalence of OAB is closely related to aging, with a rate exceeding 16% among adults in the United States (14). This disease seriously affects the quality of life of patients and adversely impacts mental health and sleep (15, 16). In addition, OAB imposes a financial burden on patients. As the population ages, this disease also puts increasing pressure on public health (17).

Research has indicated a strong correlation between OAB and interpersonal and psychological aspects. Various causes may trigger OAB and lead to psychological problems, which in turn exacerbate the symptoms of OAB, creating a vicious cycle (18, 19). In the general population, mental health problems are significantly associated with suicidal ideation (10). Therefore, people with OAB may be at risk for mental health risks including suicide (20). However, current studies tend to be limited to women or certain specific populations, which may lead to gender and population bias in the findings, thus reducing their reliability. This is due to gender differences in the urinary system and the different pathophysiologic mechanisms of OAB (21, 22). Therefore, there is a need for a larger population-based study to validate the correlation between OAB and suicidal ideation and to fully detail the interactions between the two. This study was a population-based cross-sectional analysis of U.S. adults aged 20 years and older, based on data from the National Health and Nutrition Examination Survey (NHANES). The investigation of the relationship between OAB and suicidal thoughts was the aim of the study.

Using NHANES data, the present research investigated the link between suicidal thoughts and overactive bladder (OAB), offering fresh perspectives on the connection between urologic conditions and psychological conditions. The findings indicated that in contrast to people without OAB, those with OAB had a greater incidence of suicidal thoughts, demonstrating the potential impact of OAB on mental health. The robustness of these findings highlights several key points. First, psychiatrists should focus on the impact of urinary symptoms on suicide risk to improve treatment adherence and effectiveness. A comprehensive approach that integrates both urological symptom management and psychological evaluation is essential when treating patients with OAB. Addressing mental health issues such as anxiety, depression, and suicidal ideation may improve treatment adherence, quality of life, and overall prognosis. Therefore, while routine psychological evaluation may not be necessary for all patients with OAB, it is advisable to consider mental health screening in individuals presenting with severe urinary symptoms, low treatment compliance, or signs of psychological distress.

Previous research has concentrated on the relationship between OAB and depression, frequently using samples from hospitals or particular groups of women (30, 31). These studies compared psychological conditions between two groups by dividing the population into case and control groups but were slightly less persuasive due to the limitations of the research methodology. Nonetheless, studies agree that OAB has a strong correlation with the development of depression (32). First, according to a study of a community-based population assessed using a depression scale, a significant correlation was found between depressive symptoms and OAB, suggesting that an elevated risk factor for incontinence in the urine was depressed symptoms (33). Second, Debra et al. demonstrated in their study that there is a significant association between OAB and the development of depressive symptoms (34). Third, one large population-based study found that the risk of developing depression increased as the severity of OAB increased (35). However, this study was conducted via a web-based survey and disregarded the significance of in-person interviews with doctors, and did not control for covariates. In contrast, the present study analyzed data for U.S. adults, effectively controlled for covariates, and improved the credibility and feasibility of the findings.

The relationship between overactive bladder (OAB) and mental health is likely bidirectional. On one hand, psychological distress may contribute to altered bladder function, and on the other, the burden of OAB symptoms may lead to mental health deterioration. Preclinical studies have shown that psychological stress may affect bladder contractility through pathways such as the Rho-kinase (ROCK) signaling cascade, leading to increased voiding frequency and detrusor overactivity. Stress-induced alterations in gut microbiota have also been hypothesized to influence bladder function. Additionally, anxiety and depression may contribute to heightened somatic sensitivity and lower perception thresholds, possibly exacerbating OAB symptoms (20, 36). Conversely, the social and emotional impact of OAB—such as embarrassment, sleep disturbances, reduced work productivity, and social withdrawal—may predispose individuals to depressive symptoms and suicidal ideation (19, 37, 38).

However, it is important to clarify that we do not advocate for psychology as the primary treatment for OAB or as a replacement for conventional urological interventions. OAB is primarily a bladder dysfunction, and treatment should remain focused on behavioral therapies, pharmacological interventions, and, when necessary, surgical options. However, mental health issues, particularly anxiety and depression, may exacerbate OAB symptoms and negatively impact treatment adherence and quality of life. Therefore, while the primary focus of OAB treatment should remain within the urological domain, we suggest that for individuals with significant emotional distress, poor treatment compliance, or reduced quality of life, considering integrated psychological support may improve overall health outcomes and treatment effectiveness.

This study has several noteworthy strengths. First, it evaluated a large sample of 28,085 participants, each of whom provided comprehensive clinically informative data. The data collection underwent a rigorous quality assurance process to ensure its reliability. Second, the study conducted subgroup analyses based on common co-morbidities. Subgroup and sensitivity analyses were also carried out to strengthen the reliability of the findings. This thorough examination emphasizes how crucial it is for psychiatrists to concentrate on patients’ symptoms connected to the urinary system.

Although NHANES provides a large, nationally representative sample with standardized data collection procedures, it has several limitations that must be acknowledged. First, it is a cross-sectional survey, which limits the ability to infer temporal or causal relationships between OAB and suicidal ideation. Second, the assessment of both OAB and suicidal ideation is based on self-report questionnaires rather than clinical diagnosis, which may lead to misclassification or underreporting. Third, the data lack granularity on the duration, severity, or context of symptoms, which could influence interpretation. Fourth, although we defined OAB as an OABSS ≥3 in accordance with prior NHANES-based literature, this threshold may inadvertently include individuals whose urinary symptoms stem from other causes, such as nocturnal polyuria, sleep apnea, metabolic or behavioral factors, or anatomical abnormalities. Fifth, relying solely on an OABSS ≥3 cutoff to define OAB may lead to misclassification. Future studies should consider incorporating more nuanced symptom-based subtyping and physiological markers to improve the accuracy and clinical utility of OAB phenotyping. Sixth, while NHANES utilizes a multi-stage, stratified probability sampling method to ensure national representativeness, certain subpopulations (e.g., individuals with severe OAB or hospitalized patients) may not be adequately represented. This could limit the generalizability of findings to these specific groups. Additionally, the reliance on self-reported OAB symptoms may not fully capture the clinical complexity or underlying physiology of OAB, thus affecting the precision of the data in elucidating OAB’s impact. These limitations warrant caution when extrapolating our findings to clinical settings or guiding intervention strategies.

This study reveals a positive association between OAB and suicidal ideation in U.S. adults, emphasizing the need for an integrated clinical approach to address both urinary and mental health symptoms to enhance suicide prevention efforts.