Recurrent urinary tract infections(UTIs) occur in otherwise healthy individuals, mostly female, with no risk factors such as underlying disease or urinary tract abnormalities . It is estimated that 1 in 2 female will have at least 1 episode of UTI in their lifetime, and UTIs are at least 50 times more common in female than in male. Furthermore, up to 20% of female with acute cystitis develop recurrent urinary infections (3 or more episodes per year). Female patients experience a psychological burden because they live with the anxiety of sudden acute episodes. Recurrent urinary tract infections is associated with multiple urinary tract symptoms and could affect the patient's quality of life and might relate to anxiety and depression. This study evaluated the relationship between anxiety, depression and recurrent urinary tract infections in female patients.

A total of 117 female patients with clinical diagnosis of recurrent urinary tract infections between April 2018 and August 2019 were retrospectively reviewed. Anxiety was evaluated by the State-anxiety scores with the State-Trait Anxiety Inventory (20-80) and depression was assessed by the Patients Health Questionnaire-9 (0–27).  State-anxiety scores with the State-Trait Anxiety Inventory (STAI-S) total scores and the  Patients Health Questionnaire-9 (PHQ-9) total scores provide a classification of anxiety and depression intensity levels. The classification of the scores for anxiety are as follow: normal (20-55), mild (56-65), and moderate (66-80). The classification of the scores for depression are as follow: normal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27).

In the study, 117 subjects had their complete data. 56.4% recurrent urinary tract infections in female patients had mild to moderate anxiety and 35.9% of recurrent urinary tract infections in female patients had mild to moderate depression.

Recurrent urinary tract infections in female patients reported significantly higher STAI-S anxiety scores compared to more than 3 times for 1 year of recurrence frequency (p = 0.000). Also, recurrent urinary tract infections in female patients reported significantly higher PHQ-9 depression scores compared to more than 5 times for 1 year of recurrence frequency (p = 0.009). However, STAI-S anxiety scores and PHQ-9 depression scores were no differences in recurrence period of recurrent urinary tract infections in female patients (p = 0.079 and p = 0.078).

Mild to moderate anxiety and depression are prevalent in female patients with urinary tract infections. There is a correlation between anxiety, depression and recurrence frequency of recurrent urinary tract infections in female patients. Mild to moderate anxiety levels are mainly related with more than 3 times for 1 year of recurrence frequency in female patients with recurrent urinary tract infections. Also, mild depression levels are mainly related with more than 5 times for 1 year of recurrence frequency in female patients with recurrent urinary tract infections.

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