Up to two million women worldwide have obstetric fistula, a maternal morbidity
prevalent in developing countries that causes uncontrollable leaking of urine and/or
feces and a persistent bad odor. There is both theoretical and empirical evidence for
psychopathology in patients presenting for fistula surgery, albeit with methodological
limitations. The current studies sought to improve on past limitations of study design.
Study A compared psychological symptoms and social support between fistula patients
and a comparison group recruited from gynecology outpatient clinics. Measures
included previously validated psychometric questionnaires, administered orally by data
collectors. Results showed that compared to gynecology outpatients, fistula patients had
significantly higher levels of depression, traumatic stress, somatic symptoms and
avoidant coping, and had lower social support. Study B investigated changes in
psychological symptoms, stigma and social support between the time of admission for
fistula repair and 3 months after discharge from the hospital. At follow-up, fistula
patients reported significant improvements in all study outcome variables. Exploratory
analysis revealed that the extent of leaking was associated with depression and PTSD.
These results indicate the potential benefit of mental health interventions for this
population. Additionally, future research may clarify the relationship between residual
leaking after fistula surgery, and its effect on post-surgery mental health outcomes.