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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 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2005 to 2018 Sicheng Shen, Huayi Feng, Yingqi Yang, Zhiyang Chen, Chuyue Wanga, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7448829/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Pelvic floor dysfunction urinary incontinence fecal incontinence pelvic organ prolapse depression suicidal ideation NHANES Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Pelvic floor dysfunction (PFD) refers to a collection of disorders resulting from the impairment of pelvic floor support structures, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP). These conditions are particularly prevalent among adult women and can significantly impair both physical health and quality of life. Epidemiological data suggest that approximately 25% of women in the United States experience at least one form of PFD, with prevalence increasing with age (Wu et al., 2014). In a report from Spain, the prevalence of urinary incontinence, fecal incontinence, and pelvic organ prolapse was 55.8%, 10.4%, and 14.0%, respectively(Peinado-Molina et al., 2023). Due to the impact of pregnancy and childbirth on female pelvic floor tissue, it is very common in the female population, with 56.9% of women reporting moderate pelvic floor dysfunction in one study of postpartum mothers. More studies predict that the number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050(Wu et al., 2009). It is noteworthy that women are not only at a heightened risk for pelvic floor dysfunction but also for depression and suicidal ideation. Studies have shown that the prevalence of mild and moderate to severe depression in the United States is 14.9% and 7.2%, respectively, and women are more than twice as high as men(Zhang et al., 2023), and the risk of depression in perimenopausal women is significantly increased by 2–4 times compared with premenopausal women(Sassarini, 2016). At the social level, influenced by a culture of reproductive health stigma and sexual shame, most patients suffer from a double affliction in prolonged silence: on the one hand, the physical symptoms of the disease gradually increase and interfere with daily life(Braga and Serati, 2023); On the other hand, sociocultural pressures lead to stigma, with only 32.0% of PFD patients actively seeking medical intervention(Dheresa et al., 2018). This dilemma seriously affects women's quality of life. Because exercise may exacerbate the discomfort caused by pelvic floor dysfunction, patients often actively limit daily activities, leading to social avoidance, resulting in the collapse of social support systems, a decreased sense of self-worth, and eventually may appear depression, anxiety and other psychopathological symptoms, and even suicide. This causes serious social, economic, physical and psychological problems for women, which greatly reduces their quality of life and productivity(Goodman et al., 2023; Jhangir and Jameel, 2023). Despite the strong relationship between pelvic floor dysfunction and mood disorders, and the significant challenges women face when it comes to pelvic floor dysfunction and mental health, there has been a lack of focused research on the correlation between pelvic floor dysfunction and depression and suicidal ideation in women. The study aims to fill this gap with comprehensive data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES), which includes detailed demographic characteristics, lifestyle factors, female reproductive health information, and concomitants. Determining whether this association shows consistency across demographics and coexistence aims to make a significant contribution to the nuanced public health strategies needed to address and mitigate the risk of depression and suicide in women caused by pelvic floor dysfunction. Methods Study population This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. NHANES is a large-scale national health survey managed by the Centers for Disease Control and Prevention (CDC), and all NHANES data are publicly accessible at https://www.cdc.gov/nchs/nhanes/ . Our analysis was based on data collected from participants across seven consecutive 2-year NHANES cycles (2005–2018). Since data on fecal incontinence were only available from 2005 to 2010, our study was divided into two analytical periods: 2005–2010 and 2011–2018.For both periods, the following inclusion criteria were applied: (1) female participants aged ≥ 20 years; (2) availability of complete data on pelvic floor dysfunction and PHQ-9; (3) availability of complete covariate data (Figs. 1 and 2 ). After applying these criteria, a total of 6,692 participants were included in the 2005–2010 cohort, while 8,687 participants were included in the 2011–2018 cohort. The study protocol was approved by the Research Ethics Review Committee of the National Center for Health Statistics (NCHS) at the CDC, and all NHANES procedures received approval from the NCHS Research Ethics Review Board (ERB). Definition of pelvic floor dysfunction Based on previous studies(Al-Badr et al., 2022; Wu et al., 2014), pelvic floor dysfunction was defined as fecal incontinence, urinary incontinence, and pelvic organ prolapse due to the lack of data on fecal incontinence from 2011–2018. (1) Fecal incontinence: For the purposes of our analysis, we defined fecal incontinence as any involuntary loss of mucus, liquid, or solid feces that has occurred within the past 30 days. (2) Incontinence: Incontinence is defined as the occurrence of incontinence symptoms once a month, depending on the frequency of the problem (< once a month, several times a month, several times a week, or daily and/or nightly). (3) Prolapse: Ask women questions about prolapse, "Have you ever had vaginal swelling or something fall out that you can see or feel?". We make a dichotomy of responses and define prolapse as a positive response. They were divided into two categorical variables (presence vs. absence of PFD). Multiple categorical variables (grouped by number of symptoms: none, one, two, or three symptomatic pelvic floor disorders) Definition of depression and suicidal ideation The two outcome variables in this study were suicidal ideation and depression. Depression is defined by a score on the Patient Health Questionnaire 9 (PHQ-9), a validated diagnostic tool for self-reported depression screening. It contains nine questions related to the signs and symptoms of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Each question is scored on a scale of 0 to 3, where 0 means no specific symptoms in the past 2 weeks, 1 means several days of symptoms, 2 means more than half symptoms, and 3 means almost every day. Scores on the nine questions were added together to assess depression, with an overall score of < 10 indicating no depression and a score of ≥ 10 indicating depression. The results of suicidal ideation are defined by PHQ's ninth question: "In the past two weeks, how many times have you been troubled by the following question: Think you'd be better off dead or hurting yourself in some way?" This question is thought to be a strong predictor of suicidal behavior. A score of 1, 2, or 3 indicated that participants had suicidal ideation on a few days, more than half of the days, and almost every day, respectively; 0 means no such idea. In the study, participants with a score of ≥ 1 were considered to have suicidal ideation, while a score of 0 indicated no suicidal ideation(Rossom et al., 2017). Covariate assessment The covariates included demographic characteristics (age, sex, race/ethnicity, education level, marital status, and poverty-to-income ratio), lifestyle factors (smoking status, alcohol consumption, body mass index), female reproduction (whether she had given birth, mode of delivery, number of deliveries), and associated diseases (hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid gland) Disease, cancer). The age group was divided into 20 to 39 years old, 40 to 59 years old and 60 to 80 years old. Race/ethnicity is divided into five groups: Mexican Americans, non-Hispanic whites, non-Hispanic blacks, other Hispanics, and other races. Education is classified as below high school, high school or equivalent, and above high school. Marital status was classified as married/living with a partner, divorced/widowed/separated, and unmarried. The poverty income ratio (PIR) is divided into three categories: <1.3, ≥ 1.3 but < 3.5, and ≥ 3.5. The lower the PIR, the higher the level of poverty. Smoking status was divided into three groups: never smokers (those who have smoked less than 100 cigarettes in their lifetime), former smokers (those who have smoked more than 100 cigarettes in their lifetime but do not smoke now), and current smokers (those who have smoked more than 100 cigarettes in their lifetime and currently smoke). Alcohol consumption is defined as consuming more than 12 alcoholic beverages in a year. BMI was divided into three categories: underweight (BMI < 25), normal weight (25 ≤ BMI < 30), and obesity (BMI ≥ 30). As reported by the reproductive health questionnaire, the number of births was classified as 0, 1, 2, 3 and ≥ 4, and the mode of delivery was classified as women who had never been pregnant, women who gave birth only vaginally, women who gave birth only by cesarean section, and women who had both. Type of disease By self-reporting whether a doctor or other health professional has told you that you have a certain disease is classified as with or without: high blood pressure, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer(Wang et al., 2023). Statistical analysis All statistical analyses were performed with appropriate sampling weights to account for NHANES's complex sampling design. Baseline characteristics of the study population were stratified by PFD status. The categorical variables were expressed as percentages and the difference between PFD groups was assessed using a weighted χ² test. To explore the relationship between PFD and depression and suicidal ideation, we constructed three logistic regression models: Model 1 did not make any adjustment; Model 2 adjusted for demographic variables (age, marital status, race, education level, poverty-to-income ratio) and health behavior indicators (BMI, smoking, alcohol consumption); Based on Model 2, Model 3 further adjusted obstetric history (whether birth, mode of delivery, number of deliveries) and chronic disease history (hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. In addition, we analyzed the relationship between depression and suicidal ideation in different age groups with or without PFD. After adjusting for Model 3, a stratified logistic regression model was used to explore the potential interactions among subgroups defined by covariates (age, marital status, race, education level, poverty-to-income ratio, BMI, smoking, alcohol consumption, birth history, mode of delivery, number of deliveries, hypertension, diabetes) to assess association consistency across subgroups. At the same time, interaction tests were performed to assess the potential correction effects of these covariables. All statistical analyses were performed in R software (version 4.4.2), and P < 0.05 was used as the significance test. Results Baseline characteristics As shown in Table 1 , a total of 6691 subjects were enrolled in NHANES from 2005 to 2010, including 3703 (55.4%) in the normal group and 2988 (44.6%) in the PFD group. The group with PFD showed a significant age-stratified difference, with 39.9% in those 60 years of age and older (25.7% in the normal group) and a significantly higher racial distribution among non-Hispanic whites (55.6% vs. 45.1%). In terms of reproductive characteristics, the symptomatic group had a higher pregnancy rate (91.6% vs 81.7%), a tendency to have multiple births (24.4% vs 16.6% ≥4 births), and a higher proportion of vaginal births (70.5% vs 57.0%). Comorbidities analysis showed significant increases in the prevalence of obesity (BMI 30:45.7% vs. 35.0%), hypertension (43.1% vs. 28.3%), diabetes (16.1% vs. 9.5%), and arthritis (40.0% vs. 23.6%) in the symptom group. In mental health measures, the incidence of depression (14.9% vs. 7.5%) and suicidal ideation (6.0% vs. 2.5%) were significantly higher in the symptomatic group. Notably, there was no statistically significant difference in socioeconomic indicators such as education level (p = 0.095), income level (p = 0.339) and alcohol consumption (p = 0.081). In the 2011–2018 cohort(Table 2 ), 4863 (56.0%) of the 8687 participants were in the normal group and 3824 (44.0%) were in the PFD group. The cohort reinforced the association between age and race, with 42.6% in the symptomatic group (25.4% in the normal group) and a larger difference in the proportion of non-Hispanic whites (47.0% vs. 32.6%). The new poverty income ratio varied between groups (p = 0.024), with a higher proportion of middle-income (1.3–3.5 poverty line) people in the symptom group (39.1% vs. 36.3%). Reproductive characteristics: pregnancy history (89.5% vs 78.5%), multiple births (≥ 4 births: 21.9% vs 17.0%) and vaginal delivery (65.7% vs 51.9%). Differences in metabolic diseases widened, with differences between the obesity (52.0% vs. 36.2%), hypertension (46.0% vs. 30.5%) and diabetes (20.7% vs. 11.9%) groups widening from the previous cycle. New risk factors of concern included significant smoking status (p = 0.014) and an increased proportion of previous smokers in the symptomatic group (21.8% vs 15.8%); Liver disease (5.1% vs 3.6%, p = 0.005) and asthma (20.7% vs 15.8%, p < 0.001) were new associated factors. Cancer prevalence was significantly different (13.5% vs 7.5%). Mental health disparities persisted, with depression (15.0% vs 7.6%) and suicidal ideation (4.9% vs 2.9%) remaining significant, while differences in thyroid disease prevalence widened (21.1% vs 13.5%). Table 1 Characteristics of the NHANES 2005–2010 participants Characteristics Total(n = 6691) Normal (n = 3703) Pelvic Floor dysfunction(n = 2988) P Age (year) (n/%) < 0.001 20–39 2361 (35.3%) 1698 (45.9%) 663 (22.2%) 40–59 2187 (32.7%) 1055 (28.5%) 1132 (37.9%) ≥ 60 2143 (32.0%) 950 (25.7%) 1193 (39.9%) RACE (n/%) < 0.001 Mexican American 1183 (17.7%) 665 (18.0%) 518 (17.3%) Other Hispanic 558 (8.3%) 335 (9.1%) 223 (7.5%) Non-Hispanic White 3332 (49.8%) 1670 (45.1%) 1662 (55.6%) Non-Hispanic Black 1351 (20.2%) 863 (23.3%) 488 (16.3%) Other/multiracial 267 (4.0%) 170 (4.6%) 97 (3.3%) Education (n/%) 0.095 High school 3381 (50.5%) 1911 (51.6%) 1470 (49.2%) Marital (n/%) < 0.001 Married /Living with partner 3734 (55.8%) 2006 (54.2%) 1728 (57.8%) Widowed/divorced/separated 1896 (28.3%) 937 (25.3%) 959 (32.1%) Never married 1061 (15.9%) 760 (20.5%) 301 (10.1%) Poverty income ratio(PIR) (n/%) 0.3394 < 1.3 2096 (31.3%) 1174 (31.7%) 922 (30.9%) ≥ 1.3,<3.5 2561 (38.3%) 1426 (38.5%) 1135 (38.0%) ≥ 3.5 2034 (30.4%) 1103 (29.8%) 931 (31.2%) Body mass index (BMI) (n/%) < 0.001 30 2664 (39.8%) 1297 (35.0%) 1367 (45.7%) Smoking status (n/%) < 0.001 Never 4056 (60.6%) 2345 (63.3%) 1711 (57.3%) Current 1292 (19.3%) 704 (19.0%) 588 (19.7%) Former 1343 (20.1%) 654 (17.7%) 689 (23.1%) Drink (n/%) 0.081 No 2645 (39.5%) 1454 (39.3%) 1191 (39.9%) Yes 4046 (60.5%) 2249 (60.7%) 1797 (60.1%) Depressed (n/%) < 0.001 No 5970 (89.2%) 3426 (92.5%) 2544 (85.1%) Yes 721 (10.8%) 277 (7.48%) 444 (14.9%) Suicidal ideation (n/%) < 0.001 No 6419 (95.9%) 3610 (97.5%) 2809 (94.0%) Yes 272 (4.1%) 93 (2.5%) 179 (6.0%) Whether birth (n/%) < 0.001 No 929 (13.9%) 677 (18.3%) 252 (8.43%) Yes 5762 (86.1%) 3026 (81.7%) 2736 (91.6%) Number of births < 0.001 0 1233 (18.4%) 860 (23.2%) 373 (12.5%) 1 1060 (15.8%) 638 (17.2%) 422 (14.1%) 2 1724 (25.8%) 933 (25.2%) 791 (26.5%) 3 1330 (19.9%) 658 (17.8%) 672 (22.5%) ≥ 4 1344 (20.1%) 614 (16.6%) 730 (24.4%) Mode of delivery (n/%) < 0.001 Never pregnant 1233 (18.4%) 860 (23.2%) 373 (12.5%) Vaginal delivery 4218 (63.0%) 2111 (57.0%) 2107 (70.5%) Cesarean delivery 709 (10.6%) 441 (11.9%) 268 (8.97%) Vaginal and cesarean deliveries 531 (7.9%) 291 (7.86%) 240 (8.03%) Hypertension (n/%) < 0.001 No 4354 (65.1%) 2654 (71.7%) 1700 (56.9%) Yes 2337 (34.9%) 1049 (28.3%) 1288 (43.1%) Diabetes (n/%) < 0.001 No 5857 (87.5%) 3350 (90.5%) 2507 (83.9%) Yes 834 (12.5%) 353 (9.53%) 481 (16.1%) Asthma (n/%) 0.042 No 5671 (84.8%) 3188 (86.1%) 2483 (83.1%) Yes 1020 (15.2%) 515 (13.9%) 505 (16.9%) Arthritis (n/%) < 0.001 No 4702 (69.0%) 2828 (76.4%) 1794 (60.0%) Yes 2110 (31.0%) 875 (23.6%) 1194 (40.0%) Coronary heart disease (n/%) < 0.001 No 6542 (97.8%) 3650 (98.6%) 2892 (96.8%) Yes 149 (2.2%) 53 (1.43%) 96 (3.21%) Liver disease (n/%) 0.010 No 6492 (97.0%) 3615 (97.6%) 2877 (96.3%) Yes 199 (3.0%) 88 (2.38%) 111 (3.71%) Thyroid gland (n/%) < 0.001 No 5666 (84.7%) 3249 (87.7%) 2417 (80.9%) Yes 1025 (15.3%) 454 (12.3%) 571 (19.1%) Cancer (n/%) < 0.001 No 6023 (90.1%) 3432 (92.7%) 2591 (86.7%) Yes 668 (9.9%) 271 (7.3%) 397 (13.3%) Table 2 Characteristics of the NHANES 2011–2018 participants Characteristics Total(n = 8687) Normal (n = 4863) Pelvic Floor Dysfunction(n = 3824) P Age (year) (n/%) < 0.001 20–39 2860 (33.0%) 2054 (42.2%) 806 (21.1%) 40–59 2961 (34.2%) 1573 (32.3%) 1388 (36.3%) ≥ 60 2866 (33.1%) 1236 (25.4%) 1630 (42.6%) RACE (n/%) < 0.001 Mexican American 1124 (13.0%) 618 (12.7%) 506 (13.2%) Other Hispanic 913 (10.5%) 552 (11.4%) 361 (9.44%) Non-Hispanic White 3384 (39.0%) 1586 (32.6%) 1798 (47.0%) Non-Hispanic Black 1969 (22.7%) 1221 (25.1%) 748 (19.6%) Other/multiracial 1297 (14.9%) 886 (18.2%) 411 (10.7%) Education (n/%) 0.115 High school 5235 (60.2%) 2954 (60.7%) 2281 (59.6%) Marital (n/%) < 0.001 Married /Living with partner 4665 (53.6%) 2611 (53.7%) 2054 (53.7%) Widowed/divorced/separated 2404 (27.7%) 1134 (23.3%) 1270 (33.2%) Never married 1618 (18.6%) 1118 (23.0%) 500 (13.1%) Poverty income ratio (PIR )(n/%) 0.024 < 1.3 2890 (33.3%) 1670 (34.3%) 1220 (31.9%) ≥ 1.3,<3.5 3261 (37.5%) 1764 (36.3%) 1497 (39.1%) ≥ 3.5 2536 (29.2%) 1429 (29.4%) 1107 (28.9%) Body mass index (BMI) (n/%) < 0.001 30 3748 (43.1%) 1760 (36.2%) 1988 (52.0%) Smoking status (n/%) 0.014 Never 5685 (65.4%) 3349 (68.9%) 2336 (61.1%) Current 1404 (16.1%) 748 (15.4%) 656 (17.2%) Former 1598 (18.4%) 766 (15.8%) 832 (21.8%) Drink (n/%) 0.359 No 2812 (32.3%) 1672 (34.4%) 1140 (29.8%) Yes 5875 (67.7%) 3191 (65.6%) 2684 (70.2%) Depressed (n/%) < 0.001 No 7742 (89.1%) 4492 (92.4%) 3250 (85.0%) Yes 945 (10.9%) 371 (7.63%) 574 (15.0%) Suicidal ideation (n/%) 0.001 No 8358 (96.2%) 4722 (97.1%) 3636 (95.1%) Yes 329 (3.8%) 141 (2.9%) 188 (4.9%) Whether birth (n/%) < 0.001 No 1449 (16.7%) 1046 (21.5%) 403 (10.5%) Yes 7238 (83.3%) 3817 (78.5%) 3421 (89.5%) Number of births < 0.001 0 1826 (21.0%) 1293 (26.6%) 533 (13.9%) 1 1372 (15.8%) 813 (16.7%) 559 (14.6%) 2 2254 (25.9%) 1160 (23.9%) 1094 (28.6%) 3 1572 (18.1%) 772 (15.9%) 800 (20.9%) ≥ 4 1663 (19.1%) 825 (17.0%) 838 (21.9%) Mode of delivery (n/%) < 0.001 Never pregnant 1826 (21.0%) 1293 (26.6%) 533 (13.9%) Vaginal delivery 5038 (58.0%) 2526 (51.9%) 2512 (65.7%) Cesarean delivery 1064 (12.2%) 657 (13.5%) 407 (10.6%) Vaginal and cesarean deliveries 759 (8.7%) 387 (8.0%) 372 (9.73%) Hypertension (n/%) < 0.001 No 5443 (62.7%) 3379 (69.5%) 2064 (54.0%) Yes 3244 (37.3%) 1484 (30.5%) 1760 (46.0%) Diabetes (n/%) < 0.001 No 7319 (84.2%) 4285 (88.1%) 3034 (79.3%) Yes 1368 (15.8%) 578 (11.9%) 790 (20.7%) Asthma (n/%) < 0.001 No 7150 (82.3%) 4095 (84.2%) 3055 (79.9%) Yes 1558 (17.9%) 768 (15.8%) 790 (20.7%) Arthritis (n/%) < 0.001 No 5890 (67.8%) 3712 (76.3%) 2178 (57.0%) Yes 2797 (32.2%) 1151 (23.7%) 1646 (43.0%) Coronary heart disease (n/%) < 0.001 No 8392 (96.6%) 4712 (96.9%) 3680 (96.2%) Yes 295 (3.4%) 151 (3.11%) 144 (3.77%) Liver disease (n/%) 0.005 No 6707 (95.6%) 3079 (96.4%) 3628 (94.9%) Yes 311 (4.4%) 115 (3.6%) 196 (5.13%) Thyroid gland (n/%) < 0.001 No 7226 (83.2%) 4208 (86.5%) 3018 (78.9%) Yes 1461 (16.8%) 655 (13.5%) 806 (21.1%) Cancer (n/%) < 0.001 No 7803 (89.9%) 4497 (92.5%) 3306 (86.5%) Yes 884 (10.1%) 366 (7.53%) 518 (13.5%) Relationship between PFD and Depression and Suicidal Ideation Data analysis from 2005 to 2010 (Table 3 ) showed that Model 1, without adjusting for any confounders, showed PFD and depression (OR = 2.087, 95%CI: 1.713–2.543; p < 0.001) and suicidal ideation (OR = 2.678, 95%CI: 1.942–3.694; p < 0.001) were significantly associated. Individuals with one, two, or three symptomatic pelvic floor disorders had depression (OR 1.783, 3.564, 8.186, respectively; Both p < 0.001) and suicidal ideation (OR 2.314, 4.518, 5.922, respectively; p < 0.001), the risk was gradually increased. This association was statistically significant even after adjusting for demographic variables and health behavior measures in Model 2 and covariates in Model 3 (p < 0.001). Results from 2011 to 2018 (Table 4 ) showed that the relationship between PFD and depression and suicidal ideation in the three models was as significant as in the results from 2005 to 2010 (p < 0.001). It is worth noting that, compared with normal people, the association between the two symptomatic pelvic floor disorders and depression and suicidal ideation in Model 2 and model 3 lost significance (p > 0.05), which may be due to the insufficient data of the three symptomatic pelvic floor disorders and the reduced statistical power. Table 3 Moderating correlation analysis of PFD with depression and suicidal ideation from 2005 to 2010 Characteristics Model 1 Model 2 Model 3 OR (95% CI) P OR (95% CI) P OR (95% CI) P Depression Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — PFD 2.087 (1.713, 2.543) <0.001 2.343 (1.887, 2.908) <0.001 2.076 (1.662, 2.592) <0.001 Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — One SPFD 1.783 (1.441, 2.206) <0.001 2.047 (1.627, 2.576) <0.001 1.845 (1.459, 2.335) <0.001 Two SPFD 3.564 (2.623, 4.842) <0.001 4.044 (2.876, 5.687) <0.001 3.394 (2.401, 4.799) <0.001 Three SPFD 8.186 (4.057, 16.514) <0.001 7.665 (3.887, 15.119) <0.001 5.700 (2.825, 11.500) <0.001 Suicide Ideation Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — PFD 2.678 (1.942, 3.694) <0.001 3.082 (2.148, 4.422) <0.001 2.884 (1.980, 4.200) <0.001 Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — One SPFD 2.314 (1.641, 3.263) <0.001 2.731 (1.875, 3.978) <0.001 2.598 (1.764, 3.826) <0.001 Two SPFD 4.518 (2.873, 7.104) <0.001 5.202 (3.137, 8.628) <0.001 4.618 (2.715, 7.854) <0.001 Three SPFD 5.922 (2.371, 14.790) <0.001 5.352 (2.106, 13.600) <0.001 4.321 (1.617, 11.547) <0.001 PFD:pelvic floor dysfunction SPFD:symptomatic pelvic floor disorders Model I: no adjusted. Model II: adjusted for age,marital status, race, education, PIR, BMI, smoking, drinking Model Ⅲ:adjusted for Model II, whether birth, mode of delivery, number of deliveries hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer Table 4 Moderating correlation analysis of PFD with depression and suicidal ideation from 2011 to 2018 Characteristics Model 1 Model 2 Model 3 OR (95% CI) P OR (95% CI) P OR (95% CI) P Depression Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — PFD 2.057 (1.709, 2.475) <0.001 2.187 (1.799, 2.659) <0.001 1.880 (1.533, 2.305) <0.001 Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — One SPFD 2.053 (1.705, 2.471) <0.001 2.183 (1.795, 2.654) <0.001 1.999 (1.637, 2.441) <0.001 Two SPFD 2.492 (0.752, 8.256) <0.001 2.742 (0.755, 9.962) 0.125 2.2400 (0.629, 9.167) 0.200 Suicide Ideation Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — PFD 1.600 (1.201, 2.131) 0.001 1.664 (1.255, 2.205) <0.001 1.574 (1.192, 2.077) 0.001 Normal 1.0 (reference) — 1.0 (reference) — 1.0 (reference) — One SPFD 1.600 (1.200, 2.133) <0.001 1.664 (1.254, 2.207) <0.001 1.664 (1.254, 2.207) <0.001 Two SPFD 1.601 (0.442, 5.791) <0.001 1.678 (0.483, 5.830) 0.415 1.678 (0.483, 5.830) 0.415 PFD:pelvic floor dysfunction SPFD:symptomatic pelvic floor disorders Model I: no adjusted. Model II: adjusted for age,marital status, race, education, PIR, BMI, smoking, drinking Model Ⅲ:adjusted for Model II, whether birth, mode of delivery, number of deliveries hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer Subgroup analysis and interaction analysis Stratified analyses by age groups were performed among subjects with either depression or suicidal ideation to further examine the associations between comorbid PFD and both outcomes. After adjusting for covariates, the 2005–2010 data revealed comparable rates of suicidal ideation between women with and without PFD in the 20–39 age group. Similarly, the 2011–2018 cohort showed no significant differences in depression or suicidal ideation prevalence among women aged 30–39 with versus without PFD. Both periods demonstrated elevated proportions of depression and suicidal ideation in women aged ≥ 40 with PFD, with the highest burden observed in the middle-aged subgroup (40–59 years) (Figs. 3 and 4 ). Figures 5 and 6 present stratified analyses of the associations between PFD and depression/suicidal ideation across different subgroups during 2005–2010 and 2011–2018, respectively. These analyses were conducted using Model 3, which adjusted for a comprehensive set of covariates including gender, age, race, poverty-to-income ratio, marital status, educational attainment, body mass index (BMI), baseline depression status, smoking habits, alcohol consumption, and recreational activities. The results demonstrated consistent positive associations between PFD and both depression and suicidal ideation across all examined subgroups. Interaction analysis revealed significant modifying effects: diabetes status showed an interactive effect on the PFD-suicidal ideation association during 2005–2010 (interaction p = 0.026), while smoking status exhibited a modifying effect on this association in the 2011–2018 cohort (interaction p = 0.047). Discussion This large-scale cross-sectional study, utilizing nationally representative NHANES data from 2005 to 2018, provides robust evidence for the significant association between PFD and adverse mental health outcomes in women. Our findings indicate that women with PFD exhibit a markedly higher risk of depression and suicidal ideation compared to those without PFD, with the risk escalating proportionally to the number of PFD symptoms. These associations persisted even after rigorous adjustment for demographic, socioeconomic, lifestyle, obstetric, and comorbidity-related confounders, underscoring the independent contribution of PFD to the psychological burden. Our results reinforce the need to consider PFD in the context of mental health. In recent years, several potential mechanistic pathways have been proposed to explain the link between PFD and mental health. Neuroanatomical mechanisms suggest that depression and PFD share overlapping neural substrates within the limbic system and autonomic pathways. Functional neuroimaging studies have demonstrated hyperactivation of the anterior cingulate cortex (ACC) and the insula—regions integral to pain processing and emotional regulation—in patients with depression and chronic pelvic pain syndrome (Osório et al., 2016). These regions regulate visceral sensitivity through the brain-gut-bladder axis, potentially amplifying psychological distress and pelvic floor hypertonicity (Holstege, 2016). Moreover, hyperactivation of the amygdala, a hallmark of depression, may drive excessive sympathetic nervous system (SNS) activity, leading to bladder overactivity and pelvic muscle spasms through its output pathways to the Onuf nucleus(Vrijens et al., 2017). This neuroanatomical convergence highlights the role of central sensitization in mediating the bidirectional exacerbation of symptoms. Our study found that women aged 40–59 years exhibited the highest proportion of depression and suicidal ideation among those with PFD. Additionally, women with a history of childbirth, obesity, and metabolic disorders were more susceptible to PFD. Prior research suggests that estrogen exerts protective effects on mood in middle-aged women(Cohen et al., 2003; Rasgon et al., 2001). However, during perimenopause, declining estrogen levels may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis, a key system in stress response. Estrogen normally suppresses HPA axis activity, and its reduction may lead to elevated cortisol levels, triggering depressive symptoms(Cn, 2014). Concurrently, HPA axis hyperactivity has been linked to abnormal pelvic floor muscle tone(Stoffel and Craft, 2004). Estrogen also modulates γ-aminobutyric acid (GABA) and glutamate receptors, which are involved in anxiety and depression regulation, as well as pelvic floor muscle control(Mann, 2013; Perrot-Sinal et al., 2001). Metabolic syndrome and chronic inflammation serve as common pathophysiological drivers of both depression and PFD. Adipokine dysregulation associated with obesity—such as elevated leptin and resistin—promotes systemic inflammation while mechanically increasing intra-abdominal pressure, a key factor in pelvic organ prolapse(Kowalik et al., 2017). Furthermore, diabetic neuropathy exacerbates this interplay by impairing pudendal nerve-mediated pelvic muscle control and reducing bladder compliance. Urodynamic studies indicate that patients with depression and diabetes exhibit a 42% higher prevalence of detrusor overactivity compared to controls(Leue et al., 2017).Beyond physiological mechanisms, the bidirectional exacerbation of PFD and mental health issues also manifests in psychosocial domains. Maladaptive cognitive-behavioral patterns significantly modulate the relationship between depression and PFD. Fear-avoidance behaviors reduce physical activity, exacerbating obesity-related pelvic floor stress while perpetuating social isolation. Social withdrawal leads to the collapse of support systems, diminished self-worth, and increased suicidal ideation(Till et al., 2019). These findings underscore the substantial psychological burden of PFD in women and advocate for an integrative care model. Routine depression and suicidal risk screening should be mandatory for women with PFD, particularly those reporting multiple symptoms. Conversely, clinicians treating female depression should actively assess pelvic floor health. Public health initiatives must combat the stigma surrounding pelvic health by normalizing discussions, promoting educational campaigns, and encouraging early intervention. Limitations and Prospects: The inherent limitations of the cross-sectional design of this study preclude causal inference. Self-reported measures of PFD symptoms and mental health may introduce recall bias, although PHQ-9 is a proven tool. Residual confounding of unmeasured factors (e.g. social support, history of trauma) is still possible. In addition, the lack of data on fecal incontinence in the 2011–2018 cohort may have underestimated the prevalence of PFD. Future prospective studies should describe the relationship between the two and explore the mediating mechanisms to find ways to solve the disease. Qualitative research is needed to understand how cultural narratives surrounding pelvic health modulate psychological responses. Intervention trials that test integrated mental and physical health approaches (e.g., pelvic floor rehabilitation combined with cognitive behavioral therapy) can inform evidence-based care pathways. Conclusion This study identified pelvic floor dysfunction as an independent risk factor for depression and suicidal ideation in women, with the risk amplified by symptom diversity. The findings call for increased clinical vigilance and multidisciplinary nursing strategies to address this issue, but more prospective studies are needed to refine it. Declarations Acknowledgements We gratefully acknowledge the contribution of all participants of the present research. Contributors SC and HY: Data analysis, visualization, writing–original draft, writing–review and editing. YQ: Data curation, writing–review and editing. ZY: writing–review and editing. CY: Formal analysis, writing–review and editing. XP: Conceptualization, methodology, supervision, writing–review and editing. JC: Conceptualization, supervision, writing–review and editing. Availability of data and materials Data for this study were sourced from National Health and Nutrition Examination Survey (NHANES) and available here: https://www.cdc.gov/nchs/nhanes/index.htm Funding This work was funded by the Jiangsu Province Natural Science Foundation project (No. BK20211085); Suzhou Applied Basic Research (Medical and Health) Science and Technology Innovation Project (NO. SYW2024135); Suzhou People's Livelihood Science and Technology Project (No. SS2019073). Suzhou Municipal Health Commission (No. LCZX202114); Suzhou Gusu Health Talent Plan (No. GSWS2021046). Suzhou "Science Education and Health" Top-level Project（NO. MSXM2024028） Ethics approval and consent to participation The study analyzed data downloaded from the National Health and Nutrition Examination Survey public database. The National Center for Health Statistics Ethics Review Committee granted ethics approval. The methods involved in this study were conducted in accordance with relevant guidelines and regulations (Declaration of Helsinki). All individuals provided written informed consent before participating in the study. Details are available at https://www. cdc.gov/nchs/nhanes/irba98.htm. The current study was deemed exempt from further review because the data used are deidentified and publicly accessible. Declaration of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be constructed as a potential conflict of interest. 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Gynecol. 114, 1278. https://doi.org/10.1097/AOG.0b013e3181c2ce96 Wu, J.M., Vaughan, C.P., Goode, P.S., Redden, D.T., Burgio, K.L., Richter, H.E., Markland, A.D., 2014. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet. Gynecol. 123, 141–148. https://doi.org/10.1097/AOG.0000000000000057 Zhang, Z., Jackson, S.L., Gillespie, C., Merritt, R., Yang, Q., 2023. Depressive symptoms and mortality among US adults. JAMA Netw. Open 6, e2337011. https://doi.org/10.1001/jamanetworkopen.2023.37011 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7448829","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515412455,"identity":"c22b8948-5fce-4ad8-9827-c17738dc3056","order_by":0,"name":"Sicheng Shen","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sicheng","middleName":"","lastName":"Shen","suffix":""},{"id":515412456,"identity":"d642ccea-17c2-45e1-9759-4f896efcf3b9","order_by":1,"name":"Huayi Feng","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Huayi","middleName":"","lastName":"Feng","suffix":""},{"id":515412457,"identity":"935c3e20-8420-4293-b93b-4f4db83e7ec1","order_by":2,"name":"Yingqi Yang","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yingqi","middleName":"","lastName":"Yang","suffix":""},{"id":515412458,"identity":"558eb88b-d0ab-4770-9732-db6347adce3f","order_by":3,"name":"Zhiyang Chen","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhiyang","middleName":"","lastName":"Chen","suffix":""},{"id":515412459,"identity":"f37ad069-4a7d-48bb-89e3-3380f05144d8","order_by":4,"name":"Chuyue Wanga","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chuyue","middleName":"","lastName":"Wanga","suffix":""},{"id":515412460,"identity":"8d90f0d2-6216-4f67-a989-07bafe660ae4","order_by":5,"name":"Xiaopeng Wang","email":"","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaopeng","middleName":"","lastName":"Wang","suffix":""},{"id":515412461,"identity":"b8665406-905c-4aef-8155-d0994cb53fa5","order_by":6,"name":"Jiacheng Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACPmaGhAMMDEDEwHyAQQIiaIBXCxtCC1sCkVogFEgLD1wlAS3sDA8P/Ki5I2fOv+bbA8s2u2gG9uZtEgw1d/A67GDPsWfGljPebjeQbEvObeA5VibBcOwZfr/wNhxO3HDj7DYJybYDuQ0SOWYSjA2H8dvyt+Fw/YYbZ55BtMi/IazlMNCWBIPzPWxQW3iI0CJz7LDhhhtsZhIS55Jz23jSii0SjuHWws9/Jvnjm5rD8gbnDz+Tliizy+1nP7zxxoca3FqA0ZEAoSUSGJhBUQmOqQQ8GhgY2A9A7TvAwPgBr8pRMApGwSgYqQAApvxXkpH4x7cAAAAASUVORK5CYII=","orcid":"","institution":"Suzhou TCM Hospital, Nanjing University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jiacheng","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-08-25 01:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7448829/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7448829/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91561700,"identity":"2fb103e2-512d-4b15-ae27-5a5a647ee4ca","added_by":"auto","created_at":"2025-09-17 18:49:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54463,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant screening of NHANES 2005-2010\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/056a2d4d4c83b31dc9f04c8e.png"},{"id":91561702,"identity":"b33d76e6-52f1-44bc-8879-6ab03033d9d6","added_by":"auto","created_at":"2025-09-17 18:49:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":56395,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant screening of NHANES 2011-2018\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/e91321dabf2641eee692538d.png"},{"id":91562649,"identity":"d567b93c-6b52-4afc-9a5a-d9627ac616d9","added_by":"auto","created_at":"2025-09-17 18:57:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94722,"visible":true,"origin":"","legend":"\u003cp\u003e2005-2010 Persons with or without SPFD Weighted percentage of participants with depression and suicidal ideation, by age group.**P \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/78e8d78c529ffe096d352e2e.png"},{"id":91561704,"identity":"6b46651b-19d4-4e48-8a3d-e85cc1cc6568","added_by":"auto","created_at":"2025-09-17 18:49:37","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":79848,"visible":true,"origin":"","legend":"\u003cp\u003e2011-2018 Persons with or without SPFD Weighted percentage of participants with depression and suicidal ideation, by age group. \u003cem\u003e**P \u0026lt; 0.001.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/e3458b6de333ce622037d4f1.png"},{"id":91561706,"identity":"3fd1e77c-9721-415d-ac6f-6ac7401f6ae8","added_by":"auto","created_at":"2025-09-17 18:49:37","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":962452,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis for the association between PFD and Depression and Sucidal ideation.(2005-2010)\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/b2ce49fda4ac24e7eb9ef92b.png"},{"id":91561710,"identity":"98965a87-8589-4b1b-9cd0-5b5d590caed1","added_by":"auto","created_at":"2025-09-17 18:49:37","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":521053,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis for the association between PFD and Depression and Sucidal ideation.(2011-2018)\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/7b284d3a15d0964fa3c05355.png"},{"id":93457118,"identity":"4efafa41-8d8d-4143-bb95-f75387cbb713","added_by":"auto","created_at":"2025-10-14 05:31:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4007550,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7448829/v1/edd648f2-4a02-4c24-85b2-254df7636ad9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePelvic floor dysfunction (PFD) refers to a collection of disorders resulting from the impairment of pelvic floor support structures, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP). These conditions are particularly prevalent among adult women and can significantly impair both physical health and quality of life. Epidemiological data suggest that approximately 25% of women in the United States experience at least one form of PFD, with prevalence increasing with age (Wu et al., 2014). In a report from Spain, the prevalence of urinary incontinence, fecal incontinence, and pelvic organ prolapse was 55.8%, 10.4%, and 14.0%, respectively(Peinado-Molina et al., 2023). Due to the impact of pregnancy and childbirth on female pelvic floor tissue, it is very common in the female population, with 56.9% of women reporting moderate pelvic floor dysfunction in one study of postpartum mothers. More studies predict that the number of American women with at least one pelvic floor disorder will increase from 28.1\u0026nbsp;million in 2010 to 43.8\u0026nbsp;million in 2050(Wu et al., 2009). It is noteworthy that women are not only at a heightened risk for pelvic floor dysfunction but also for depression and suicidal ideation. Studies have shown that the prevalence of mild and moderate to severe depression in the United States is 14.9% and 7.2%, respectively, and women are more than twice as high as men(Zhang et al., 2023), and the risk of depression in perimenopausal women is significantly increased by 2\u0026ndash;4 times compared with premenopausal women(Sassarini, 2016).\u003c/p\u003e\u003cp\u003eAt the social level, influenced by a culture of reproductive health stigma and sexual shame, most patients suffer from a double affliction in prolonged silence: on the one hand, the physical symptoms of the disease gradually increase and interfere with daily life(Braga and Serati, 2023); On the other hand, sociocultural pressures lead to stigma, with only 32.0% of PFD patients actively seeking medical intervention(Dheresa et al., 2018). This dilemma seriously affects women's quality of life. Because exercise may exacerbate the discomfort caused by pelvic floor dysfunction, patients often actively limit daily activities, leading to social avoidance, resulting in the collapse of social support systems, a decreased sense of self-worth, and eventually may appear depression, anxiety and other psychopathological symptoms, and even suicide. This causes serious social, economic, physical and psychological problems for women, which greatly reduces their quality of life and productivity(Goodman et al., 2023; Jhangir and Jameel, 2023).\u003c/p\u003e\u003cp\u003eDespite the strong relationship between pelvic floor dysfunction and mood disorders, and the significant challenges women face when it comes to pelvic floor dysfunction and mental health, there has been a lack of focused research on the correlation between pelvic floor dysfunction and depression and suicidal ideation in women. The study aims to fill this gap with comprehensive data from the 2005\u0026ndash;2018 National Health and Nutrition Examination Survey (NHANES), which includes detailed demographic characteristics, lifestyle factors, female reproductive health information, and concomitants. Determining whether this association shows consistency across demographics and coexistence aims to make a significant contribution to the nuanced public health strategies needed to address and mitigate the risk of depression and suicide in women caused by pelvic floor dysfunction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003eThis study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. NHANES is a large-scale national health survey managed by the Centers for Disease Control and Prevention (CDC), and all NHANES data are publicly accessible at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/nhanes/\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/nhanes/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Our analysis was based on data collected from participants across seven consecutive 2-year NHANES cycles (2005\u0026ndash;2018). Since data on fecal incontinence were only available from 2005 to 2010, our study was divided into two analytical periods: 2005\u0026ndash;2010 and 2011\u0026ndash;2018.For both periods, the following inclusion criteria were applied: (1) female participants aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years; (2) availability of complete data on pelvic floor dysfunction and PHQ-9; (3) availability of complete covariate data (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After applying these criteria, a total of 6,692 participants were included in the 2005\u0026ndash;2010 cohort, while 8,687 participants were included in the 2011\u0026ndash;2018 cohort. The study protocol was approved by the Research Ethics Review Committee of the National Center for Health Statistics (NCHS) at the CDC, and all NHANES procedures received approval from the NCHS Research Ethics Review Board (ERB).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDefinition of pelvic floor dysfunction\u003c/h3\u003e\n\u003cp\u003eBased on previous studies(Al-Badr et al., 2022; Wu et al., 2014), pelvic floor dysfunction was defined as fecal incontinence, urinary incontinence, and pelvic organ prolapse due to the lack of data on fecal incontinence from 2011\u0026ndash;2018. (1) Fecal incontinence: For the purposes of our analysis, we defined fecal incontinence as any involuntary loss of mucus, liquid, or solid feces that has occurred within the past 30 days. (2) Incontinence: Incontinence is defined as the occurrence of incontinence symptoms once a month, depending on the frequency of the problem (\u0026lt;\u0026thinsp;once a month, several times a month, several times a week, or daily and/or nightly). (3) Prolapse: Ask women questions about prolapse, \"Have you ever had vaginal swelling or something fall out that you can see or feel?\". We make a dichotomy of responses and define prolapse as a positive response. They were divided into two categorical variables (presence vs. absence of PFD). Multiple categorical variables (grouped by number of symptoms: none, one, two, or three symptomatic pelvic floor disorders)\u003c/p\u003e\n\u003ch3\u003eDefinition of depression and suicidal ideation\u003c/h3\u003e\n\u003cp\u003eThe two outcome variables in this study were suicidal ideation and depression. Depression is defined by a score on the Patient Health Questionnaire 9 (PHQ-9), a validated diagnostic tool for self-reported depression screening. It contains nine questions related to the signs and symptoms of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Each question is scored on a scale of 0 to 3, where 0 means no specific symptoms in the past 2 weeks, 1 means several days of symptoms, 2 means more than half symptoms, and 3 means almost every day. Scores on the nine questions were added together to assess depression, with an overall score of \u0026lt;\u0026thinsp;10 indicating no depression and a score of \u0026ge;\u0026thinsp;10 indicating depression.\u003c/p\u003e\u003cp\u003eThe results of suicidal ideation are defined by PHQ's ninth question: \"In the past two weeks, how many times have you been troubled by the following question: Think you'd be better off dead or hurting yourself in some way?\" This question is thought to be a strong predictor of suicidal behavior. A score of 1, 2, or 3 indicated that participants had suicidal ideation on a few days, more than half of the days, and almost every day, respectively; 0 means no such idea. In the study, participants with a score of \u0026ge;\u0026thinsp;1 were considered to have suicidal ideation, while a score of 0 indicated no suicidal ideation(Rossom et al., 2017).\u003c/p\u003e\n\u003ch3\u003eCovariate assessment\u003c/h3\u003e\n\u003cp\u003eThe covariates included demographic characteristics (age, sex, race/ethnicity, education level, marital status, and poverty-to-income ratio), lifestyle factors (smoking status, alcohol consumption, body mass index), female reproduction (whether she had given birth, mode of delivery, number of deliveries), and associated diseases (hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid gland) Disease, cancer). The age group was divided into 20 to 39 years old, 40 to 59 years old and 60 to 80 years old. Race/ethnicity is divided into five groups: Mexican Americans, non-Hispanic whites, non-Hispanic blacks, other Hispanics, and other races. Education is classified as below high school, high school or equivalent, and above high school. Marital status was classified as married/living with a partner, divorced/widowed/separated, and unmarried. The poverty income ratio (PIR) is divided into three categories: \u0026lt;1.3, \u0026ge;\u0026thinsp;1.3 but \u0026lt;\u0026thinsp;3.5, and \u0026ge;\u0026thinsp;3.5. The lower the PIR, the higher the level of poverty. Smoking status was divided into three groups: never smokers (those who have smoked less than 100 cigarettes in their lifetime), former smokers (those who have smoked more than 100 cigarettes in their lifetime but do not smoke now), and current smokers (those who have smoked more than 100 cigarettes in their lifetime and currently smoke). Alcohol consumption is defined as consuming more than 12 alcoholic beverages in a year. BMI was divided into three categories: underweight (BMI\u0026thinsp;\u0026lt;\u0026thinsp;25), normal weight (25\u0026thinsp;\u0026le;\u0026thinsp;BMI\u0026thinsp;\u0026lt;\u0026thinsp;30), and obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30). As reported by the reproductive health questionnaire, the number of births was classified as 0, 1, 2, 3 and \u0026ge;\u0026thinsp;4, and the mode of delivery was classified as women who had never been pregnant, women who gave birth only vaginally, women who gave birth only by cesarean section, and women who had both. Type of disease By self-reporting whether a doctor or other health professional has told you that you have a certain disease is classified as with or without: high blood pressure, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer(Wang et al., 2023).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed with appropriate sampling weights to account for NHANES's complex sampling design. Baseline characteristics of the study population were stratified by PFD status. The categorical variables were expressed as percentages and the difference between PFD groups was assessed using a weighted χ\u0026sup2; test. To explore the relationship between PFD and depression and suicidal ideation, we constructed three logistic regression models: Model 1 did not make any adjustment; Model 2 adjusted for demographic variables (age, marital status, race, education level, poverty-to-income ratio) and health behavior indicators (BMI, smoking, alcohol consumption); Based on Model 2, Model 3 further adjusted obstetric history (whether birth, mode of delivery, number of deliveries) and chronic disease history (hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.\u003c/p\u003e\u003cp\u003eIn addition, we analyzed the relationship between depression and suicidal ideation in different age groups with or without PFD. After adjusting for Model 3, a stratified logistic regression model was used to explore the potential interactions among subgroups defined by covariates (age, marital status, race, education level, poverty-to-income ratio, BMI, smoking, alcohol consumption, birth history, mode of delivery, number of deliveries, hypertension, diabetes) to assess association consistency across subgroups. At the same time, interaction tests were performed to assess the potential correction effects of these covariables. All statistical analyses were performed in R software (version 4.4.2), and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used as the significance test.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eBaseline characteristics\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 6691 subjects were enrolled in NHANES from 2005 to 2010, including 3703 (55.4%) in the normal group and 2988 (44.6%) in the PFD group. The group with PFD showed a significant age-stratified difference, with 39.9% in those 60 years of age and older (25.7% in the normal group) and a significantly higher racial distribution among non-Hispanic whites (55.6% vs. 45.1%). In terms of reproductive characteristics, the symptomatic group had a higher pregnancy rate (91.6% vs 81.7%), a tendency to have multiple births (24.4% vs 16.6% \u0026ge;4 births), and a higher proportion of vaginal births (70.5% vs 57.0%). Comorbidities analysis showed significant increases in the prevalence of obesity (BMI 30:45.7% vs. 35.0%), hypertension (43.1% vs. 28.3%), diabetes (16.1% vs. 9.5%), and arthritis (40.0% vs. 23.6%) in the symptom group. In mental health measures, the incidence of depression (14.9% vs. 7.5%) and suicidal ideation (6.0% vs. 2.5%) were significantly higher in the symptomatic group. Notably, there was no statistically significant difference in socioeconomic indicators such as education level (p\u0026thinsp;=\u0026thinsp;0.095), income level (p\u0026thinsp;=\u0026thinsp;0.339) and alcohol consumption (p\u0026thinsp;=\u0026thinsp;0.081).\u003c/p\u003e\u003cp\u003eIn the 2011\u0026ndash;2018 cohort(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), 4863 (56.0%) of the 8687 participants were in the normal group and 3824 (44.0%) were in the PFD group. The cohort reinforced the association between age and race, with 42.6% in the symptomatic group (25.4% in the normal group) and a larger difference in the proportion of non-Hispanic whites (47.0% vs. 32.6%). The new poverty income ratio varied between groups (p\u0026thinsp;=\u0026thinsp;0.024), with a higher proportion of middle-income (1.3\u0026ndash;3.5 poverty line) people in the symptom group (39.1% vs. 36.3%). Reproductive characteristics: pregnancy history (89.5% vs 78.5%), multiple births (\u0026ge;\u0026thinsp;4 births: 21.9% vs 17.0%) and vaginal delivery (65.7% vs 51.9%). Differences in metabolic diseases widened, with differences between the obesity (52.0% vs. 36.2%), hypertension (46.0% vs. 30.5%) and diabetes (20.7% vs. 11.9%) groups widening from the previous cycle. New risk factors of concern included significant smoking status (p\u0026thinsp;=\u0026thinsp;0.014) and an increased proportion of previous smokers in the symptomatic group (21.8% vs 15.8%); Liver disease (5.1% vs 3.6%, p\u0026thinsp;=\u0026thinsp;0.005) and asthma (20.7% vs 15.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were new associated factors. Cancer prevalence was significantly different (13.5% vs 7.5%). Mental health disparities persisted, with depression (15.0% vs 7.6%) and suicidal ideation (4.9% vs 2.9%) remaining significant, while differences in thyroid disease prevalence widened (21.1% vs 13.5%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the NHANES 2005\u0026ndash;2010 participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;6691)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormal (n\u0026thinsp;=\u0026thinsp;3703)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePelvic Floor dysfunction(n\u0026thinsp;=\u0026thinsp;2988)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (year) (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e20\u0026ndash;39\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2361 (35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1698 (45.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e663 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e40\u0026ndash;59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2187 (32.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1055 (28.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1132 (37.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;60\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2143 (32.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e950 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1193 (39.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRACE (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMexican American\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1183 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e665 (18.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e518 (17.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Hispanic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e558 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e335 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e223 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNon-Hispanic White\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3332 (49.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1670 (45.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1662 (55.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNon-Hispanic Black\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1351 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e863 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e488 (16.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther/multiracial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e267 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e170 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97 (3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;High school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1754 (26.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e931 (25.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e823 (27.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHigh school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1556 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e861 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e695 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026gt;High school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3381 (50.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1911 (51.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1470 (49.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarried /Living with partner\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3734 (55.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2006 (54.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1728 (57.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWidowed/divorced/separated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1896 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e937 (25.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e959 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever married\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1061 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e760 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e301 (10.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePoverty income ratio(PIR) (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.3394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2096 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1174 (31.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e922 (30.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;1.3,\u0026lt;3.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2561 (38.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1426 (38.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1135 (38.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;3.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2034 (30.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1103 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e931 (31.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody mass index (BMI) (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2063 (30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1348 (36.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e715 (23.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;25, \u0026le;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1964 (29.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1058 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e906 (30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026gt;30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2664 (39.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1297 (35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1367 (45.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking status (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4056 (60.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2345 (63.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1711 (57.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1292 (19.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e704 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e588 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFormer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1343 (20.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e654 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e689 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrink (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2645 (39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1454 (39.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1191 (39.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4046 (60.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2249 (60.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1797 (60.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDepressed (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5970 (89.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3426 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2544 (85.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e721 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e277 (7.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e444 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuicidal ideation (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6419 (95.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3610 (97.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2809 (94.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e272 (4.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e179 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhether birth (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e929 (13.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e677 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e252 (8.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5762 (86.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3026 (81.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2736 (91.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of births\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1233 (18.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e860 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e373 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1060 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e638 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e422 (14.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1724 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e933 (25.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e791 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1330 (19.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e658 (17.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e672 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1344 (20.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e614 (16.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e730 (24.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMode of delivery (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever pregnant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1233 (18.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e860 (23.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e373 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVaginal delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4218 (63.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2111 (57.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2107 (70.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCesarean delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e709 (10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e441 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e268 (8.97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVaginal and cesarean deliveries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e531 (7.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e291 (7.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e240 (8.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4354 (65.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2654 (71.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1700 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2337 (34.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1049 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1288 (43.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5857 (87.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3350 (90.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2507 (83.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e834 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e353 (9.53%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e481 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAsthma (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5671 (84.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3188 (86.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2483 (83.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1020 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e515 (13.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e505 (16.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArthritis (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4702 (69.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2828 (76.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1794 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2110 (31.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e875 (23.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1194 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoronary heart disease (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6542 (97.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3650 (98.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2892 (96.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53 (1.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96 (3.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiver disease (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6492 (97.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3615 (97.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2877 (96.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e199 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88 (2.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e111 (3.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThyroid gland (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5666 (84.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3249 (87.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2417 (80.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1025 (15.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e454 (12.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e571 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCancer (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6023 (90.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3432 (92.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2591 (86.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e668 (9.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e271 (7.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e397 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the NHANES 2011\u0026ndash;2018 participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;8687)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNormal (n\u0026thinsp;=\u0026thinsp;4863)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePelvic Floor Dysfunction(n\u0026thinsp;=\u0026thinsp;3824)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year) (n/%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e20\u0026ndash;39\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2860 (33.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2054 (42.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e806 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e40\u0026ndash;59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2961 (34.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1573 (32.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1388 (36.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;60\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2866 (33.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1236 (25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1630 (42.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRACE (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMexican American\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1124 (13.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e618 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e506 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Hispanic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e913 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e552 (11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e361 (9.44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNon-Hispanic White\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3384 (39.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1586 (32.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1798 (47.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNon-Hispanic Black\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1969 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1221 (25.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e748 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther/multiracial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1297 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e886 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e411 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.115\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;High school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1618 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e943 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e675 (17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHigh school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1834 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e966 (19.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e868 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026gt;High school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5235 (60.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2954 (60.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2281 (59.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarried /Living with partner\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4665 (53.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2611 (53.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2054 (53.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWidowed/divorced/separated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2404 (27.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1134 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1270 (33.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever married\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1618 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1118 (23.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e500 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePoverty income ratio (PIR )(n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;1.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2890 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1670 (34.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1220 (31.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;1.3,\u0026lt;3.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3261 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1764 (36.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1497 (39.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;3.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2536 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1429 (29.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1107 (28.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody mass index (BMI) (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2538 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1734 (35.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e804 (21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;25, \u0026le;\u0026thinsp;30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2401 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1369 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1032 (27.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026gt;30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3748 (43.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1760 (36.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1988 (52.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking status (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5685 (65.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3349 (68.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2336 (61.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1404 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e748 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e656 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFormer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1598 (18.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e766 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e832 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrink (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.359\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2812 (32.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1672 (34.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1140 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5875 (67.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3191 (65.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2684 (70.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDepressed (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7742 (89.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4492 (92.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3250 (85.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e945 (10.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e371 (7.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e574 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuicidal ideation (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8358 (96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4722 (97.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3636 (95.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e329 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e188 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhether birth (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1449 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1046 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e403 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7238 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3817 (78.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3421 (89.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of births\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1826 (21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1293 (26.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e533 (13.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1372 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e813 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e559 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2254 (25.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1160 (23.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1094 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1572 (18.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e772 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e800 (20.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1663 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e825 (17.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e838 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMode of delivery (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNever pregnant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1826 (21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1293 (26.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e533 (13.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVaginal delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5038 (58.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2526 (51.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2512 (65.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCesarean delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1064 (12.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e657 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e407 (10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVaginal and cesarean deliveries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e759 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e387 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e372 (9.73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5443 (62.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3379 (69.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2064 (54.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3244 (37.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1484 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1760 (46.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7319 (84.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4285 (88.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3034 (79.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1368 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e578 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e790 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAsthma (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7150 (82.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4095 (84.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3055 (79.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1558 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e768 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e790 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArthritis (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5890 (67.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3712 (76.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2178 (57.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2797 (32.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1151 (23.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1646 (43.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoronary heart disease (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8392 (96.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4712 (96.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3680 (96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e295 (3.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151 (3.11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e144 (3.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiver disease (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6707 (95.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3079 (96.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3628 (94.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e311 (4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e115 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e196 (5.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThyroid gland (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7226 (83.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4208 (86.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3018 (78.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1461 (16.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e655 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e806 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCancer (n/%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7803 (89.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4497 (92.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3306 (86.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e884 (10.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e366 (7.53%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e518 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRelationship between PFD and Depression and Suicidal Ideation\u003c/h3\u003e\n\u003cp\u003eData analysis from 2005 to 2010 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed that Model 1, without adjusting for any confounders, showed PFD and depression (OR\u0026thinsp;=\u0026thinsp;2.087, 95%CI: 1.713\u0026ndash;2.543; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and suicidal ideation (OR\u0026thinsp;=\u0026thinsp;2.678, 95%CI: 1.942\u0026ndash;3.694; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated. Individuals with one, two, or three symptomatic pelvic floor disorders had depression (OR 1.783, 3.564, 8.186, respectively; Both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and suicidal ideation (OR 2.314, 4.518, 5.922, respectively; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the risk was gradually increased. This association was statistically significant even after adjusting for demographic variables and health behavior measures in Model 2 and covariates in Model 3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eResults from 2011 to 2018 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that the relationship between PFD and depression and suicidal ideation in the three models was as significant as in the results from 2005 to 2010 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). It is worth noting that, compared with normal people, the association between the two symptomatic pelvic floor disorders and depression and suicidal ideation in Model 2 and model 3 lost significance (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which may be due to the insufficient data of the three symptomatic pelvic floor disorders and the reduced statistical power.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModerating correlation analysis of PFD with depression and suicidal ideation from 2005 to 2010\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModel 3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.087 (1.713, 2.543) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.343 (1.887, 2.908) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.076 (1.662, 2.592) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOne SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.783 (1.441, 2.206) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.047 (1.627, 2.576) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.845 (1.459, 2.335) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTwo SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.564 (2.623, 4.842) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.044 (2.876, 5.687) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.394 (2.401, 4.799) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThree SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.186 (4.057, 16.514) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.665 (3.887, 15.119) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.700 (2.825, 11.500) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuicide Ideation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.678 (1.942, 3.694) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.082 (2.148, 4.422) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.884 (1.980, 4.200) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOne SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.314 (1.641, 3.263) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.731 (1.875, 3.978) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.598 (1.764, 3.826) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTwo SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.518 (2.873, 7.104) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.202 (3.137, 8.628) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.618 (2.715, 7.854) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThree SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.922 (2.371, 14.790) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.352 (2.106, 13.600) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.321 (1.617, 11.547) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePFD:pelvic floor dysfunction SPFD:symptomatic pelvic floor disorders\u003c/h2\u003e\u003cp\u003e\u003cem\u003eModel I: no adjusted. Model II: adjusted for age,marital status, race, education, PIR, BMI, smoking, drinking\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eModel Ⅲ:adjusted for Model II, whether birth, mode of delivery, number of deliveries hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModerating correlation analysis of PFD with depression and suicidal ideation from 2011 to 2018\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModel 3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI) \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.057 (1.709, 2.475) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.187 (1.799, 2.659) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.880 (1.533, 2.305) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOne SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.053 (1.705, 2.471) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.183 (1.795, 2.654) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.999 (1.637, 2.441) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTwo SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.492 (0.752, 8.256) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.742 (0.755, 9.962) 0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2400 (0.629, 9.167) 0.200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSuicide Ideation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.600 (1.201, 2.131) 0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.664 (1.255, 2.205) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.574 (1.192, 2.077) 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.0 (reference) \u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOne SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.600 (1.200, 2.133) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.664 (1.254, 2.207) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.664 (1.254, 2.207) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTwo SPFD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.601 (0.442, 5.791) \u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.678 (0.483, 5.830) 0.415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.678 (0.483, 5.830) 0.415\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePFD:pelvic floor dysfunction SPFD:symptomatic pelvic floor disorders\u003c/h2\u003e\u003cp\u003e\u003cem\u003eModel I: no adjusted. Model II: adjusted for age,marital status, race, education, PIR, BMI, smoking, drinking\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eModel Ⅲ:adjusted for Model II, whether birth, mode of delivery, number of deliveries hypertension, diabetes, asthma, arthritis, coronary heart disease, liver disease, thyroid disease, cancer\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSubgroup analysis and interaction analysis\u003c/h2\u003e\u003cp\u003eStratified analyses by age groups were performed among subjects with either depression or suicidal ideation to further examine the associations between comorbid PFD and both outcomes. After adjusting for covariates, the 2005\u0026ndash;2010 data revealed comparable rates of suicidal ideation between women with and without PFD in the 20\u0026ndash;39 age group. Similarly, the 2011\u0026ndash;2018 cohort showed no significant differences in depression or suicidal ideation prevalence among women aged 30\u0026ndash;39 with versus without PFD. Both periods demonstrated elevated proportions of depression and suicidal ideation in women aged\u0026thinsp;\u0026ge;\u0026thinsp;40 with PFD, with the highest burden observed in the middle-aged subgroup (40\u0026ndash;59 years) (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFigures \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and 6 present stratified analyses of the associations between PFD and depression/suicidal ideation across different subgroups during 2005\u0026ndash;2010 and 2011\u0026ndash;2018, respectively. These analyses were conducted using Model 3, which adjusted for a comprehensive set of covariates including gender, age, race, poverty-to-income ratio, marital status, educational attainment, body mass index (BMI), baseline depression status, smoking habits, alcohol consumption, and recreational activities. The results demonstrated consistent positive associations between PFD and both depression and suicidal ideation across all examined subgroups. Interaction analysis revealed significant modifying effects: diabetes status showed an interactive effect on the PFD-suicidal ideation association during 2005\u0026ndash;2010 (interaction p\u0026thinsp;=\u0026thinsp;0.026), while smoking status exhibited a modifying effect on this association in the 2011\u0026ndash;2018 cohort (interaction p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis large-scale cross-sectional study, utilizing nationally representative NHANES data from 2005 to 2018, provides robust evidence for the significant association between PFD and adverse mental health outcomes in women. Our findings indicate that women with PFD exhibit a markedly higher risk of depression and suicidal ideation compared to those without PFD, with the risk escalating proportionally to the number of PFD symptoms. These associations persisted even after rigorous adjustment for demographic, socioeconomic, lifestyle, obstetric, and comorbidity-related confounders, underscoring the independent contribution of PFD to the psychological burden. Our results reinforce the need to consider PFD in the context of mental health.\u003c/p\u003e\u003cp\u003eIn recent years, several potential mechanistic pathways have been proposed to explain the link between PFD and mental health. Neuroanatomical mechanisms suggest that depression and PFD share overlapping neural substrates within the limbic system and autonomic pathways. Functional neuroimaging studies have demonstrated hyperactivation of the anterior cingulate cortex (ACC) and the insula\u0026mdash;regions integral to pain processing and emotional regulation\u0026mdash;in patients with depression and chronic pelvic pain syndrome (Os\u0026oacute;rio et al., 2016). These regions regulate visceral sensitivity through the brain-gut-bladder axis, potentially amplifying psychological distress and pelvic floor hypertonicity (Holstege, 2016). Moreover, hyperactivation of the amygdala, a hallmark of depression, may drive excessive sympathetic nervous system (SNS) activity, leading to bladder overactivity and pelvic muscle spasms through its output pathways to the Onuf nucleus(Vrijens et al., 2017). This neuroanatomical convergence highlights the role of central sensitization in mediating the bidirectional exacerbation of symptoms.\u003c/p\u003e\u003cp\u003eOur study found that women aged 40\u0026ndash;59 years exhibited the highest proportion of depression and suicidal ideation among those with PFD. Additionally, women with a history of childbirth, obesity, and metabolic disorders were more susceptible to PFD. Prior research suggests that estrogen exerts protective effects on mood in middle-aged women(Cohen et al., 2003; Rasgon et al., 2001). However, during perimenopause, declining estrogen levels may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis, a key system in stress response. Estrogen normally suppresses HPA axis activity, and its reduction may lead to elevated cortisol levels, triggering depressive symptoms(Cn, 2014). Concurrently, HPA axis hyperactivity has been linked to abnormal pelvic floor muscle tone(Stoffel and Craft, 2004). Estrogen also modulates γ-aminobutyric acid (GABA) and glutamate receptors, which are involved in anxiety and depression regulation, as well as pelvic floor muscle control(Mann, 2013; Perrot-Sinal et al., 2001).\u003c/p\u003e\u003cp\u003eMetabolic syndrome and chronic inflammation serve as common pathophysiological drivers of both depression and PFD. Adipokine dysregulation associated with obesity\u0026mdash;such as elevated leptin and resistin\u0026mdash;promotes systemic inflammation while mechanically increasing intra-abdominal pressure, a key factor in pelvic organ prolapse(Kowalik et al., 2017). Furthermore, diabetic neuropathy exacerbates this interplay by impairing pudendal nerve-mediated pelvic muscle control and reducing bladder compliance. Urodynamic studies indicate that patients with depression and diabetes exhibit a 42% higher prevalence of detrusor overactivity compared to controls(Leue et al., 2017).Beyond physiological mechanisms, the bidirectional exacerbation of PFD and mental health issues also manifests in psychosocial domains. Maladaptive cognitive-behavioral patterns significantly modulate the relationship between depression and PFD. Fear-avoidance behaviors reduce physical activity, exacerbating obesity-related pelvic floor stress while perpetuating social isolation. Social withdrawal leads to the collapse of support systems, diminished self-worth, and increased suicidal ideation(Till et al., 2019).\u003c/p\u003e\u003cp\u003eThese findings underscore the substantial psychological burden of PFD in women and advocate for an integrative care model. Routine depression and suicidal risk screening should be mandatory for women with PFD, particularly those reporting multiple symptoms. Conversely, clinicians treating female depression should actively assess pelvic floor health. Public health initiatives must combat the stigma surrounding pelvic health by normalizing discussions, promoting educational campaigns, and encouraging early intervention.\u003c/p\u003e\u003cp\u003eLimitations and Prospects: The inherent limitations of the cross-sectional design of this study preclude causal inference. Self-reported measures of PFD symptoms and mental health may introduce recall bias, although PHQ-9 is a proven tool. Residual confounding of unmeasured factors (e.g. social support, history of trauma) is still possible. In addition, the lack of data on fecal incontinence in the 2011\u0026ndash;2018 cohort may have underestimated the prevalence of PFD. Future prospective studies should describe the relationship between the two and explore the mediating mechanisms to find ways to solve the disease. Qualitative research is needed to understand how cultural narratives surrounding pelvic health modulate psychological responses. Intervention trials that test integrated mental and physical health approaches (e.g., pelvic floor rehabilitation combined with cognitive behavioral therapy) can inform evidence-based care pathways.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified pelvic floor dysfunction as an independent risk factor for depression and suicidal ideation in women, with the risk amplified by symptom diversity. The findings call for increased clinical vigilance and multidisciplinary nursing strategies to address this issue, but more prospective studies are needed to refine it.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the contribution of all participants of the present research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSC and HY: Data analysis, visualization, writing\u0026ndash;original draft, writing\u0026ndash;review and editing. YQ: Data curation, writing\u0026ndash;review and editing. ZY: writing\u0026ndash;review and editing. CY: Formal analysis, writing\u0026ndash;review and editing. XP: Conceptualization, methodology, supervision, writing\u0026ndash;review and editing. JC: Conceptualization, supervision, writing\u0026ndash;review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData for this study were sourced from National Health and Nutrition Examination Survey (NHANES) and available here: https://www.cdc.gov/nchs/nhanes/index.htm\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Jiangsu Province Natural Science Foundation project (No. BK20211085); Suzhou Applied Basic Research (Medical and Health) Science and Technology Innovation Project (NO. SYW2024135); Suzhou People\u0026apos;s Livelihood Science and Technology Project (No. SS2019073). Suzhou Municipal Health Commission (No. LCZX202114); Suzhou Gusu Health Talent Plan (No. GSWS2021046). Suzhou \u0026quot;Science Education and Health\u0026quot; Top-level Project（NO. MSXM2024028）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study analyzed data downloaded from the National Health and Nutrition Examination Survey public database. The National Center for Health Statistics Ethics Review Committee granted ethics approval. The methods involved in this study were conducted in accordance with relevant guidelines and regulations (Declaration of Helsinki). All individuals provided written informed consent before participating in the study. Details are available at https://www. cdc.gov/nchs/nhanes/irba98.htm. The current study was deemed exempt from further review because the data used are deidentified and publicly accessible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationship that could be constructed as a potential conflict of interest.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAl-Badr, A., Saleem, Z., Kaddour, O., Almosaieed, B., Dawood, A., Al-Tannir, M., AlTurki, F., Alharbi, R., Alsanea, N., 2022. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Womens Health 22, 27. https://doi.org/10.1186/s12905-022-01609-0\u003c/li\u003e\n\u003cli\u003eBraga, A., Serati, M., 2023. New advances in female pelvic floor dysfunction management. Medicina (Mex.) 59, 1010. https://doi.org/10.3390/medicina59061010\u003c/li\u003e\n\u003cli\u003eCn, S., 2014. Mood disorders in midlife women: understanding the critical window and its clinical implications. Menopause N. Y. N 21. https://doi.org/10.1097/GME.0000000000000193\u003c/li\u003e\n\u003cli\u003eCohen, L.S., Soares, C.N., Poitras, J.R., Prouty, J., Alexander, A.B., Shifren, J.L., 2003. Short-term use of estradiol for depression in perimenopausal and postmenopausal women: a preliminary report. Am. J. Psychiatry 160, 1519\u0026ndash;1522. https://doi.org/10.1176/appi.ajp.160.8.1519\u003c/li\u003e\n\u003cli\u003eDheresa, M., Worku, A., Oljira, L., Mengiste, B., Assefa, N., Berhane, Y., 2018. One in five women suffer from pelvic floor disorders in kersa district eastern Ethiopia: a community-based study. BMC Womens Health 18, 95. https://doi.org/10.1186/s12905-018-0585-1\u003c/li\u003e\n\u003cli\u003eGoodman, F.R., Birg, J.A., Daniel, K.E., Kashdan, T.B., 2023. Stress generation in social anxiety and depression: a two-study community assessment. J. Affect. Disord. 329, 285\u0026ndash;292. https://doi.org/10.1016/j.jad.2023.02.053\u003c/li\u003e\n\u003cli\u003eHolstege, G., 2016. How the emotional motor system controls the pelvic organs. Sex. Med. Rev. 4, 303\u0026ndash;328. https://doi.org/10.1016/j.sxmr.2016.04.002\u003c/li\u003e\n\u003cli\u003eJhangir, S., Jameel, R., 2023. Sociotropy-autonomy, self-criticism and self-esteem In individuals with or without depression. JPMA J. Pak. Med. Assoc. 73, 2196\u0026ndash;2199. https://doi.org/10.47391/JPMA.8189\u003c/li\u003e\n\u003cli\u003eKowalik, C.G., Cohn, J.A., Kaufman, M.R., Stuart Reynolds, W., Dmochowski, R.R., Milam, D.F., 2017. Impact of autonomic dysfunction on lower urinary tract symptoms. Curr. Bladder Dysfunct. Rep. 12, 273\u0026ndash;279. https://doi.org/10.1007/s11884-017-0426-3\u003c/li\u003e\n\u003cli\u003eLeue, C., Kruimel, J., Vrijens, D., Masclee, A., van Os, J., van Koeveringe, G., 2017. 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Open 6, e2337011. https://doi.org/10.1001/jamanetworkopen.2023.37011\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic floor dysfunction, urinary incontinence, fecal incontinence, pelvic organ prolapse, depression, suicidal ideation, NHANES","lastPublishedDoi":"10.21203/rs.3.rs-7448829/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7448829/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWomen 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe analyzed data from 15,379 female participants aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years from the NHANES 2005\u0026ndash;2018 dataset. Weighted logistic regression and subgroup analyses were performed to examine the association between PFD and depression/suicidal ideation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn the 2005\u0026ndash;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Fully adjusted models showed that PFD was independently associated with depression (OR\u0026thinsp;=\u0026thinsp;2.076, 95% CI: 1.662\u0026ndash;2.592) and suicidal ideation (OR\u0026thinsp;=\u0026thinsp;2.884, 95% CI: 1.980\u0026ndash;4.200). A dose-response relationship was observed, with participants reporting three pelvic floor symptoms having the highest risk (OR for depression\u0026thinsp;=\u0026thinsp;5.700; OR for suicidal ideation\u0026thinsp;=\u0026thinsp;4.321).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePFD (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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 18:49:32","doi":"10.21203/rs.3.rs-7448829/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"751d2da6-2dff-4151-86ce-456118d8ef69","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T05:23:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 18:49:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7448829","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7448829","identity":"rs-7448829","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}