Objectives: We aim to evaluate the psychological impact and risk factors associated with new onset FI over 12. years in adults over 18. years for the first time in a population-based study. Methods: Participants (n = 1775) were a random population sample from Penrith, Australia who responded to a survey in 1997 and completed a 12-year follow-up survey (response rate = 60%). FI was defined as having leakage of stool over the past 12. months. The original and follow-up surveys contained valid questions on demographic, gastrointestinal and psychological symptoms. Results: 114 (11.4%) reported new onset FI at the 12. year follow-up. People who reported FI at the 12. year follow-up were significantly more anxious and depressed. In terms of baseline risk factors only bloating (OR = 1.3; 95%CI 1.0-1.6, P = 0.026) was an independent predictor of developing new onset FI. However, current bowel symptoms measured at follow-up including less likelihood of <. 3 bowel motions a week, increased urgency and mucus were independently associated with having FI at follow-up. Conclusion: FI is associated with anxiety and depression. Baseline GI symptoms do not appear to be as important as current bowel symptoms in determining who develops FI.