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Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms

Abstract

Erectile dysfunction (ED) is commonly associated with depressed mood and diminished quality of life (QoL), but few studies have investigated the causal associations involved. Therefore, we evaluated the correlation between several measures of mood, QoL, and sexual function in a retrospective analysis of a sample of depressed men (n=152), with ED enrolled in a clinical trial of sildenafil citrate (VIAGRA®). Strong correlations were observed at baseline among measures of erectile function (EF), mood, and overall QoL. Significant treatment effects were observed on all three domains, with significant interactions between changes in mood and QoL. Based on multiple regression and path analysis, a model was developed in which EF changes were associated with improved mood and quality of sexual life, which resulted in improved partner satisfaction, family life, and overall life satisfaction. These data suggest that QoL changes associated with ED therapy may be mediated by changes in sexual function, mood, and family relationships.

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References

  1. Litwin MS, Nied RJ, Dhanani N . Health-related quality of life in men with erectile dysfunction. J Gen Intern Med 1998; 13: 159–166.

    Article  CAS  Google Scholar 

  2. Shabsigh R et al. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998; 52: 848–852.

    Article  CAS  Google Scholar 

  3. Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  CAS  Google Scholar 

  4. Althof SE . Quality of life and erectile dysfunction. Urology 2002; 59: 803–810.

    Article  Google Scholar 

  5. Jønler M et al. The effect of age, ethnicity and geographical location on impotence and quality of life. Br J Urol 1995; 75: 651–655.

    Article  Google Scholar 

  6. Litwin MS . Health related quality of life in older men without prostate cancer. J Urol 1999; 161: 1180–1184.

    Article  CAS  Google Scholar 

  7. Guest JF, Das Gupta R . Health-related quality of life in a UK-based population of men with erectile dysfunction. Pharmacoeconomics 2002; 20: 109–117.

    Article  Google Scholar 

  8. De Berardis G et al. Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked. Diabetes Care 2002; 25: 284–291.

    Article  Google Scholar 

  9. Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  Google Scholar 

  10. Araujo AB et al. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–465.

    Article  CAS  Google Scholar 

  11. Moreira ED et al. Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior. Urology 2001; 58: 583–588.

    Article  Google Scholar 

  12. Seidman SN et al. Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.

    Article  CAS  Google Scholar 

  13. Rosen RC, Lane RM, Menza M . Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999; 19: 67–85.

    Article  CAS  Google Scholar 

  14. Seidman SN, Roose SP . The relationship between depression and erectile dysfunction. Curr Psychiatry Rep 2000; 2: 201–205.

    Article  CAS  Google Scholar 

  15. Nurnberg HG et al. Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Am J Psychiatry 2001; 158: 1926–1928.

    Article  CAS  Google Scholar 

  16. Roose SP, Glassman AH, Walsh BT, Cullen K . Reversible loss of nocturnal penile tumescence during depression: a preliminary report. Neuropsychobiology 1982; 8: 284–288.

    Article  CAS  Google Scholar 

  17. Nofzinger EA et al. Sexual function in depressed men. Assessment by self-report, behavioral, and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy. Arch Gen Psychiatry 1993; 50: 24–30.

    Article  CAS  Google Scholar 

  18. Seidman SN . Exploring the relationship between depression and erectile dysfunction in aging men. J Clin Psychiatry 2002; 63(Suppl 5): 5–12, discussion 23–25.

    PubMed  Google Scholar 

  19. Willke RJ et al. Quality of life effects of alprostadil therapy for erectile dysfunction. J Urol 1997; 157: 2124–2128.

    Article  CAS  Google Scholar 

  20. Williams G et al. The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners. MUSE Study Group. Br J Urol 1998; 82: 847–854.

    Article  Google Scholar 

  21. Muller MJ, Benkert O . Lower self-reported depression in patients with erectile dysfunction after treatment with sildenafil. J Affect Disord 2001; 66: 255–261.

    Article  CAS  Google Scholar 

  22. Paige NM et al. Improvement in emotional well-being and relationships of users of sildenafil. J Urol 2001; 166: 1774–1778.

    Article  CAS  Google Scholar 

  23. Seidman SN, Roose RP . Sexual dysfunction and depression. Curr Psychiatry Rep 2001; 3: 202–208.

    Article  CAS  Google Scholar 

  24. First MB, Spitzer RL, Gibbon M, Williams JBW . Structured Clinical Interview for DSM IV Axis I Disorders—Patient Edition, (SCID-I/P, Version 2:0). Biometrics Research Department, New York State Psychiatric Institute: New York, 1995.

    Google Scholar 

  25. Hamilton MA . A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.

    Article  CAS  Google Scholar 

  26. Beck AT, Epstein N, Brown G, Steer RA . Psychometric properties of the Beck Depression Inventory: twenty-five years later. Clin Psychol Rev 1988; 8: 77–100.

    Article  Google Scholar 

  27. Rosen RC et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.

    Article  CAS  Google Scholar 

  28. Cappelleri JC et al. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999; 54: 346–351.

    Article  CAS  Google Scholar 

  29. Fugl-Meyer AR, Lodnert G, Branholm IB, Fugl-Meyer KS . On life satisfaction in male erectile dysfunction. Int J Impot Res 1997; 9: 141–148.

    Article  CAS  Google Scholar 

  30. Retherford R, Choe MK . Path analysis. In: Statistical Methods for Causal Analysis. John Wiley & Sons: New York, 1993, pp 93–99.

    Chapter  Google Scholar 

  31. Sobel M . Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhard S (ed). Sociological Methodology. Jossey-Bass: San Francisco, 1982, pp 290–312.

    Google Scholar 

  32. Sobel M . Some results on indirect effects and their standard errors in covariance structure models. In: Tuma NB (ed). Sociological Methodology. American Sociological Society: Washington, DC, 1986, pp 158–186.

    Google Scholar 

  33. Hultling C et al. Quality of life in patients with spinal cord injury receiving Viagra (sildenafil citrate) for the treatment of erectile dysfunction. Spinal Cord 2000; 38: 363–370.

    Article  CAS  Google Scholar 

  34. Miller J, Fowler C, Sharief M . Effect of sildenafil citrate (Viagra) on quality of life in men with erectile dysfunction and multiple sclerosis. Ann Neurol 1999; 46: 496.

    Article  Google Scholar 

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Rosen, R., Seidman, S., Menza, M. et al. Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 16, 334–340 (2004). https://doi.org/10.1038/sj.ijir.3901197

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