The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction - Beyond the Abstract

While erectile dysfunction (ED) has been studied extensively in older men, there is growing interest in understanding the underlying causes and risk factors of ED in younger men. Studies of men under 40 years old have estimated a prevalence of ED as high as 30%.1–5  While the etiology is multifactorial, involving biological, psychiatric, and sociocultural factors, ED among young men has been largely classified as psychogenic.6–13  Several studies have examined the effects of ED on depression and anxiety and conversely the risk of ED from these psychiatric conditions.7,10,14,15  However, the temporal relationship between mental health and erectile dysfunction in young men is not well understood. How long after a diagnosis of ED is a young man at increased risk of mental illness? Could an ED diagnosis precipitate or perhaps uncover underlying depression or anxiety? Importantly, should mental health screening be normalized in this population?

We performed a case control study on men under 40 using a large U.S. claims database to investigate temporal associations between ED and depression and anxiety. We found the prevalence of mental illness to be 17.1% in young men with ED compared to 12.9% in men without ED in the 12-month period before an ED diagnosis. This supports a large base of literature establishing depression and anxiety as risk factors for ED. Interestingly, in each of the three years following their diagnosis of ED, young men were increasingly more likely to receive a new mental health diagnosis than their matched controls. The incidence of new mental illness was 11.7%, 14.5%, and 15.9% for men with ED in the 36 months following their diagnosis compared to 6.3%, 9.0%, and 10.6% respectively in controls. These findings not only highlight the significant effects ED can have on mental health but also the potential of streamlined mental health screenings to benefit young men with newly diagnosed ED. Further study is needed to elucidate this potential bidirectional association, as well as better, characterize these findings in the context of one’s socioeconomic status.

Written by: Henry Biermann & Tad Manalo, Department of Urology, Emory University School of Medicine, Atlanta, GA

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