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Cited by 215Sexual function and dysfunction studiesSexuality, Behavior, and TechnologyUrological Disorders and Treatments

Erectile dysfunction and depression: A systematic review and meta-analysis

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Liu, Qian, Zhang, Youpeng, Wang, Jin, Li, Sen, Cheng, Yongbiao, Guo, Jialun, Tang, Yong, Zeng, Hanqing +1 more·2018·The Journal of Sexual Medicine
DOI 10.1016/j.jsxm.2018.05.016
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Abstract

Abstract Background Some studies have reported that exposure to depression increases the risk of erectile dysfunction (ED), whereas others have observed no association. Moreover, additional studies have reported that exposure to ED increases the risk of depression. Aim To identify and quantitatively synthesize all studies evaluating the association between ED and depression and to explore factors that may explain differences in the observed association. Methods We conducted a systematic review and meta-analysis. We searched Medline, Ovid Embase, and the Cochrane Library through October 2017 for studies that had evaluated the association between ED and depression. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting (PICOS) inclusion criteria. Outcomes The odds ratio (OR) was regarded as the effect size, and the heterogeneity across studies was assessed using the I2 statistic. Results We identified 49 eligible publications. The pooled OR for studies evaluating depression exposure and risk of ED was 1.39 (95% CI: 1.35–1.42; n = 46 publications with 48 studies). Although we observed large heterogeneity (I2 = 93.6%), subgroup analysis indicated that it may have been as a result of variations in study design, comorbidities, ED assessment, depression assessment, the source of the original effect size, etc. No significant publication bias was observed (P = .315), and the overall effect size did not change by excluding any single study. The pooled OR for studies evaluating ED exposure and risk of depression was 2.92 (95% CI: 2.37–3.60; n = 5 publications with 6 studies). No significant heterogeneity (P < .257, I2 = 23.5%) or publication bias (P = .260) was observed. Clinical Implications Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED. Strengths and Limitations There are several strengths to this study. First, evaluations of the association between ED and depression are timely and relevant for clinicians, policymakers, and patients. Second, we intentionally conducted 2 meta-analyses on the association, allowing us to include all potentially relevant studies. However, our study also possesses some limitations. First, the OR is a measure of association that only reveals whether an association is present. Thus, this study was unable to determine the direction of causality between ED and depression. Second, the high heterogeneity among studies makes it difficult to generalize the conclusions. Conclusion This study demonstrates an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED.

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Authors
Liu, Q., Zhang, Y., Wang, J., Li, S., Cheng, Y., Guo, J., Tang, Y., Zeng, H., & Zhu, Z.
Affiliations
Wuhan Union Hospital (CN)
Corresponding author
Zhu, Zhaohui
ORCID
Venue
The Journal of Sexual Medicine
Publisher
Oxford University Press (OUP)
Published
2018-06-27
Volume
15
Issue
8
Pages
1073-1082
ISSN
  • 1743-6095 (ISSN-L)
  • 1743-6109
DOI
10.1016/j.jsxm.2018.05.016
OpenAlex
W2810937690
Cited by
215
References
77
Citations by year
2026: 25 · 2025: 40 · 2024: 36 · 2023: 31 · 2022: 26 · 2021: 26 · 2020: 13 · 2019: 15 · 2018: 2
FWCI
2.13
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Sexual Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
  • Health Sciences › Medicine › Urology › Urological Disorders and Treatments
Keywords
erectile dysfunction, depression, bidirectional relationship, comorbidities, depression screening, causal direction, study heterogeneity, depression assessment, sex differences, age differences, mental health, cardiovascular risk factors, lifestyle factors, psychological factors, biological factors, psychosocial factors, neuroendocrine factors, neuroinflammation
MeSH terms
Depression, Humans, Erectile Dysfunction, Male, Odds Ratio

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