Many studies have demonstrated an association between erectile dysfunction (ED) and mental health conditions such as anxiety and depression, particularly in older men. Nevertheless, the causal relationship between these conditions remains difficult to define. For instance, depression and anxiety have been identified as risk factors for ED, but past research also suggests that having ED may predispose a person to developing depression or anxiety. What’s more, growing evidence has indicated a greater prevalence of ED in young men than what has historically been acknowledged. Therefore, it is increasingly important to clarify the association between ED and mental health conditions in young men.

To this end, the authors of a recent study in the Journal of Sexual Medicine examined the anonymous health data of 314,761 U.S. patients between the ages of 18-40 years who were diagnosed with ED between 2009 and 2018. Through the health information database, the researchers identified which of these patients also had a diagnosed mental health condition using the International Classification of Diseases (ICD) codes for anxiety, depression, and/or two or more prescribed psychiatric medications. They then matched the individuals in this cohort to men without an ED diagnosis based on age, geographic region, history of hypertension, year of presentation, and the Charlson Comorbidity Index (CCI). In total, they matched 181,402 ED patients with 181,402 control patients.

Considering the possible bidirectional association between ED and mental health issues, the authors looked at the depression and anxiety diagnoses of the patients at four distinct timepoints: 12 months before ED diagnosis, and 12, 24, and 36 months after ED diagnosis. Consistently, the patients with ED diagnoses had higher rates of anxiety and depression diagnosis than their matched counterparts.

Specifically, the men with ED showed higher rates of pre-existing depression and anxiety than the men without ED, and 17.1% had a depression or anxiety diagnosis 12 months prior to ED diagnosis, compared to 12.9% of the control population. New anxiety and depression diagnosis rates remained higher for the men with ED at 12 months after ED diagnosis (11.7% vs. 6.3%), 24 months after ED diagnosis (14.5% vs. 9.0%), and 36 months after ED diagnosis (15.9% vs. 10.6%).

These findings are in line with previous research that has demonstrated a connection between sexual dysfunction, including ED, and mental health conditions. However, it further emphasizes the importance of screening for anxiety and depression in men with ED, especially younger men who may feel reluctant to speak about their mental health concerns with their health care providers. Additionally, the authors of this study strongly advocate for normalizing ED in men under 40 years old because growing awareness indicates that this condition affects younger men in addition to older men. Assuring patients that ED can affect men of all ages may help address stigma around the topic and empower these individuals to seek treatment that could greatly improve their quality of life.

Resources:

• Manalo, T.A., Biermann, H.D., Patil, D.H., & Mehta, A. (2022). The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction. The Journal of Sexual Medicine, 19(2), 201-206. DOI: https://doi.org/10.1016/j.jsxm.2021.11.011