Association Of Low Bone Mineral Density With Erectile Dysfunction And Predictors Of Depression, Anxiety And Stress Symptomatology Among Depressive Men In Malaysia
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Date
2017-08
Authors
Fata Nahas, Abdul Rahman Mahmoud
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Publisher
Universiti Sains Malaysia
Abstract
Depression exemplifies a devastating disease with a heterogeneity in the course and treatment outcomes. The documented depression-associated diseases and disturbances can be appreciated by the various changes in the biological, mental and physical aspects that depression imposes on depressive patients. Among these diseases, osteoporosis and erectile dysfunction (ED) are of interest, whose association attracted few researchers, and as a result, an increased risk of osteoporosis in patients with ED had been revealed. Yet, there are no published data in exploring the association between these two disorders among depressive men. On the other hand, depression is a difficult to treat disease, with more than half of the patients retaining some of the depressive symptoms, which might be associated with the symptoms of anxiety and stress, nevertheless, anxiety and stress are commonly overlooked in depressive patients. The main trigger of the current study was to determine possible association between low bone mineral density (BMD) and ED among a group of depressive men. Other objectives were to evaluate the presence and severity of depression, anxiety and stress symptomatology and their predictors. In this cross-sectional study, 119 depressive men from three psychiatric departments were recruited, and all patients received a calcaneal BMD scanning. ED was determined using the 5-item International Index of Erectile Function (IIEF-5), whereas the 21-item Depression,
Anxiety, Stress Scale was utilized to measure the three traits symptoms. Of the study participants, 90 patients had ED, while only 29 patients had normal erectile function. Low BMD was highly prevalent among the study subjects (79.8%). Markedly, 54.6% of the patients had considerable impairment of erectile function. Within the ED group, there was significantly higher proportion of patients with low BMD compared to the non-ED group (85.6% vs 62.1%, p = .006). After adjustment for age, body mass index, diabetes, hypertension, hyperlipidemia, smoking, alcohol consumption and physical activity; patients with ED were 4.17 times more likely to have low BMD. Additionally, ED patients had lower T-scores than non-ED patients, which was significant among younger (< 50 years old) patients (Md = ̶ 2.2 vs. ̶ 1.3, p = .001), but not the elderly. Noticeably, anxiety symptoms were the most observed (69.7%), followed by depression (58.8%) and stress (43.7%). The results also revealed that lower IIEF-5 score (representing increased ED severity) significantly predicted more severe symptoms of depression, anxiety and stress, while age significantly predicted only less severe anxiety symptoms. In conclusion, clinicians should be aware of the possible comorbidities of osteoporosis and ED in depressive men. Besides, the observed association of low BMD with ED may suggest for the necessity of evaluating either one in the presence of the other in depressive men. Additionally, clinicians should consider depressive men for the evaluation of their depression, anxiety and stress symptoms, they should also pay heed that ED among these patients may increase the severity of these symptoms, especially anxiety among younger patients. Future research should investigate current findings in more rigorous study design and larger samples.
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Keywords
Depression exemplifies a devastating disease , with a heterogeneity in the course and treatment outcomes