Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Sex Med. 2018 Aug;15(8):1073-1082. doi: 10.1016/j.jsxm.2018.05.016. Epub 2018 Jun 28.
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.
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.
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.
The odds ratio (OR) was regarded as the effect size, and the heterogeneity across studies was assessed using the I statistic.
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 (I = 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, I = 23.5%) or publication bias (P = .260) was observed.
Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED.
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.
This study demonstrates an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED. Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018;15:1073-1082.
一些研究报告称，抑郁暴露会增加勃起功能障碍（ED）的风险，而其他研究则没有观察到相关性。此外，其他研究报告称，ED 暴露会增加抑郁的风险。
确定并定量综合所有评估 ED 和抑郁之间关联的研究，并探讨可能解释观察到的关联差异的因素。
我们进行了系统评价和荟萃分析。我们通过 2017 年 10 月在 Medline、Ovid Embase 和 Cochrane 图书馆中搜索了评估 ED 和抑郁之间关联的研究。研究符合患者人群或问题、干预、比较、结局和设置（PICOS）纳入标准。
比值比（OR）被视为效应大小，使用 I 统计量评估研究之间的异质性。
我们确定了 49 篇符合条件的出版物。评估抑郁暴露与 ED 风险的研究的合并 OR 为 1.39（95%CI：1.35-1.42；n=46 篇文献，48 项研究）。尽管我们观察到很大的异质性（I=93.6%），但亚组分析表明，这可能是由于研究设计、合并症、ED 评估、抑郁评估、原始效应大小来源等方面的差异所致。未观察到显著的发表偏倚（P=0.315），并且通过排除任何单个研究，总体效应大小没有改变。评估 ED 暴露与抑郁风险的研究的合并 OR 为 2.92（95%CI：2.37-3.60；n=5 篇文献，6 项研究）。未观察到显著的异质性（P<0.257，I=23.5%）或发表偏倚（P=0.260）。
报告 ED 的患者应常规筛查抑郁，而出现抑郁症状的患者应常规评估 ED。
本研究有几个优势。首先，对 ED 和抑郁之间关联的评估是及时的，对临床医生、政策制定者和患者都具有相关性。其次，我们有意对该关联进行了 2 项荟萃分析，从而能够纳入所有潜在相关的研究。但是，我们的研究也存在一些局限性。首先，OR 是一种关联度量，只能表明是否存在关联。因此，本研究无法确定 ED 和抑郁之间的因果关系方向。其次，研究之间的高度异质性使得难以推广结论。
本研究表明抑郁与 ED 之间存在关联。政策制定者、临床医生和患者都应关注抑郁和 ED 之间的关联。Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018;15:1073-1082.
