School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA.
Program in Public Health, University of California, Merced, Merced, CA, 95343, USA.
Eur J Epidemiol. 2021 May;36(5):531-537. doi: 10.1007/s10654-021-00738-4. Epub 2021 Apr 1.
Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50-59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50-59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations.
许多理论断言，性亲密关系有助于维持心理健康。但此类理论的实验测试仍然很少见，并且没有提供令人信服的证据，因为伦理、实践和文化方面的限制会影响样本和结果的偏差。因此，鉴于该学科为准实验研究带来的严谨性，采用流行病学方法似乎是合适的。然而，出于一些仍不清楚的原因，尽管涉及的过程具有合理性，例如幸福感、归属感和自我价值感，以及预防抑郁，流行病学家在很大程度上忽略了此类理论，而这些过程会产生影响。我们使用意向治疗设计，通过中断时间序列方法来检验假设，即在 2013 年 7 月西地那非（即伟哥）的专利到期、价格下降且其使用大幅增加后，50-59 岁瑞典男性的每月自杀率（这是人群心理健康的一个重要的远端指标）会降低。该测试使用了 102 个降价前和 18 个降价后的月份。在西地那非价格降低后的测试月份中，50-59 岁男性的自杀人数比预期减少了 65 人。我们的发现不可能是由于共同趋势或季节性、有偏差的样本或反向因果关系引起的。我们的结果在 10000 次实验中出现的几率不到一次。我们的发现与表明性亲密关系可以增强心理健康的理论相一致。使用自杀作为我们的心理健康远端指标进一步表明，旨在解决自我毁灭行为驱动因素的公共卫生计划应该减少中年人群中亲密关系的障碍。
