Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, China.
Department of Anatomy, Histology and Embryology, Air Force Medical University, Xi'an, China.
Front Public Health. 2022 Jun 17;10:836898. doi: 10.3389/fpubh.2022.836898. eCollection 2022.
Although erectile dysfunction (ED) often occurs simultaneously with depression, not all patients with ED suffer major depression (MD), with a PHQ-9 score ≥15 indicating MD. Because the PHQ-9 questionnaire includes phrases such as "I think I am a loser" and "I want to commit suicide," the psychological burdens of ED patients are likely to increase inevitably after using the PHQ-9, which, in turn, may affect ED therapeutic effects. Accordingly, we endeavored to develop a nomogram to predict individual risk of PHQ-9 score ≥15 in these patients.
The data of 1,142 patients with ED diagnosed in Xijing Hospital and Northwest Women and Children's Hospital from January 2017 to May 2020 were analyzed. While the Least Absolute Shrinkage and Selection Operator regression was employed to screen PHQ-9 score ≥15 related risk factors, multivariate logistic regression analysis was performed to verify these factors and construct the nomogram. The training cohort and an independent cohort that comprised 877 prospectively enrolled patients were used to demonstrate the efficacy of the nomogram.
The IIEF-5 score, PEDT score, physical pain score, frequent urination, and feeling of endless urination were found to be independent factors of PHQ-9 score ≥15 in patients with ED. The nomogram developed by these five factors showed good calibration and discrimination in internal and external validation, with a predictive accuracy of 0.757 and 0.722, respectively. The sensitivity and specificity of the nomogram in the training cohort were 0.86 and 0.52, respectively. Besides, the sensitivity and specificity of the nomogram in the validation cohort were 0.73 and 0.62, respectively. Moreover, based on the nomogram, the sample was divided into low-risk and high-risk groups.
This study established a nomogram to predict individual risk of PHQ-9 score ≥15 in patients with ED. It is deemed that the nomogram may be employed initially to avoid those with a low risk of MD completing questionnaires unnecessarily.
尽管勃起功能障碍（ED）常与抑郁同时发生，但并非所有 ED 患者都患有重度抑郁症（MD），PHQ-9 评分≥15 表示 MD。由于 PHQ-9 问卷包含“我觉得自己是个失败者”和“我想自杀”等表述，ED 患者使用 PHQ-9 后心理负担可能会不可避免地增加，进而影响 ED 的治疗效果。因此，我们努力开发了一个列线图来预测这些患者 PHQ-9 评分≥15 的个体风险。
分析了 2017 年 1 月至 2020 年 5 月在西京医院和西北妇女儿童医院诊断为 ED 的 1142 例患者的数据。应用最小绝对收缩和选择算子回归筛选 PHQ-9 评分≥15 的相关危险因素，多因素 logistic 回归分析验证这些因素并构建列线图。采用训练队列和前瞻性纳入的 877 例患者的独立队列验证列线图的疗效。
IIEF-5 评分、PEDT 评分、躯体疼痛评分、尿频和尿不尽感是 ED 患者 PHQ-9 评分≥15 的独立危险因素。由这五个因素建立的列线图在内部和外部验证中具有良好的校准度和区分度，预测准确率分别为 0.757 和 0.722。在训练队列中，列线图的灵敏度和特异度分别为 0.86 和 0.52。此外，验证队列中列线图的灵敏度和特异度分别为 0.73 和 0.62。此外，基于列线图，将样本分为低危和高危组。
本研究建立了预测 ED 患者 PHQ-9 评分≥15 的个体风险的列线图。该列线图可以初步用于避免低 MD 风险的患者不必要地完成问卷。
