(099) Intersection of Sexual and Mental Health: Prevalence of Anxiety and Depression in a Men's Health Clinic and Feasibility of Mental Health Surveys
Authors: Suria Cordero NF , Jansen N , Periera TA , Bernie HL 
Published: February 2024

Abstract

Introduction
Depression and general anxiety disorder (GAD) are the most prevalent mental health conditions in men, affecting 5% and 2%, respectively. 31% of men suffer depression in their lifetime and only 1/4 of men speak to a mental health professional about it. Suicide rates are 4 times higher in men and men are more likely to succeed at attempts. Men with high depression scores are nearly twice as likely to report erectile dysfunction (ED) than nondepressed men.

Objective
We aim to identify the prevalence of depression and GAD among patients presenting to a men's health clinic (MHC). Secondary objectives include demonstrating the feasibility of administering mental health surveys in a busy MHC to early identify men who may benefit from a referral to a mental health practitioner in order to improve overall men's health.

Methods
We retrospectively reviewed the records of patients presenting to a MHC during a three-month period in 2023 who completed all surveys. We measured ED and ejaculatory dysfunction severity with the Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire (MSHQ-EJ), respectively. Screening for depression and anxiety was performed with the Patient Health Questionnaire (PHQ-7) and the General Anxiety Disorder (GAD-7) questionnaire. Both questionnaires rate disease severity as mild, moderate, or severe. Linear regression models were used to compare the severity of depression and anxiety to ED severity. Non-parametric statistics were used to analyze the prevalence of mental health disorders and the reason for the patient’s visit to the men’s health clinic. Referral to a mental health specialist was offered for any patients meeting scoring criteria.

Results
We identified 255 men (77% white, 18% black, 5% Asian, and 94% non-Hispanic) with a median age of 48 years (IQR: 33-64) and a BMI of 28 (IQR: 25-32). Overall, 63% of men had some ED, while 88% had some degree of ejaculatory dysfunction. Prevalence of depression and GAD was 15% and 11%, respectively. A linear regression model showed that as ED severity increases, so does depression severity (F [1, 244] = 13.53, p = .0001, coefficient: 0.15, R-squared: 0.05) and anxiety severity (F [1, 244] = 5.93, p=0.02, coefficient: 0.08, R-squared: 0.02). The study found no significant correlation between prevalence of depression and the reason for the patients' visits to the MHC: ED (17%, 20/117), hypogonadism (22%, 26/120), Peyronie's (28%, 7/25), fertility evaluation (33%, 5/15), varicocele (30%, 8/27), and vasectomy evaluation (5%, 1/21) (p=0.27).

Conclusions
The prevalence of depression and GAD among men attending a MHC is higher than that of the general male population. The degree of ED and its association with the severity of depression and anxiety emphasizes the importance of addressing both sexual and mental health in the context of men's healthcare. ED should be considered a multifactorial condition that requires a multidisciplinary approach to treatment, especially when depression is present. Patients reporting ED should be routinely screened for depression. Administration of mental health surveys in a MHC is feasible and helps guide early referral to a mental health specialist.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast and BK Ultrasound.