JMIR Publications

ABSTRACT

Background:

Acceptance and Commitment Therapy (ACT) utilizes a transdiagnostic method to analyze psychological issues within individual health conditions. Psychological inflexibility is one example that has shown its effectiveness as a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and/or maintain a penile erection that is sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men below 40, whereas biological factors are more likely to be the underlying cause in older men. Given these findings, it is possible that people under 40 are more psychologically inflexible than those over 40 and that ACT is more effective.

Objective:

This online cross-sectional study examined the difference in depression, anxiety, and psychological inflexibility in ED men under and over the age of 40 in a Japanese population.

Methods:

We used an online survey to gather data from various community samples. ED was assessed by the IIEF-5 questionnaire, while depression, anxiety, and psychological inflexibility were considered by the PHQ-9, GAD-7, AAQ-II, CFQ, and VQ-OB questionnaires, respectively. The chi‐square test estimated the severity of PHQ-9 and GAD-7 between under 40 years and over 40 years ED men. Additionally, the two-way ANOVA was conducted with ED severity and age group as independent variables and the score of the psychological inflexibility.

Results:

Valid responses from 643 individuals (aged 36.19±7.54 years) were obtained. Of these, 422 were under 40 years (aged 31.76±5.00 years) and 221 were over 40 years (aged 44.67±2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≧10 between under 40 and over 40 years of ED men (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≧10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that the under 40 years ED men had significantly higher CFQ (P=.01, d=0.62) and VQ (P<.001, d=0.87) than the over 40 years ED men in moderate ED and severe ED. Also, it was found that moderate ED to severe ED men under 40 years had significantly higher CFQ (P=.01, d=0.42) and VQ (P=.02, d=0.38) than no-ED men under 40 years. On the other hand, no interaction was found for AAQ-II (P=.16).

Conclusions:

To our best knowledge, this online, cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that moderate and severe ED men under 40 years of age have higher psychological inflexibility and might be eligible for the ACT.