Sexual function and depressive symptoms among female North American medical students.
BACKGROUND
Depression and sexual dysfunction are often comorbid.


OBJECTIVE
We explored the relationship between sexuality, sexual dysfunction, and depressive symptoms in female medical students in North America.


METHODS
Female North American medical students were invited to participate in an internet survey. The CES-D was utilized to screen for depressive symptoms and an abbreviated Spielberger State-Trait Anxiety Index (STAI) was used to quantify anxiety symptoms.


METHODS
Subjects completed an ethnodemographic survey, a sexuality survey, and modified instruments for the quantification of sexual function (the Female Sexual Function Index [FSFI] and the Index of Sexual Life [ISL]). Multivariable logistic regression was used to explore the relationship between sexuality and depressive symptoms.


RESULTS
There were 1,241 female subjects with complete data on CES-D and STAI. Mean age was 25.4 years. Depressive symptoms (CES-D>16) were present in 46% of respondents and were more common in subjects with anxiety symptoms. Subjects who were Caucasian, younger than 28, heterosexual, and in a relationship were least likely to report depressive symptoms. High risk of female sexual dysfunction (HRFSD) was significantly associated with greater likelihood of depressive symptoms (odds ratio [OR] 2.25, P<0.001). After adjusting for ethnodemographic and sexual history factors, HRFSD remained significantly positively associated with depressive symptoms (OR 1.85, P<0.001). Analysis of FSFI and ISL domains indicated that depressive symptoms were most directly associated with worse orgasmic function, interference in sex life from stress and lack of partner, and lower general life satisfaction (P<0.05). Interestingly, greater ISL-sexual satisfaction was associated with greater odds of depressive symptoms (OR 1.40, P=0.01).


CONCLUSIONS
Depressive symptoms are common in female medical students. HRFSD is associated with depressive symptoms, although the relationship is complex when psychosocial factors are included in the multivariate model. Attention to sexuality factors from student health providers may enhance quality-of-life, academic achievement, and patient care.
University of California Davis-Department of Urology, Sacramento, CA 95816, USA. awshindel@ucdavis.edu
Alan W
AW
Shindel
Michael L
ML
Eisenberg
Benjamin N
BN
Breyer
Ira D
ID
Sharlip
James F
JF
Smith
D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009656:North America / Q000453:epidemiology; D011788:Quality of Life; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology / Q000523:psychology; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult