title: Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis.
abstract: BACKGROUND
  Depression is frequently associated with sexual dysfunction in both men and women.
  
  
  OBJECTIVE
  To examine whether depression predicts sexual dysfunction and, conversely, whether sexual dysfunction predicts depression.
  
  
  METHODS
  A systematic review and meta-analysis was conducted. PubMed and EMBASE biomedical answers electronic databases were searched for relevant studies up to November 2011. Reference lists of relevant articles were hand-searched and expert opinions were sought. Studies identified for inclusion had to be prospective cohort studies in adult populations that reported an association between depression and sexual dysfunction variables.
  
  
  METHODS
  Odds ratios (ORs), prioritized where available, or relative risks (RRs) were pooled across studies using random-effects meta-analysis models.
  
  
  RESULTS
  Eight citations included for review yielded six studies on depression and risk of sexual dysfunction in 3,285 participants followed for 2-9 years, and six studies on sexual dysfunction and risk of depression in 11,171 participants followed for 1-10 years. Depression increased the risk of sexual dysfunction in pooled unadjusted (RR/OR 1.52 with 95% confidence intervals [1.02, 2.26]) and adjusted (RR/OR 1.71 [1.05, 2.78]) meta-analyses but not in the partially adjusted model (RR/OR 1.41 [0.90, 2.23]). There was significant heterogeneity between studies, but after removal of a single outlying study was diminished and the pooled partially adjusted, RR/OR increased to 1.69 (1.15, 2.47). Sexual dysfunction increased the odds of depression in the pooled unadjusted (OR 2.30 [1.74, 3.03]), adjusted (OR 3.12 [1.66, 5.85]), and partially adjusted (OR 2.71 [1.93, 3.79]) meta-analyses; heterogeneity was significant only in the adjusted model. Meta-regression analyses did not detect significant sources of heterogeneity in either examination.
  
  
  CONCLUSIONS
  Clinicians should be aware of a bidirectional association between depression and sexual dysfunction. Patients reporting sexual dysfunction should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for sexual dysfunction.
authors.affiliation: Royal Adelaide Hospital/Institute of Medical and Veterinary Science, SA Health, Government of South Australia, Adelaide, SA, Australia. evan.atlantis@adelaide.edu.au
authors.forename: Evan
authors.initials: E
authors.lastname: Atlantis
authors.forename: Thomas
authors.initials: T
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012306:Risk; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000523:psychology