title: Depression Mediates the Effect of Sexual Function on Quality of Life among Men but Not Women with Coronary Artery Disease.
abstract: BACKGROUND
  Poor sexual function is associated with impaired Health-Related Quality of Life (HRQoL), and patients with Coronary Artery Disease (CAD) are not exceptions. It is not known, however, if symptoms of depression mediate the effect of sexual function on HRQoL among men and women with CAD.
  
  
  OBJECTIVE
  This study aimed to determine the mediating effect of depressive symptoms on the association between sexual function and HRQoL among men and women with CAD.
  
  
  METHODS
  This cross-sectional study was conducted on 401 men and 156 women with CAD. Sexual function, measured by the Relation and Sexuality Scale (RSS), was the independent variable. In addition, physical and mental HRQoL measured using physical and mental health summary scores of Short Form 36 (SF-36) were dependent variables. Besides, the severity of depressive symptoms measured by the Hospital Anxiety and Depression Scale (HADS) was conceptualized as the mediator. Age, income, education, and medical comorbidities (Ifudu index) were control variables, and gender was the moderator. Multi-group path analysis was conducted using AMOS20.0 for data analysis.
  
  
  RESULTS
  When the effects of age, education, income, and comorbidities were controlled, sexual function was correlated with poor mental HRQoL in both genders. However, the association between sexual function and poor physical HRQoL could be found only among men but not women. Evidence also supported partial mediation of depressive symptoms on the effect of sexual function on mental HRQoL of both men and women. Nonetheless, the results suggested partial mediation of depressive symptoms on the effect of sexual function on physical HRQoL only among men but not women.
  
  
  CONCLUSIONS
  Symptoms of depression may not have a similar role in explaining the effect of sexual function on physical HRQoL of men and women with CAD. Our findings suggest that only among men, depressive symptoms might be the mechanism by which sexual function affects the CAD patients' physical HRQoL.
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA ; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA ; Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
keywords: Comorbidity; Coronary Artery Disease; Depression