Erectile Dysfunction and Mental Health Challenges in Heart Attack Recovery

Credit: Adobe Stock/Viacheslav Yakobchuk

Erectile dysfunction (ED) negatively impacts self-esteem, which in turn is closely linked to higher depression levels, according to a study of 80 male patients who have experienced myocardial infarction (MI) within the last six months.

“The interplay between the physical and mental health of patients recovering from MI is crucial,” wrote a group of Polish investigators. “ED is a common sexual issue, particularly among patients who have had a MI and arterial diseases, and it significantly affects self-esteem and overall psychological well-being.”

However, the psychosocial factors related to cardiovascular and sexual health continue to be underexplored.

Self-esteem is considered a central factor affecting an individual’s perception of their illness and how they cope with its subsequent results. Besides the physical consequences of cardiovascular disease (CVD), psychological issues, including depression and reduced self-esteem can significantly influence the course of disease as well as a person’s response to treatment. Additionally, patients with severe CVD are more likely to report lower self-esteem and higher levels of depression compared with the general population or those with milder forms of the disease, leading investigators to theorize self-esteem may be a crucial component on modulating their subjective health experience and their quality of life.

ED, which is often a result of combination of both physical and psychological factors, can further reduce self-esteem and exacerbate depression.

To determine the relationship between ED, self-esteem and depression among male patients with post-MI, as well as analyzing how ED treatment impacts the patient’s psychological health, investigators recruited male patients with a recently confirmed MI aged between 35 and 77 years. Psychological wellbeing was assessed using the Beck Depression Inventory-II (BDI-II) and the Rosenberg Self-Esteem Scale (SES). ED was evaluated using the International Index of Erectile Function-5 (IIEF-5).

Within the cohort, 73.8% had chronic cardiac conditions, including hypertension, dyspnea or chest pain, and cardiac arrhythmia. Of the 80 patients, only one said they used any pharmacological treatment for ED.

The cross-sectional study demonstrated that psychological resilience, particularly self-esteem, plays a vital role in recovery, as higher self-esteem helps reduce depressive symptoms and promotes better rehabilitation outcomes.

Age was also found to be a significant predictor of lower self-esteem, likely due to greater health challenges in older patients, but other demographics had minimal influence on self-esteem, depression or ED. Other factors impacting self-esteem included a more challenging recovery period post-MI.

Investigators noted limitations such as the exclusion of the evaluation of testosterone levels among patients, which are known to influence erectile function. In doing so, the understanding of sexual dysfunction within the cohort was hindered. Investigators want future analyses to include this measurement to ensure a more comprehensive view of sexual health. Additionally, the long-term effects of treatment on patient outcomes were not available. Further, the relatively small and homogenous sample, recruited from a single rehabilitation unit, may have limited the generalizability. Finally, as measurements were only taken once, investigators could not determine the long-term changes in mental and physical health.

“These findings emphasize the importance of an integrated rehabilitation approach that addresses both mental health and sexual health,” investigators concluded. While these results offer valuable insights into the interaction between physical and mental health, further research is needed to evaluate the clinical effectiveness of such interventions and better understand their impact on patients’ psychological resilience and quality of life.”