A Prospectively Validated Nomogram for Predicting the Risk of PHQ-9 Score ≥15 in Patients With Erectile Dysfunction

Background: Although erectile dysfunction (ED) often occurs simultaneously with depression, not all patients with ED suffer major depression (MD), with a PHQ-9 score ≥15 indicating MD. Because the PHQ-9 questionnaire includes phrases such as "I think I am a loser" and "I want to commit suicide," the psychological burdens of ED patients are likely to increase inevitably after using the PHQ-9, which, in turn, may affect ED therapeutic effects. Accordingly, we endeavored to develop a nomogram to predict individual risk of PHQ-9 score ≥15 in these patients. Methods: The data of 1,142 patients with ED diagnosed in Xijing Hospital and Northwest Women and Children's Hospital from January 2017 to May 2020 were analyzed. While the Least Absolute Shrinkage and Selection Operator regression was employed to screen PHQ-9 score ≥15 related risk factors, multivariate logistic regression analysis was performed to verify these factors and construct the nomogram. The training cohort and an independent cohort that comprised 877 prospectively enrolled patients were used to demonstrate the efficacy of the nomogram. Results: The IIEF-5 score, PEDT score, physical pain score, frequent urination, and feeling of endless urination were found to be independent factors of PHQ-9 score ≥15 in patients with ED. The nomogram developed by these five factors showed good calibration and discrimination in internal and external validation, with a predictive accuracy of 0.757 and 0.722, respectively. The sensitivity and specificity of the nomogram in the training cohort were 0.86 and 0.52, respectively. Besides, the sensitivity and specificity of the nomogram in the validation cohort were 0.73 and 0.62, respectively. Moreover, based on the nomogram, the sample was divided into low-risk and high-risk groups. Conclusion: This study established a nomogram to predict individual risk of PHQ-9 score ≥15 in patients with ED. It is deemed that the nomogram may be employed initially to avoid those with a low risk of MD completing questionnaires unnecessarily

Anxiety · Cohort · Depressive symptoms · Erectile dysfunction · Framingham Risk Score · Logistic regression · Nomogram · Patient Health Questionnaire · Physical therapy · Psychiatry · Medicine · Sexual function and dysfunction studies · Tryptophan and brain disorders · Urinary Bladder and Prostate Research · Internal Medicine

• The relationship between disability and quality of life among older adults

  Open Access•Jing Zhu, Zhiqiang Feng et al.•Frontiers in Public Health•2026

  Add to list

• Dose‐response analyses using restricted cubic spline functions in public health research

  Open Access•Loic Desquilbet, François Mariotti•Statistics in Medicine•2010

  Add to list

• Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression

  Open Access•Brooke Levis, Andrea Benedetti et al.•BMJ•2019

  Add to list

• The meaning and use of the area under a receiver operating characteristic (ROC) curve.

  J A Hanley, Barbara J Mcneil•Radiology•1982

  Add to list

• Regularization Paths for Generalized Linear Models via Coordinate Descent

  Open Access•Jerome Friedman, Jerome H Friedman et al.•Journal of Statistical Software•2010

  Add to list