Erectile Dysfunction and Depression in Males with Type 2 Diabetes Mellitus in a Tertiary Healthcare Facility in Uyo, South-South Nigeria

Main Article Content

Henry Effiong Jombo
Samuel Inih Onung
Alphonsus Udo Idung
Victory Edet Iyanam


Background: Co-morbidity between erectile dysfunction and depression is reported high among males with type 2 diabetes mellitus and these constitute a major public health challenge due to the number of persons affected by these conditions and the negative impact on their physical and mental wellbeing.

Aim: This study assesses the prevalence of self-reported erectile dysfunction and depression among males with type 2 diabetes mellitus and examines factors associated with them.

Materials and Methods: This was a cross-sectional descriptive study of 103 male subjects with type 2 diabetes mellitus who were consecutively recruited from May 2019 to September 2019. Data were obtained with an interviewer-administered structured questionnaire. Sexual dysfunction was assessed using the international index of erectile function questionnaire (IIEF) and depressive symptoms were assessed using the Hamilton depression rating scale.

Results: The mean age of the respondents was 62.78±14.1 year. Mean duration of illness and erectile dysfunction are 8.92±6.3 years and 5.64±5.7 years respectively. The prevalence of sexual dysfunction was 71.8%. About 50.2% of respondents reported severe degree of erectile dysfunction and 28.2% reported no erectile problems. Erectile dysfunction was significantly associated with depression in our sample (x2=9.26, P=.002). The mean depression score was 24.52±8.2 and the prevalence was 68.6%. Time with diabetes mellitus and glycaemic control status were factors significantly related to the risk of developing erectile dysfunction and depression.

Conclusion: Erectile dysfunction and depression is highly prevalent among males with type 2 diabetes mellitus and these should be addressed in the course of treatment of these patients.

Diabetes mellitus, depressive symptoms, males, prevalence, sexual dysfunctions, Nigeria.

Article Details

How to Cite
Effiong Jombo, H., Inih Onung, S., Udo Idung, A., & Edet Iyanam, V. (2020). Erectile Dysfunction and Depression in Males with Type 2 Diabetes Mellitus in a Tertiary Healthcare Facility in Uyo, South-South Nigeria. Asian Journal of Medical Principles and Clinical Practice, 3(1), 9-17. Retrieved from
Original Research Article


Cramer JA. A systematic review of adherence with medication for diabetes. Diabetes Care. 2004;27:1218-1224.

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.
DOI: 10.1016/j.diabres.2009.10.007
PubMed PMID: 19896746

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14.

Lunghi C, Moisan J, Gregoire JP. Incidence of depression and associated factors in patients with type 2 diabetes in Quebec, Canada: A population-based cohort study. Medicine. 2016;95:e3514.

Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: Current perspectives. Diabetes Metab Synd Obes. 2014;7:95-105.

Pastuszak AW. Current diagnosis and management of erectile dysfunction. Curr Sex Health Rep. 2014;6(3):164–176.
DOI: 10.1007/s11930-014-0023-9

Nisahan B, Kumanan T, Rajeshkannan N, Peranantharajah T, Aravinthan M. Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka. BMC Res Notes. 2019;12:210.
DOI: 10.1186/s13104-019-4244-x

Sharifi F, Asghari M, Jaberi Y, Salehi O, Mirzamohammadi F. Independent predictors of erectile dysfunction in type 2 diabetes mellitus: Is it true what they say about risk factors? ISRN Endocrinol. 2012;2012:5.
DOI: 10.5402/2012/502353

Dandona P, Dhindsa S, Chandel A. Low testosterone in men with type 2 diabetes, a growing public health concern. Diabetes Voice. 2009;54:27-29.

Kim GM, Woo JM, Jung SY, Shin S, Song HJ, Park J, Ahn J. Positive association between serious psychiatric outcomes and complications of diabetes mellitus in patients with depressive disorders. Int J Psychiatry Med. 2015;50:131–146.

Meurs M, Roest AM, Wolffenbuttel BH, Stolk RP, De JP, Rosmalen JG. Association of depressive and anxiety disorders with diagnosed versus undiagnosed diabetes: An epidemiological study of 90,686 participants. Psycho Som Med. 2016;78:233–241.

Bartoli F, Carra G, Crocamo C, Carretta D, La TD, Tabacchi T, Gamba P, Clerici M. Association between depression and neuropathy in people with type 2 diabetes: A meta-analysis. Int J Geriatr Psychiatry. 2016;8:829-36.
DOI: 10.1002/gps.4397

Li C, Ford ES, Zhao G, Ahluwalia IB, Pearson WS, Mokdad AH. Prevalence and correlates of undiagnosed depression among US adults with diabetes: the behavioral risk factor surveillance system. Diabetes Res. Clin. Pract. 2009:83(2):268-279.

Petrak F, Baumeister H, Skinner TC, Brown A, Holt RI. Depression and diabetes: Treatment and health-care delivery. Lancet Diabetes Endocrinol. 2015;3:472–485.

Egede EL, Osborn CY. Role of motivation in the relationship between depression, self-care, and glycemic control in adults with type 2 diabetes. Diabetes Educ. 2010;36(2):276–282 .

Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: The search for shared mechanisms. Lancet Diabetes Endocrinol. 2015;3:461–471.

Twist K, Stahl D, Amiel SA, Thomas S, Winkley K, Ismail K. Comparison of depressive symptoms in type 2 diabetes using a two-stage survey design. Psychosom Med. 2013;75:791–797.

Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: A systematic review and meta-analysis. J Sex Med. 2012;9: 1497–507.

Bąk E, Marcisz C, Krzemińska S, Dobrzyn-Matusiak D, Foltyn A, Drosdzol-CopA. Relationships of sexual dysfunction with depression and acceptance of illness in women and men with type 2 diabetes mellitus. Int J Environ Res Public Health [Internet]. 2017;14(9).

American Diabetes Association: Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33:S629.

Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatricinterview for DSM-IV and ICD-10. Journal of Clinical Psychiatry. 1998; 59(20):22–33.

Gilmore JE, Temple DJ, Taggart HM. A study of drug compliance, including the effects of a treatment card, in elderly patients following discharge home from hospital. Aging (Milano). 1989;1(2):153-8.

Rosen RC, Cappelleri JC, Smith MD, Lipky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction Int J Impot Res. 1999;11:319-326.

Rhoden EL, Teloken C, Sogari, Vargas Souto CA. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction International Journal of Impotence Research. 2002;14:245-250.

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23: 56-62.

NIH Consensus Conference. NIH consensus development panel on impotence. Journal of the American Medical Association. 1993;270(1):83–90.

Ugwu T, Ezeani I, Onung S, Kolawole B, Ikem R. Predictors of erectile dysfunction in men with type 2 diabetes mellitus referred to a tertiary healthcare centre. Advances in Endocrinology; 2016.
Article ID 9753154:8.

Seid A, Gerensea H, Tarko S, Zenebe Y, Mezemir R. Prevalence and determinants of erectile dysfunction among diabetic patients attending in hospitals of central and northwestern zone of Tigray, northern Ethiopia: Across-sectional study. BMC Endocr Disord [Internet]. 2017;17(1):16.
DOI: 10.1186/s12902-017-0167-5

Amanyam CT, Yohanna S, Obilom RE. Assessment of sexual dysfunction in patients with diabetes mellitus in the general out-patient of Dalhatu Araf specialist Hospital, Lafia. Nigeria. J Family Pract. 2016;7(3):35-42.

Adebusoye LA, Olapede-olaopa OE, Ladipo MM, Owoaje ET. Prevalence and correlates of erectile dysfunction among primary care clinic attendees in Nigeria. Global Journal of Health Science. 2012; 4:4.
ISSN 1916-9736 E-ISSN 1916-9744

Asefa A, Nigussie T, Henok A, Mamo Y. Prevalence of sexual dysfunction andrelated factors among diabetes mellitus patients in Southwest Ethiopia. BMC Endocrine Disorders. 2019;19:141.

Laumann EO, Glasser DB, Neves RC, Moreira ED Jr. GSSAB investigators' group. A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. Int. J. Impot. Res. 2009; 21(3):171-78.

Tina KT, Nana OA, Vivian AF. Erectile Dysfunction Clinical Diabetes. 2005;23(3): 105-113.

Giugliano F, Maiorino M, Bellastella G, Gicchino M, Giugliano D, Esposito K, Determinants of erectile dysfunction in type 2 diabetes International Journal of Impotence Research. 2010;22(3):204-209.

Khatib FA, Jarrah NS, Shegem NS, Bateiha AM, Abu-Ali RM, Ajlouni KM. Sexual dysfunction among Jordanian men with diabetes. Saudi Medical Journal. 2006;27(3):351-6.

Lu CC, Jiann BP, Sun CC, Lam HC, Chu CH and Lee JK. Association of glycemic control with risk of erectile dysfunction in men with type 2 diabetes. Journal of Sexual Medicine. 2009;6:1719–1728.

Nicolau J, Simo R, Sanchis P. Prevalence and clinical correlators of undiagnosed significant depressive symptoms among individuals with type 2 diabetes in a mediterranean population. Exp Clin Endocrinol Diabetes Off J Ger Soc Endocrinol Ger Diabetes Assoc. 2016;124: 630–6.

Katon W, Russo J, Lin EH, Heckbert SR, Karter AJ, Williams LH, et al. Diabetes and poor disease control: Is comorbid depression associated with poor medication adherence or lack of treatment intensification? Psychosom Med. 2009;71: 965–72.

Alonso-Moron E, Satylganova A, Orueta JF. Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs. BMC Public Health. 2014;14:769.
DOI: 10.1186/1471-2458-14-769

Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: A systematic review and meta-analysis. J Sex Med. 2012;9: 1497–507.