Nomogram for stratifying patients with lifelong premature ejaculation before using the PHQ-9: An observational study

Area of Science:

• Urology
• Psychiatry
• Medical Informatics

Background:

• Major depressive disorder (MDD) is indicated by a PHQ-9 score ≥ 15 (PHQ-9+).
• The PHQ-9 assessment can exacerbate psychological distress in patients with lifelong premature ejaculation (LPE), potentially contributing to LPE development.
• Accurate risk stratification for PHQ-9+ in LPE patients is crucial for targeted screening.

Purpose of the Study:

• To develop a predictive nomogram for identifying LPE patients at risk of PHQ-9+.
• To discern LPE patients with low risk of PHQ-9+ who may not require the PHQ-9 assessment.
• To enhance the efficiency and appropriateness of MDD screening in LPE populations.

Main Methods:

• A nomogram was constructed using data from 802 LPE patients from Xijing Hospital and Northwest Women's & Children's Hospital.
• Independent predictors of PHQ-9+ were identified using LASSO and multivariable logistic regression analyses.
• The nomogram's discrimination, calibration, and clinical usefulness were validated in an independent cohort of 505 patients.

Main Results:

• Independent predictors for PHQ-9+ included PE duration, IELT, PE exacerbation history, IIEF-5 score, urinary frequency, and physical pain score.
• The nomogram demonstrated excellent calibration and discrimination, with predictive accuracies of 0.781 (derivation) and 0.763 (validation).
• Patients were categorized into low, intermediate, and high-risk groups for PHQ-9+, with corresponding PHQ-9+ rates of 3.5%, 9.3%, and 30.7%.

Conclusions:

• A validated nomogram effectively identifies LPE patients at low risk for PHQ-9+.
• This tool can improve the diagnostic yield of MDD screening in LPE patients.
• Utilizing the nomogram may enhance therapeutic outcomes by focusing resources on high-risk individuals.