Mental disorder risk elevated in men with Peyronie’s disease

Men with Peyronie’s disease (PD) have an increased risk of developing psychiatric disorders, according to findings from a population-based cohort study published in the Journal of Urology.¹

The study showed that men with PD were at an elevated risk of receiving a diagnosis of any psychiatric outcomes (HR, 1.4), as well as substance use disorder (HR, 1.4), anxiety disorder (HR, 1.9), depression (HR, 1.7), and self-injurious behaviors (HR, 2.0). There was not an elevated risk of alcohol misuse (HR, 0.9).

“PD may be a serious but partially hidden public health concern. We reported for the first time that men with PD had increased risks of being diagnosed with several psychiatric outcomes, including self-injurious behaviors,” the researchers wrote.

The investigators conducted a longitudinal cohort study using data from Swedish national registers. The analysis included 8105 men with PD and 3.5 million comparison subjects without PD. The patients in the PD cohort were born between 1933 and 1996 and had received their diagnosis between 1997 and 2013.

In the PD cohort, 13.4% of men had been diagnosed with adverse psychiatric outcomes compared with 10.7% in the control cohort. The rates of anxiety disorder, depression, and self-injurious behaviors were 4.1% versus 3.2%, 6.4% versus 4.1%, 3.6% versus 2.5%, respectively.

“Although many urologists are aware of the impact of PD on mental health, they rarely assess these issues formally. We suggest that the PD care at urology clinics would be improved by implementing 2 simple practices: 1) confirm a documented mental health status and 2) refer those without a documented mental health status to primary care,” the investigators wrote.

There were 2 accompanying editorial commentaries simultaneously published in the Journal of Urology. In the first, Martin Gelbard, MD, department of Urology, Men’s Health University of California, Los Angeles Los Angeles, California, wrote, “For the urologist, these data reinforce the benefit of inquiring about psychological issues in their patients with Peyronie’s disease and for general healthcare providers the need to tactfully explore sexual function of patients with the above problems. Additionally, troubled patients may find much needed support when their health care providers use this extremely informative data set to show them they are not alone in feelings that may be difficult to express.”²

In the second commentary Brian Le, MD, Department of Urology School of Medicine and Public Health University of Wisconsin Madison, Wisconsin, noted that he found the findings useful, but urged caution when interpreting the results for clinical practice.³

“From a practical standpoint, this study certainly would encourage urologists to consider a psychiatric evaluation if there are any hints of this in your clinical evaluation as it may affect patient expectations and perceptions of outcomes of PD treatment. However, we should also keep in mind that the population attributable risk of PD for being diagnosed with a psychiatric disorder is 2.7%, which puts into question the efficacy of widespread screening of all men with PD for psychiatric disorders,” wrote Le.

Reference

1. Kuja-Halkola R, Henningsohn L, D'Onofrio BM, et al. Mental disorders in Peyronie’s disease: a Swedish cohort study of 3.5 million men. J Urol. 2021;205(3):864-870. doi: 10.1097/JU.0000000000001426

2. Gelbard M. Editorial comment. J Urol. 2021;205(3):869. doi: 10.1097/JU.0000000000001426.01

3. Le B. Editorial comment. J Urol. 2021;205(3):869-870. doi: 10.1097/JU.0000000000001426.02