Search Results (669)

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

In sociocultural situations where aging is firmly associated with family roles, spirituality, and reliance, depression and death anxiety are prevalent mental health issues among older individuals. Although their functions may vary depending on the situation, psychological resources, such as purpose in life, self-worth, and life satisfaction, are often considered protective in later life. This descriptive–correlational study examined the relationships between meaning in life, self-esteem, life satisfaction, depression, and death anxiety among 119 community-dwelling older Filipinos aged 60 years and older. Data were analyzed using descriptive statistics, Pearson correlation, and multiple linear regression in JAMOVI version 2.7.6. The standardized instruments included the Meaning in Life Questionnaire, Rosenberg Self-Esteem Scale, Satisfaction with Life Scale, Revised Death Anxiety Scale, and Beck Depression Inventory. Regression analysis revealed that while meaning in life and life satisfaction independently predicted higher death anxiety, they independently predicted lower depression. After adjustment, self-esteem predicted neither outcome. These results suggest that psychological resources have distinct effects on mental health in later life, acting as protective factors against depressive symptoms and raising awareness of mortality. To promote healthy aging among older individuals, culturally responsive therapies that address existential factors and emotional well-being are necessary. Full article

Background/Objectives: Sleep disorders and depressive symptoms are common among college students and can negatively impact quality of life. Physical activity is recommended as a non-pharmacological approach to support sleep and mental health; however, findings regarding regular evening aerobic exercise in young adults are limited. This study aimed to examine changes in sleep quality, depressive symptoms and sleep–wake preferences among university students participating in an eight-week evening aerobic exercise program. Methods: This quasi-experimental study included 51 university students who were assessed before and after an eight-week intervention. Participants engaged in 60 min of aerobic exercise three days a week in the evening (between 6:00 PM and 10:00 PM). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms using the Beck Depression Inventory (BDI), and morning–evening type using the Morning–Evening Questionnaire (MEQ). Results: At the end of the eight-week period, a significant improvement was observed in total PSQI scores; significant changes were also noted in the subscales of sleep onset latency, habitual sleep efficiency, sleep disturbances, and daytime dysfunction (p < 0.05). A significant decrease was observed in BDI scores (median: from 17 to 9; p < 0.001), and the proportion of students with moderate-to-severe depressive symptoms decreased. A significant increase was also observed in MEQ scores (p < 0.001), which was found to be consistent with a shift toward an earlier sleep–wake preference. Conclusions: While these findings suggest that an eight-week evening aerobic exercise program may offer potential benefits in improving sleep quality and reducing depressive symptoms among university students, it is thought that changes in sleep–wake preferences may reflect short-term behavioral adaptation. Full article

Background: Adult circumcision is an effective surgical treatment for symptomatic phimosis, but its effects on sexual function and psychosocial outcomes remain incompletely characterized. This study aimed to assess patient-reported motivations for circumcision due to phimosis and to evaluate changes in sexual function, genital self-image, and depressive symptoms after surgery. Methods: We performed a prospective, single-center observational pre–post cohort study of adult men who underwent circumcision for symptomatic phimosis at a tertiary academic center in Poland between January 2023 and April 2025. Participants completed an author-designed questionnaire and validated patient-reported outcome measures before surgery and at six months after circumcision. The primary endpoint was the change in sexual function measured by the International Index of Erectile Function (IIEF-15). Secondary endpoints included changes in genital self-image assessed using the Male Genital Self-Image Scale (MGSIS-7), depressive symptoms measured with the Beck Depression Inventory (BDI-II), and patient-reported motivations for surgery. Paired comparisons were performed using the Wilcoxon signed-rank test. Results: A total of 148 men were included in the study. The most common reasons for surgery were pain/discomfort (58/148, 39.2%) and impaired sexual activity (51/148, 34.5%). The total IIEF-15 score increased from 46.4 ± 20.4 to 57.5 ± 21.0 (p < 0.001), with significant improvements across all domains (all p < 0.001). The total MGSIS-7 score improved from 19.9 ± 4.5 to 23.1 ± 4.0 (p < 0.001). Paired BDI-II data were available for 77 men; the total BDI-II score decreased from 1.2 ± 3.8 to 0.3 ± 1.6 (p = 0.004). Most men reported improved sexual life (127/148, 85.8%) and cosmetic satisfaction (124/148, 83.8%), and 119/148 (80.4%) reported no complications. Conclusions: Circumcision for symptomatic phimosis was associated with improved sexual function and genital self-image, alongside a statistically significant but clinically negligible decrease in subclinical depressive symptoms. Full article

The use of smartphones and social media has become an increasing feature of daily life among university students. Although technology use can offer benefits, growing evidence links heavier engagement to poorer mental health outcomes. This study examined the associations between social media use and indices of psychological distress among South African university students, and it tested whether smartphone addiction represents a pathway linking social media use to distress. Participants (n = 491) were students who completed the Social Media Use Integration Scale, the Smartphone Application-Based Addiction Scale, the Center for Epidemiological Studies Depression Scale-10, the Posttraumatic Stress Disorder Checklist for DSM-5, the Beck Hopelessness Scale-9, and the trait scale of the State-Trait Anxiety Inventory-5. Mediation analyses with the PROCESS macro was conducted to examine smartphone addiction as a possible pathway between social media use and indices of psychological distress. The results of the mediation analysis indicated that social media use and smartphone addiction had significant positive direct effects on depression, PTSD, and anxiety, but not on hopelessness. In addition, social media use had significant indirect effects via smartphone addiction on depression, PTSD, and anxiety, pointing to the partial mediating role of smartphone addiction. The results highlight the importance of incorporating targeted support within student mental health services. Interventions aimed at reducing distress may benefit from targeting problematic smartphone engagement alongside broader efforts to promote healthier social media practices. Full article

Background: Families caring for children with medical complexity (CMC) face sustained psychosocial demands that may impair health-related quality of life (HRQoL) and mental health. A clear map of how these outcomes are assessed and which factors shape them is needed to guide family-centered care. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, and reports were prepared according to the PRISMA guidelines. Searches were conducted in PubMed, CINAHL, and EMBASE (January 2011 to December 2023) to find studies reporting on health-related quality of life (HRQoL) and/or mental health outcomes (anxiety, depression, burden) of family members and/or caregivers of CMC, including operationalization based on complex chronic condition (CCC) classifications, technology dependency, or the Pediatric Medical Complexity Algorithm (PMCA). Two reviewers independently screened records and recorded data, and the findings were synthesized narratively and thematically. Results: Sixty-seven studies met the inclusion criteria and spanned cross-sectional, cohort, case–control, pre–post and qualitative designs across conditions such as epilepsy, congenital heart disease, cerebral palsy, technology dependence and cancer. Common measures were PedsQL™ Family Impact Module, SF-36/12, HADS, Beck inventories and Zarit burden scales. Across the included studies, caregivers, predominantly mothers, frequently reported poorer HRQoL and higher levels of anxiety, depressive symptoms, or burden than comparison groups when these were available. Six recurrent themes emerged: (1) gendered caregiving with disproportionate maternal burden; (2) socio-economic gradients and financing models shaping outcomes; (3) culture, religion and spirituality as coping resources; (4) family and social support buffering distress; (5) school participation and coordinated services potentially reducing burden; and (6) interdependence between caregiver and child outcomes. Conclusions: Heterogeneous CMC definitions, outcome measures, and study designs limited comparability across studies. The mapped evidence suggests that family HRQoL and mental health outcomes are shaped by interacting clinical, social, and contextual factors. These findings may inform more family-centered and equity-oriented approaches to care. Future research should harmonize CMC definitions, standardize outcome measures, and prospectively evaluate multicomponent interventions. Full article

Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional and psychological resilience. Probiotics and postbiotics are gaining attention for their potential to modulate mood and stress via microbiome-related mechanisms, but human evidence remains limited, particularly in non-clinical populations. Objectives: We aimed to assess the effects of a two-strain combination of live microorganisms alongside a two-strain combination of heat-treated inactivated microorganisms on outcomes associated with anxiety, mood, perceived stress, and quality of life in healthy adults experiencing mild stress. Methods: This study was conducted in two parts. In Part I, a randomized, double-blind, placebo-controlled study, 100 participants were randomized to receive either a blend of live microorganisms (Bifidobacterium longum CECT 7347 and Lactobacillus rhamnosus CECT 8361) or an identical placebo once daily for 12 weeks. In Part II, a pilot feasibility study, a subset of eight placebo non-responders from Part I received the heat-inactivated preparation of the same bacterial strains in a 6-week trial extension phase. For Parts I and II, the primary outcome was the change in the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes included measures of mood (Beck Depression Inventory (BDI); Patient Health Questionnaire-9 (PHQ-9)), stress (state and trait anxiety inventory (STAI); Perceived Stress Scale (PSS)), sleep (Pittsburgh Sleep Quality Index (PSQI)), quality of life (36-item Short Form Survey (SF-36)), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale (GSRS)), salivary cortisol and microbiome modulation. Results: In Part I, there were no significant effects of the live blend on the HAM-A, indicating that the primary endpoint was not met. In addition, no significant effects were seen on the STAI or PSS scores when compared to the placebo. However, participants consuming the live blend trended toward a reduction in total PHQ-9 scores compared to placebo (p = 0.089), whilst preliminary exploratory analyses suggested an improvement in anhedonia (p = 0.045). Furthermore, there was a significant improvement in the vitality domain of the SF-36 compared to placebo (p = 0.017). On microbiome analysis, it was noted that consumption of the live blend was linked to the preservation of butyrate-producing bacteria, particularly members of the Pseudoflavonifractor genus and the Clostridium SGB6179 species. Furthermore, the abundance of B. longum species was found to be inversely associated with the total PSS Scores. In Part II, supplementation with the inactivated preparation resulted in significant within-group improvements for the vitality (p = 0.006) and social functioning (p = 0.010) domains of the SF-36 and improvements in PSS scores compared to baseline (p = 0.050). Conclusions: Supplementation with either the dual-strain live or inactivated formulations was associated with significant improvements in the vitality domain of the SF-36, whilst participants receiving the inactivated formulation demonstrated lower perceived stress and improved social functioning compared to baseline. Overall, the findings from this pilot study suggest that these two biotic consortia are well-tolerated and may be associated with improvements in measures of vitality in individuals with subclinical psychological symptoms. The subtle observations detected for stress and anhedonia suggest that further well-powered trials are needed to better characterize these findings, potentially in populations with greater baseline symptomatology. Full article

Background and Objectives: Rates of obesity have been consistently increasing in recent years across all age groups, with a notable rise among young people. Obesity represents a persistent inflammatory condition and a key contributor to various chronic health problems, such as cardiovascular disorders, metabolic abnormalities, cancer, and psychological conditions. The move from high school to university is a transitional phase accompanied by specific pressures that can affect both body weight control and mental health in students. This cross-sectional investigation aimed to investigate potential associations between excess weight and the presence of depressive and anxiety symptoms in university populations. Methods: This cross-sectional analysis included 5298 students enrolled at universities across ten geographic areas of Greece. Participants filled out questionnaires concerning demographic information and lifestyle behaviors. Levels of depression and anxiety were measured using the Beck Depression Inventory (BDI-II) and the short form of the State Anxiety Inventory (STAI-6), respectively. Measurements of height and body weight were obtained to compute Body Mass Index (BMI). Results: The presence of overweight or obesity among students was significantly and independently related to female sex, urban residence, living independently, tobacco use, and lower academic performance (p = 0.0103, p = 0.0102, p = 0.0203, p = 0.0075, and p = 0.0168, respectively). Individuals reporting insufficient physical activity had 85% higher odds of being overweight or obese (p = 0.0068). Similarly, participants experiencing depressive or anxious symptomatology had more than double odds of excess body weight compared with those without such symptoms (p = 0.0015 and p = 0.0012, respectively). Furthermore, poor Mediterranean diet adherence was linked to more than a twofold increase in the odds of overweight or obesity (p = 0.0005). Conclusions: These findings offer considerable evidence that symptoms of depression and anxiety may serve as significant contributors to the development of overweight and obesity among university students. Additional longitudinal studies are strongly encouraged to substantiate these observations. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with substantial symptom burden and functional limitations, which may co-occur with psychological distress. This pilot study aimed to assess depressive symptoms, anxiety, insomnia, and sexual quality of life in patients with COPD living in the Podlaskie Voivodeship. Materials and Methods: This cross-sectional pilot study included 47 patients with COPD, including outpatients (n = 11) and inpatients (n = 36), recruited at the University Teaching Hospital in Bialystok between February and August 2025. The original survey questionnaire, Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), and Sexual Quality of Life (SQoL) questionnaires were used. Results: In the study sample, median scores indicated a considerable burden of depressive symptoms (BDI Me = 16), anxiety (HAM-A Me = 27; GAD-7 Me = 15), and insomnia (AIS Me = 9; ISI Me = 14), alongside reduced sexual quality of life (SQoL Me = 46). Age in the total sample correlated positively with depressive symptoms, anxiety, and sleep difficulties, and negatively with SQoL; however, these relationships were not consistently maintained in age-stratified analyses. Crude inpatient–outpatient differences were substantial, but supplementary adjusted models showed that subjective symptom severity was the most consistent predictor across outcomes, whereas the independent role of hospitalization status was attenuated. Strong associations were observed between depression, anxiety, insomnia, and sexual quality of life. Conclusions: This pilot study indicates a substantial within-sample psychological burden in patients with COPD and suggests that these outcomes are closely associated with subjective symptom burden. Given the small sample size, marked group imbalance, cross-sectional design, and lack of objective COPD severity measures, the findings should be interpreted as exploratory and require confirmation in larger multicenter studies. Full article

Background: Recent data show that approximately 3.8% of the global population has a diagnosis of depression. Understanding psychological risk and protective factors is crucial for improving prevention strategies and mental health interventions. Among these, worry and emotional intelligence (EI) have emerged as relevant, yet they are rarely studied together. To date, no studies that analyzed the relationship between emotional intelligence, worry, and depression have been found. Therefore, this study aims to investigate the association among EI, worry, and depression. Methods: This study included 924 participants (N = 806 non-clinical and N = 118 subclinical sample with elevated depressive symptoms), with a mean age of M = 25.55 years (SD = 11.38). A total of 118 participants (12.8%) met the criteria for clinical depression based on the BDI-II cut-off. All participants completed the Penn State Worry Questionnaire, the Beck Depression Inventory-II, and the Emotional Intelligence Scale. To examine the relationships among all variables examined, zero-order correlation coefficients were calculated. To investigate the predictive power of EI and worry on depression, Bayesian linear regression was conducted. Results: The results showed significant and positive correlations between worry and depression in both samples. EI showed significant and negative correlations with both depression and worry in both the subclinical sample with elevated depressive symptoms and the non-clinical sample. Finally, worry emerged as the strongest contributor to the somatic dimension of depression in both groups. In the subclinical sample with elevated depressive symptoms, age and Evaluation and Expression of Emotion to Self, along with worry, were the best predictors of somatic symptoms. Conclusions: Our data suggest that higher worry levels are associated with higher levels of depressive symptoms, whereas higher EI was negatively associated with depressive symptoms and may play a potential buffering role. Training programs designed to enhance EI could help mitigate the impact of negative events, improve problem-solving skills, and enhance the expression of one’s own emotions. Full article

Apathy is a neuropsychiatric symptom that is present in various disorders, including dementia and Mild Cognitive Impairment (MCI). Patients with MCI who exhibit symptoms of apathy are at a higher risk of progressing to dementia compared to those with depressive symptoms. The aim of the present study was to investigate the psychometric properties of the clinician-rated version of the Apathy Evaluation Scale (AES-C) in a Greek sample of MCI patients and healthy older adults. The translation and adaptation of the scale were conducted using the forward–backward method. The final sample consisted of 100 participants, 14 men (n = 14) and 86 women (n = 86), with a mean age of 72 years. Participants were administered the translated and adapted version of the AES-C, as well as the Greek version of the Beck Depression Inventory. In terms of reliability, Cronbach’s alpha was found to be high (α = 0.91), indicating excellent internal consistency. Confirmatory Factor Analysis (CFA) revealed a one-factor solution with a very good model fit (RMSEA = 0.018, CFI = 0.985, TLI = 0.983, SRMR = 0.076). The AES-C can serve as an important addition to neuropsychological assessment for detecting apathy symptoms in patients with MCI, thereby contributing to the early prognosis of dementia. Full article

Background: The impact of thoracolumbosacral orthosis (TLSO) bracing on sagittal spinopelvic alignment and psychosocial outcomes in adolescent idiopathic scoliosis (AIS) remains debated. Methods: This retrospective comparative study included 120 girls (10–18 years) with AIS (baseline Cobb angle 20–40°) and skeletal immaturity (Risser 0–1). Patients were managed with a thoracolumbosacral orthosis (TLSO) brace (n = 60) or observation alone (n = 60). Standing posteroanterior and lateral full-spine radiographs were obtained at baseline and at 24 ± 6 months; follow-up radiographs were acquired out of brace after a standardized 48 h brace-free interval. They were used to measure coronal and sagittal spinopelvic parameters. Patient-reported outcomes included the Scoliosis Research Society-22r (SRS-22r), Pediatric Quality of Life Inventory (PedsQL), Spinal Appearance Questionnaire (SAQ), Trunk Appearance Perception Scale (TAPS), and Beck Depression Inventory (BDI). The primary endpoint was curve progression (≥5° increase or exceeding 40°) at 24 months. Multivariable regression was used to adjust for baseline Cobb angle and maturity. Mean follow-up was 24 ± 6 months. Results: Mean Cobb change was +1.2° in the brace group vs. +7.3° in the observation group (group × time interaction p < 0.001). Progression (≥5°) occurred in 15% vs. 45%, respectively, and 18% of observed patients exceeded 40° (risk ratio 0.33, 95% CI 0.17–0.65; number needed to treat 4, 95% CI 3–7). Sagittal spinopelvic parameters showed no significant group-by-time interaction. No significant between-group differences were observed in SRS-22r, PedsQL, SAQ, TAPS, or BDI at baseline or follow-up. Patients with curve progression exhibited worse appearance-related scores. In multivariable analysis, depressive symptoms were the strongest determinant of PedsQL (β = −0.55, p < 0.001). Conclusions: Brace treatment was associated with reduced curve progression in girls with moderate AIS. Over approximately two years of follow-up, we did not observe clinically relevant between-group differences in sagittal spinopelvic alignment or psychosocial patient-reported outcomes. Given the retrospective, non-randomized design and self-reported adherence, psychosocial findings should be interpreted cautiously and require confirmation in prospective, objectively monitored, psychologically informed bracing studies. Full article

Background: Major depressive disorder (MDD) is a common mental disorder characterized by a wide range of symptoms and a substantial contribution to global disease burden. Our study aimed to examine the relationships between childhood trauma, sleep quality, dissociative symptoms, posttraumatic growth, and suicidality in patients diagnosed with MDD. Methods: Our sample consisted of 115 patients with MDD and 84 healthy controls. Participants were administered the Hamilton Depression Rating Scale (HDRS), Beck Scale for Suicidal Ideation (BSSI), Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Questionnaire (CTQ-33), Dissociative Experiences Scale (DES), and Posttraumatic Growth Inventory (PTGI). Group differences were analyzed, and associations among variables within the MDD group were examined using correlation and mediation analyses. Results: Compared to healthy controls, patients with MDD had significantly higher scores on all scales except the PTGI (p < 0.001 for each). Within the MDD group, individuals with a history of suicide attempts had significantly higher CTQ total scores, physical and sexual abuse subscale scores, and DES scores than those without previous attempts. Additionally, dissociative experiences had a partial mediating role in the relationship between depression severity and suicidal ideation, as well as in the relationship between childhood traumas and sleep quality. Conclusions: The findings highlight the clinical relevance of dissociative experiences and sleep disturbances in the heterogeneous presentation of MDD and their association with illness severity and suicidality. In the follow-up and treatment process of patients with MDD, risk and protective factors should be evaluated together, and individualized treatment programs should be targeted. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and depression frequently occur together. Identifying the genes that influence both MASLD and depression may facilitate the discovery of biological pathways associated with disease risk. Methods: We recruited 525 participants from Mexican American families living in the Rio Grande Valley of south Texas. We collected clinical data, biometric measurements, hepatic health assessments using Vibration-Controlled Transient Elastography (VCTE), and depression evaluations determined with the Beck Depression Inventory-II. We estimated the heritability (h²) of MASLD-related measures, depression status, aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST/ALT ratio, and Vibration-Controlled Transient Elastography measurements. For each gene, we derived a genetic endophenotype representing its expression level. We then performed functional network and gene ontology enrichment analyses to characterize the underlying protein pathways. Results: We observed significant associations between the expression of two genes, Thyroid Hormone Receptor-Associated Protein 3 (THRAP3) (h² = 0.56 [0.45, 0.67]) and ADAM Metallopeptidase with Thrombospondin Type 1 Motif 7 (ADAMTS7) (h² = 0.66 [0.55, 0.77]), with depression and multiple MASLD-related phenotypes. We identified 351 genes with expression levels significantly correlated with one or more MASLD phenotypes and depression. Among these, five genes—ADAMTS7, THRAP3, CHPM4A, RAB9A, and PDIA3—were jointly associated with three phenotypes: AST/ALT, ALT, and Controlled Attenuation Parameter (CAP kPa). Based on the Fisher Combined Test, only THRAP3 (p = 3.0 × 10⁻²) and ADAMTS7 (p = 2 × 10⁻²) were jointly significant for depression (BDI-II) and AST, ALT, AST/ALT ratio, FAST, and CAP (kPa). We present a protein–protein interaction network comprising nodes (proteins) and edges (interactions), and a gene ontology enrichment analysis of cellular components. Discussion: Our findings highlight pleiotropic genes underlying MASLD and depression. Two genes, ADAMTS7 and THRAP3, warrant further investigation as potential targets for therapeutic interventions to manage MASLD and depression among Mexican Americans. These results may improve our understanding of the pathways involved in these two diseases, advance current research, and contribute to improvements in personalized medicine. Conclusion: We identified possible shared gene expression phenotypes linking MASLD and depression, which may provide insight into a common molecular underpinning. Pathway enrichment and gene analysis were used to help refine networks and enhance our understanding of complex gene-environmental interactions and their implications for precision medicine. Full article

Background: Elevated prolactin levels are associated with disturbances in female sexual function. While long-term therapy with dopamine agonists has been shown to improve these disturbances, the therapeutic benefits appear to be reduced in the presence of vitamin D deficiency or insufficiency. Therefore, the present study aimed to examine whether vitamin D status modulates the effects of metformin—a medication with less pronounced prolactin-lowering properties—on sexual function and depressive symptoms. Methods: The study cohort comprised three groups of reproductive-age women with drug-induced hyperprolactinemia and prediabetes, matched for age, glycated hemoglobin, and prolactin concentrations. Group I included 25 women with normal vitamin D status who were not receiving vitamin D supplementation. Group II consisted of 25 women with vitamin D deficiency or insufficiency that was adequately corrected through supplementation, while group III included 25 women with untreated vitamin D deficiency or insufficiency. All participants received metformin throughout the six-month study period. Female sexual function and depressive symptoms were assessed before and after metformin therapy using the Female Sexual Function Index (FSFI) and the Beck Depression Inventory-II (BDI-II), respectively. Additional outcome measures included plasma 25-hydroxyvitamin D, fasting plasma glucose, glycated hemoglobin (HbA_1c), the homeostatic model assessment of insulin resistance (HOMA-IR), prolactin, gonadotropins, and sex hormones. Results: Improvements in glucose homeostasis were observed across all groups; however, these changes were more pronounced in groups I and II than in group III. Reductions in prolactin concentrations (total and monomeric), accompanied by increases in gonadotropins, estradiol, and testosterone, were observed exclusively in women with normal vitamin D status. In groups I and II, metformin therapy resulted in significant improvements in total FSFI scores as well as in all individual domain scores. In contrast, in group III, the effects of metformin were limited to increases in the domain scores for lubrication and sexual satisfaction. Improvements in sexual function were positively associated with baseline 25-hydroxyvitamin D levels, reductions in prolactin concentrations, and, to a lesser extent, treatment-related changes in HbA_1c and increases in testosterone. A treatment-induced reduction in total BDI-II scores was observed only among women with normal vitamin D status. Conclusions: Low vitamin D status diminishes the beneficial effects of metformin on sexual function and depressive symptoms in reproductive-age women with iatrogenic hyperprolactinemia. Full article