Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49–2.95), nurse (OR 1.38; 95% CI 1.04–1.84), and ‘other clinical’ (OR 2.02; 95% CI 1.45–2.82); being redeployed (OR 1.27; 95% CI 1.02–1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98–2.99), anxiety (OR 4.87; 95% CI 3.92–6.06) and depression (OR 4.06; 95% CI 3.04–5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51–0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22–0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

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DETERMINANTS OF BURNOUT AND OTHER ASPECTS OF PSYCHOLOGICAL WELL-BEING IN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC: A MULTINATIONAL CROSS-SECTIONAL STUDY

10.1101/2020.07.16.20155622 ◽

2020 ◽

Author(s):

Max Denning ◽

Ee Teng Goh ◽

Benjamin Tan ◽

Abhiram Kanneganti ◽

Melanie Almonte ◽

...

Keyword(s):

Healthcare Workers ◽

Strong Association ◽

Depression Scale ◽

Well Being ◽

Psychological Outcomes ◽

Psychological State ◽

Anxiety And Depression ◽

Safety Attitudes ◽

Job Role ◽

The Relationship

Background The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. Methods From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Results Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and other clinical staff (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Factors significantly protective for burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Conclusion Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

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Caregiver Burden Domains and Their Relationship with Anxiety and Depression in the First Six Months of Cancer Diagnosis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17114101 ◽

2020 ◽

Vol 17 (11) ◽

pp. 4101 ◽

Cited By ~ 2

Author(s):

Francisco García-Torres ◽

Marcin J. Jabłoński ◽

Ángel Gómez Solís ◽

María José Jaén-Moreno ◽

Mario Gálvez-Lara ◽

...

Keyword(s):

Longitudinal Study ◽

Caregiver Burden ◽

Cancer Diagnosis ◽

Depression Scale ◽

Psychological State ◽

Anxiety And Depression ◽

Hospital Anxiety ◽

Predictive Utility ◽

Cancer Caregiving ◽

The Relationship

Cancer caregiving is associated with burden and a poor psychological state. However, there is no previous information about the predictive utility of specific burden domains on anxiety and depression in the first six months after a partner’s cancer diagnosis. In a longitudinal study, 67 caregivers completed the Zarit Burden Interview (ZBI) and Hospital Anxiety and Depression Scale (HADS) at T1 (45–60 days after diagnosis) and T2 (180–200 days after diagnosis). Most of the caregivers were female (65.7%, mean age = 51.63, SD = 13.25), while patients were mostly male (56.7%). The TRIPOD checklist was applied. ZBI scores were moderate and HADS anxiety reached significant values. There were no differences in ZBI and HADS between T1 and T2. The relationship between burden, anxiety, and depression were more consistent at T2, while emotional burden at T1 were related and predicted anxiety and depression at T2. Some burden domains were related and predicted anxiety in caregivers in the first six months after partner cancer diagnosis. This information could be useful to prevent the onset of these symptoms in the first six months after diagnosis.

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190 Determinants of Psychological Well-Being in Healthcare Workers During the Covid-19 Pandemic: A Multinational Cross-Sectional Study

British Journal of Surgery ◽

10.1093/bjs/znab134.043 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E T Goh ◽

M Denning ◽

S Purkayastha ◽

J Kinross

Keyword(s):

Healthcare Workers ◽

Well Being ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Sectional Study ◽

Cross Sectional ◽

Psychological Well Being ◽

Safety Attitudes ◽

The Uk ◽

The Impact

Abstract Introduction The Covid-19 pandemic has placed unprecedented pressures on healthcare systems globally, impacting working conditions, safety attitudes and the psychological well-being of healthcare workers. This cross-sectional study explores the prevalence and predictors of anxiety/depression amongst healthcare workers in the UK, Singapore, and Poland. Method From 22 March to 18 June 2020, healthcare workers from the UK, Singapore and Poland were invited to complete a self-administered questionnaire on psychological well-being. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Other components of the questionnaire include demographic information, Safety Attitudes Questionnaire (SAQ) measuring safety culture and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Multivariate logistic regression was used to determine predictors of anxiety and depression. Results Of 3537 healthcare workers who participated in the study, 701 (20%) screened positive for anxiety and 389 (11%) for depression. Significant predictors of depression and anxiety include low SAQ score, nursing role, redeployment, burnout, and depression. There was significant overlap between anxiety and depression. The doctor role was protective. Conclusions Our findings demonstrate a significant burden of anxiety and depression amongst healthcare workers during Covid-19. These findings highlight the impact of Covid-19 on psychological well-being and suggests which groups would benefit from targeted support.

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The Relationship Between Spiritual Health With The Levels of Anxiety And Depression Among Cancer Patients

10.21203/rs.3.rs-914472/v1 ◽

2021 ◽

Author(s):

Mohammad Ali Hossein Tehrani ◽

Mohammad Hadi Yadollahpour ◽

Mohsen Vakili Sadeghi ◽

Angela Hamidia

Keyword(s):

Mental Health ◽

Cancer Patients ◽

Pearson Correlation ◽

Depression Scale ◽

Well Being ◽

Tertiary Hospital ◽

Spiritual Health ◽

Anxiety And Depression ◽

Cross Sectional ◽

The Relationship

Abstract Purpose: Spiritual health is one of the dimensions of health associated with physical, social, and mental health. It can play an essential role in coping with stressful disease-related conditions. The purpose of this study was to evaluate the association between spiritual health and the level of anxiety and depression among cancer patients. Methods: In this cross-sectional study, 200 cancer patients were referred to a tertiary hospital in Iran. Hospital Anxiety and Depression Scale (HADS) and Spiritual Well Being Scale questionnaires were provided to the patients. Results: The mean score of spiritual health was 76.61±20.007 in cancer patients, which was considered moderate. The relationship between spiritual health and anxiety and between spiritual health and depression was significant. According to the Pearson correlation coefficient, the relationship between spiritual health and anxiety (r=-0.838) and depression (r=-0.834) was inverse. Furthermore, the relationship between spiritual health and anxiety (P<0.001) (r=-0.832) and depression (P<0.001) (r=-0.842) and the relationship between existential health and anxiety (P<0.001) (r=-0.830) and depression (P<0.001) (r=-0.813) were significant and inverse. Conclusion: The present study showed that spiritual health positively reduces anxiety and depression in cancer patients, promotes mental health, and accelerates and improves the disease.

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Family Physicians’ Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic—A Nationwide Survey Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042093 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2093

Author(s):

Tina Vilovic ◽

Josko Bozic ◽

Marino Vilovic ◽

Doris Rusic ◽

Sanja Zuzic Furlan ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Perceived Stress ◽

Depression Scale ◽

Family Physicians ◽

Knowledge Score ◽

Well Being ◽

Anxiety And Depression ◽

Event Scale ◽

The Impact

During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) are the backbone of the healthcare system with considerable impact on the general population, and their well-being is of great importance. The aim of this investigation was to assess FPs mental health, as well as knowledge, attitudes and practices (KAPs) regarding the pandemic, and opinions on non-communicable disease (NCD) health care provided to patients. A cross-sectional study was carried out with a sample of 613 FPs. Anxiety and depression levels were estimated with the Hospital Anxiety and Depression Scale, subjective perceived stress with the Perceived Stress Scale, while trauma-related symptoms were assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and opinions regarding NCD patients were evaluated with questionnaires accordingly. Results have shown that age (β = −0.02, p = 0.013) and personal risk of COVID‑19 (β = 1.05, p < 0.001) were significant independent correlates of the knowledge score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an independent predictor of perceived stress (β = −0.33, p = 0.023) and anxiety (β = −0.31, p = 0.006) levels. Limited accessibility to healthcare services and decreased number of newly-diagnosed NCD cases were mostly agreed on. The pandemic puts a considerable strain on FPs mental health, as well as on public health measures, due to the decreased overall quality of NCD patient health care. Educational programs may bridge the gaps between FPs’ knowledge. Thus lowering anxiety and improving patient care.

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Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217420982085 ◽

2020 ◽

pp. 009121742098208

Author(s):

Ali Kandeğer ◽

Memduha Aydın ◽

Kürşat Altınbaş ◽

Alparslan Cansız ◽

Özge Tan ◽

...

Keyword(s):

Social Support ◽

Coping Strategies ◽

Perceived Social Support ◽

Depression Scale ◽

Negative Association ◽

Anxiety And Depression ◽

Control Group ◽

Depression Symptoms ◽

Adaptive Coping ◽

The Relationship

Objective We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. Method The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. Results The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04–17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73–0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79–0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93– 0,99) had a negative association with depression symptoms. Conclusions Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

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AB0177 ANXIETY-DEPRESSIVE SPECTRUM IN PATIENTS WITH RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDILITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3444 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1114.2-1114

Author(s):

M. Letaeva ◽

M. Koroleva ◽

J. Averkieva ◽

O. Malyshenko ◽

T. Raskina

Keyword(s):

Rheumatoid Arthritis ◽

Depressive Disorders ◽

Depression Scale ◽

Well Being ◽

Depressive Syndrome ◽

Depression Screening ◽

Anxiety And Depression ◽

Control Group ◽

Subjective Well Being ◽

Anxiety Depression

Objectives:to assess the frequency of occurrence of the anxiety-depressive spectrum in patients with rheumatoid arthritis and ankylosing spondylitis.Methods:A survey was conducted of 44 patients aged from 21 to 57 years (average age - 42.3 ± 6.7 years), who were treated at GAUZ KO OKGVV. All patients had a verified diagnosis of RA and AS according to the ACR criteria and received treatment with basic drugs. The control group consisted of 40 people comparable in age and sex, without concomitant pathology of RA and AS.The depression screening card, the subjective well-being scale, and the hospital anxiety and depression scale (HADS) were used to assess and detect anxiety-depressive syndrome. The assessment of the condition is carried out over the last 2 weeks, which corresponds to the temporary diagnostic criterion for depression.The Depression Screening Scale is a 35-item self-questionnaire that assesses 7 categories of signs: sleep and appetite disorders, anxiety, emotional instability, cognitive impairment, loss of self, guilt, and suicidal tendencies. A total score of 65 and above indicates a high likelihood of depression.The Subjective Well-Being Scale is a psychodiagnostic screening tool for measuring the emotional component of subjective well-being or emotional comfort.Hospital Anxiety and Depression Scale Zigmond A.S., Snaith R.P. was developed for the primary detection of depression and anxiety in a general medical practice. The HADS scale consists of 14 statements with 4 possible answers and includes two parts: anxiety and depression. The sum of points of 8 or more is regarded as “subclinically expressed anxiety / depression”, 11 or more points - “clinically expressed anxiety / depression”.Results:According to the results of the depression screening questionnaire, 34 (77.3%) patients with RA and AS showed signs of depression, while in the control group only 6 (15%) patients tested positive for the presence of depressive disorders. According to the data obtained when assessing the scale of well-being in the main group, 26 (59.1%) patients showed signs of emotional discomfort (the indicator was 80% or more), in the control group - in 6 (15%). Using the hospital scale of anxiety and depression HADS, anxiety-depressive syndrome was detected in 36 (81.8%) patients with RA and AS: 16 (44.4%) patients had anxiety, 20 (55.6%) - depression, of them, subclinically expressed anxiety and depression were observed in 10 (27.7%) and 12 (33.3%) people, respectively. Anxiety-depressive syndrome in the control group, according to the HADS questionnaire, was detected only in 8 (20%) patients, of whom 4 (10%) patients had subclinical anxiety and 4 (10%) had signs of depression. No clinically pronounced anxiety and depression were registered in the control group.Conclusion:In most patients with rheumatoid arthritis and ankylosing spondylitis, anxiety-depressive disorders have been identified, which can directly affect both the course of the disease itself and the development of various complications. Timely diagnosis of mental disorders and close cooperation of rheumatologists, psychiatrists and psychologists in the selection of adequate therapy can improve the course and prognosis of the disease.Disclosure of Interests:None declared

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P–478 Quality of life assessment in women undergoing assisted reproduction. A study of FertiQol and HADS

Human Reproduction ◽

10.1093/humrep/deab130.477 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Figueras-Puigderrajols ◽

A Ballesteros ◽

D Guerra

Keyword(s):

Quality Of Life ◽

Depression Scale ◽

Well Being ◽

Self Esteem ◽

Mobile App ◽

Life Assessment ◽

Fertility Treatment ◽

Anxiety And Depression ◽

Gamete Donation

Abstract Study question The present study aims to explore infertility-related psychosocial outcomes, including fertility quality of life (QoL), as well as anxiety and depression levels, in women diagnosed with infertility. Summary answer Differences on fertility-related QoL appeared when comparing treatment types (gamete donation vs own gamete). Furthermore, statistically significant associations were found between QoL and anxious-depressive symptomatology. What is known already Those who wish to have children and do not achieve their objective just like other peers can see their goals and expectations with pessimism, generating concern and a series of negative emotions. Several psychological implications of infertility have been described, such as increased levels of stress, anxiety, depression, decreased self-esteem, mood and hope, or poor relationship adjustment. The emotional impact of infertility in people’s life cycle can be so strong that reducing it only to biological aspects would lead to a dangerous situation of neglect. For this reason, QoL assessment in ART becomes an important need. Study design, size, duration FertiQol stands as the most widely used tool to assess infertility-related QoL, overcoming the limitations of other instruments that only target specific medical conditions. The present is a multi-site cross-sectional study over patients with infertility (n = 104), aiming to explore their fertility-QoL, as well as their anxiety and depression levels, which are symptoms that have been previously associated.Questionnaire administration, and sociodemographic and medical data gathering took place between January 2019 and December 2020. Participants/materials, setting, methods Participants were 104 female patients (M.age= 39.8) undergoing or expecting a fertility treatment. The FertiQol Spanish version was administered through mobile app, and its paper version distributed at medical/psychological appointments. QoL was self-reported through FertiQol, assessing the influence of infertility problems in various areas (e.g. impact on self-esteem, emotions, general health, family, partners, social relationships, work, life projects...). Additionally, HADS (Hospital Anxiety and Depression Scale) was provided as a measurement of anxiety and depression levels. Main results and the role of chance Regarding treatments, 50.6% of participants were currently undergoing gamete donation while 44.3% were undergoing treatments that involved using their own gametes. After comparing QoL between these treatment types, results showed that patients who underwent egg donation, compared to those who used their own eggs, reported statistically significantly lower scores of QoL in the Social Subscale (p = .03), but not in the other psychological outcomes. Also, statistically significant negative correlations were found between HADS and all core FertiQol subscales (p< .05). Results are consistent with previous studies showing similar associations between fertility QoL and anxiety and depression, as well as with increased psychological negative implications of gamete donation. The majority of participants reported non-pathological scores of anxiety and depression when considering the cut off value of 8 for HADS, thus suggesting the presence of a relatively healthy sample. The number of treatments that patients had previously taken and the years of infertility were not associated with any of the psychological variables. Limitations, reasons for caution Some limitations to consider are presence of co-morbid diagnosis, differences in medication, or patient’s cultural backgrounds.Also, conclusions should be interpreted cautiously since the design doesn’t allow causal inferences. Further investigations should consider a continuous assessment to explore changes in psychological well-being at different points of intervention, specially with gamete donation. Wider implications of the findings: The great advantage we’ve seen so far when using FertiQol is the possibility to identify more accurately the true impact on other aspects of patient’s well-being besides the emotional area.ART professionals, including psychologists and counselors,will have more information within a small amount of time about QoL when using this tool. Trial registration number 1503-BCN–019-DG

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Level of anxiety among a sample of battered women in Gaza governorates: مستوى القلق لدى عينة من السيدات المعنفات بمحافظات غزة

المجلة العربية للعلوم ونشر الأبحاث مجلة العلوم التربوية والنفسية ◽

10.26389/ajsrp.r050320 ◽

2020 ◽

Vol 4 (29) ◽

Author(s):

Alaa Maher Elshafie

Keyword(s):

Statistical Analysis ◽

Battered Women ◽

Communication Skills ◽

Pearson Correlation ◽

Depression Scale ◽

Anxiety And Depression ◽

Marital Communication ◽

Training Courses ◽

The Relationship ◽

Descriptive Method

The current study aimed to identify the level of anxiety and depression among a sample of battered women in the governorates of Gaza, and to uncover the relationship between anxiety and depression after the statistical analysis, The study used the descriptive method, and the study sample consisted of (130) battered women who are married and registered with the institutions and associations concerned with that category at the level of Gaza governorates. And to achieve the goals of the study, the researcher developed the anxiety scale and used the Depression Scale (Labik) (Al-Hussein, translation: Ahmed Abdel-Khalek, 2002). The results revealed that the level of anxiety among battered women in the governorates of Gaza was "average", and that the level of depression among them was high, and that the Pearson correlation between anxiety and depression was equal to (0.85), which is a direct correlation coefficient statistically significant at the level of (0.01), which means that whenever Increased anxiety increased depression. The researcher recommends the need to apply counseling programs to both husbands and wives in developing marital communication skills. Conducting training courses for those who are about to get married to learn how to manage marital life, and know the rights and duties.

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Premature Ejaculation in Urban Malaysian Population: The Associations between Erectile Dysfunction(ED), Anxiety and Depression

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v15i1.413 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shamini Arasalingam ◽

Hatta Sidi ◽

Ng Chong Guan ◽

Srijit Das ◽

Marhani Midin ◽

...

Keyword(s):

Erectile Dysfunction ◽

Clinical Diagnosis ◽

Premature Ejaculation ◽

Strong Association ◽

Depression Scale ◽

Anxiety And Depression ◽

Health Issues ◽

Dsm V ◽

Male Patients ◽

The Relationship

Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population. Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS). Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE. Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.

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