2001

ORIGINAL RESEARCH—PSYCHOLOGY

Trait-Affect, Depressed Mood, and Male Sexual Functioning:

A Preliminary Study jsm_2779 2001..2008

Manuela Peixoto, MA and Pedro Nobre, PhD

Departamento de Educação, Universidade de Aveiro, Aveiro, Portugal

DOI: 10.1111/j.1743-6109.2012.02779.x

ABSTRACT

Introduction. The relationship between trait-affect, depressed mood, and sexual functioning has been studied;
however, the nature of that relation is not yet well established.
Aim. The aim of the present study was to investigate the mediator role that depressed mood plays in the relation
between trait-affect and sexual functioning in men.
Methods. A total of 205 men from the general population participated in the study and completed self-reported
measures assessing trait-affect, depressed mood, and sexual functioning.
Main Outcome Measures. Trait-affect was measured by the Positive Affect–Negative Affect Scale—Expanded
Version, depressed mood was assessed by the Beck Depression Inventory, and male sexual function was measured by
the International Index of Erectile Function.
Results. Regression analysis showed that negative trait-affect and depressed mood were significant predictors of
sexual functioning. Moreover, mediation analyses indicated that depressed mood partially mediate the relationship
between negative trait-affect and sexual functioning in men.
Conclusion. Findings support the role of negative trait-affect and depressed mood on male sexual functioning.
Peixoto M and Nobre P. Trait-affect, depressed mood, and male sexual functioning: A preliminary study. J
Sex Med 2012;9:2001–2008.
Key Words. Comorbid Association of Depression and Sexual Dysfunction; Depressed Mood; Male Sexual Func-
tioning; Positive and Negative Trait-Affect

Introduction Positive and negative trait-affect as well as physi-

ological hyperarousal has been indicated as main

D epression and sexual dysfunction are often

comorbid clinical conditions in both men
and women [1–6]. The nature of this overlap and
the causal link between the two conditions is,
however, not yet known. Depression may act as a
precipitant for sexual dysfunction and the opposite
may also occur. Moreover, the two conditions may
share a common vulnerability factor that could
explain their strong overlap. One potential vulner-
ability factor is trait-affect as it is conceptualized
by Clark and Watson [7] in the Tripartite Model.
The Tripartite Model [7] has been proposed as
the preferred conceptualization of the relationship
between depression and anxiety disorders [8,9].
components of the Tripartite Model and concep-
tualized as latent structures of emotional disorders
(e.g., depression and anxiety disorders). According
to this theoretical paradigm, high levels of nega-
tive trait-affect are common to anxiety disorders
and depression; the absence of positive trait-affect
is a specific characteristic of depression, while
physiological hyperarousal is more exclusive of
anxiety disorders [7]. In the last two decades,
several studies have been conducted, using differ-
ent samples, in order to collect empirical data to
support the Tripartite Model, and those findings
reveal robust support [7,8,10–14]. A few studies
[15–17] have also demonstrated the strength of the

© 2012 International Society for Sexual Medicine J Sex Med 2012;9:2001–2008

2002
paradigm using structural equation modeling.
According to this empirical data, the latent struc-
tures, specifically trait-affect and physiological
hyperarousal, presumably act as vulnerability
factors for the development and maintenance of
depression and anxiety disorders.
Regarding the relationship between depressed
mood and sexual dysfunction there is accumulated
knowledge suggesting their strong association
[1,2,5,18–21]. Although there is lack of evidence
about causality direction, studies indicated that the
experience of depressed mood is associated with
diminished sexual desire and sexual interest
[5,6,22]. Moreover, despite a small percentage of
individuals reporting an increase on sexual interest
and sexual performance in the presence of
depressed mood [23–25], most men complain
about erectile difficulties, lack of pleasure, and
decreased sexual satisfaction [1–3,19,26]. Studies
based on retrospective reports of emotional states
have indicated that sadness, lack of pleasure, and
lack of satisfaction during sexual activity were sig-
nificantly more common among men with sexual
dysfunction compared with sexually healthy men
[27,28]. In summary, research has shown that
affective states (and particularly negative and posi-
tive trait-affect) are implicated in both depression
and sexual dysfunction.
Barlow’s model [29] proposed that negative
affect plays a major role in the etiology of sexual
dysfunction, particularly erectile disorder. Barlow
[29] suggested that individuals with sexual prob-
lems would respond with negative affect when
exposed to a sexual event and this would promote
the focus of attention on the negative conse-
quences of not performing. On the other hand,
sexually healthy men would respond to sexual
events with positive affect which leads to focusing
attention on erotic and sexual cues.
Several studies have been conducted to test the
role of affect on sexual functioning. Experimental
studies indicated that manipulated negative affect
produced a delay in subjective sexual arousal [30]
and a decrease in penile tumescence [31] in sexually
healthy men. Moreover, findings from Beck and
Barlow [32] indicated that men with sexual dysfunc-
tion reported significantly lower levels of positive
affect during exposure to erotica in comparison
with sexually healthy men. Additionally, studies
have indicated a positive correlation between posi-
tive affect and subjective sexual arousal in men with
and without sexual dysfunction, during exposure to
erotic films [33–37]. Although the experimental
studies have highlighted the role of positive and
J Sex Med 2012;9:2001–2008
Peixoto and Nobre
negative affect in male sexual functioning, their
major focus is the state-affect, and little is known
about trait-affect.
The Tripartite Model may be a useful framework
to understand the relationship among trait-affect,
depression, and sexual dysfunction. Data suggest
that trait-affect (both negative and positive trait-
affect) is associated with depression. Moreover,
clinical and empirical data support the idea of the
strong overlap between depression and sexual func-
tion. Lastly, recent conceptual models have pro-
posed that trait-affect may work as a potential
vulnerability factor for sexual dysfunction in both
men and women [38,39]. Despite this knowledge,
there are no published studies on the relationship
among trait-affect, depression, and sexual function.
The aim of the present study was to explore the
relationship among trait-affect, depressed mood,
and sexual functioning in men. Using the Tripartite
Model as a framework, we hypothesized that trait-
affect (both positive and negative affect as measured
by the Positive Affect–Negative Affect Scale
[PANAS]) would be significantly associated with
state depressed mood (as measured by the Beck
Depression Inventory [BDI]). Moreover, taking
into account the high comorbidity and overlap
between depressed mood and sexual dysfunction,
we expected that these two dimensions would be
strongly correlated (negative correlations between
the BDI and the International Index of Erectile
Function [IIEF] total score). Consequently, we also
expected that sexual functioning (as measured by
the IIEF total score) would be associated with trait-
affect (positively correlated with positive affect and
negatively correlated with negative affect). Finally,
and taking into consideration the fact that trait-
affect has been conceptualized as a vulnerability
factor for depression [7,8,10–17] and sexual dys-
function [37,38], we aimed at testing the mediator
role of depressed mood (as an emotional state) in
the relationship between trait-affect and male
sexual functioning in order to investigate the ability
of trait-affect to predict sexual functioning above
and beyond depressed mood.
Methods
Participants and Procedures
A total of 205 men from the general population
(convenience sample) participated in the study.
Participants were recruited in north of Portugal,
by a group of master students from Trás-os-
Montes e Alto Douro University using nonran-
dom methods. Participants were contacted directly
Trait-Affect, Depressed Mood, Male Sexual Functioning
Table 1 Demographic characteristics of the sample: age,
marital status, and educational level (N = 205)
N = 205
Age (in years)
Mean 37.4
Standard deviation 11.1
Range 18–70
Marital status
Single 27%
Married/living together 69.6%
Divorced 3.4%
Education
0–9 years 27.5%
10–12 years 30.3%
>13 years 42.2%
by the group of students, received an explanation
of the purpose of the study, and signed a consent
form. Participants received the questionnaires and
were instructed to answer them when alone and in
the privacy of their homes and then to return
them, using sealed envelopes. Individuals were not
paid for their participation. The sample was
obtained between February and May 2010, and the
participation rate was 80% (percentage of men
who were approached and accepted to participate).
Participants who were not in a relationship and did
not engage in sexual activity for the last 4 weeks
were excluded from the study. The study was
approved by an ethics committee. Demographic
characteristics of the sample are shown in Table 1.
Materials
The IIEF
The IIEF [40] is a 15-item self-administered
measure assessing different areas of sexual func-
tioning in men. The participants answered about
their sexual functioning in the past 4 weeks. A
principal component analysis identified five
factors: erectile function, orgasmic function,
sexual desire, intercourse satisfaction, and overall
satisfaction. The IIEF allows the calculation of a
sexual function total index as well as specific
indexes for each dimension (total: 5–75; erectile
function: 1–30; orgasmic function: 0–10; sexual
desire: 2–10; intercourse satisfaction: 0–15; overall
satisfaction: 2–10). Higher values at specific and
total indexes correspond to better levels of sexual
functioning. Psychometric studies supported the
validity (significant mean score differences
between a clinical and a control group) and reli-
ability (Cronbach’s alpha values of 0.73 and higher
and test–retest from r = 0.64 to r = 0.84) of the
measure. Studies with clinical samples demon-
2003
strated its sensitivity and specificity for detecting
treatment-related changes [40]. The measure
allows the calculation of specific indexes for each
dimension as well as a sexual function total index
(calculated through the sum of the specific dimen-
sional indexes), with higher scores indicating
greater levels of sexual functioning. The Portu-
guese version also presented good psychometric
properties [41]. Test–restest analysis indicated cor-
relations between two administrations with a
2-week interval ranging from 0.69 to 0.90 and
Cronbach’s alpha values were between 0.72 and
0.86 [41].
The BDI
The BDI [42] is a self-administered measure, com-
prising 21 items that assess six types of depressive
symptoms: affective, cognitive, motivational, delu-
sional, physical, and functional. Each item consists
of four or five statements, arranged according to
symptom severity, and the subject must indicate
the response that best represents his current state
(during the last week). The BDI allows calculating
a total index of depressive symptomatology (total:
0–63), with higher scores corresponding to more
severe levels of depressed mood. This instrument
has good psychometric properties, including good
internal consistency (Cronbach’s alpha 0.93) and
good test–retest reliability (r = 0.93) [43]. Accord-
ing to studies conducted in Portugal, the Portu-
guese version also has good psychometric
properties [44].
The PANAS—Expanded Version (PANAS-X)
The PANAS-X [45] is a self-administered ques-
tionnaire comprising 60 items, assessing two
dimensions of emotional condition, Positive Affect
(PA) and Negative Affect (NA) and 11 specific
affects: Fear, Sadness, Guilt, Hostility, Shyness,
Fatigue, Surprise, Playfulness, Self-Affirmation,
Attention, and Serenity. Answers are given accord-
ing to a Likert scale of 5 points (from 1 “very little
or nothing” to 5 “extremely”), and participants
answered about what they feel in general (trait
measure). The PANAS-X allows calculating an
index of Positive Trait-Affect and an index of
Negative Trait-Affect (Positive trait-affect: 1–5;
Negative trait-affect: 1–5), with higher scores in
those indexes indicating higher levels of positive
and negative trait-affect, respectively. In terms of
psychometric characteristics, PANAS-X have a
high internal consistency and temporal stability
and convergent and discriminant validity. The two
subscales (PA and NA) of PANAS-X have a Cron-
J Sex Med 2012;9:2001–2008
2004 Peixoto and Nobre

Table 2 Means, SD, range, and median of Negative and positive trait-affect showed no significant correla-
Positive Trait-Affect, Depressed Mood, and Male Sexual tions with any of the IIEF domains or its total
Functioning (N = 205)
score.
M SD Range Median In order to explore the ability of the dimensions
Negative trait-affect 1.98 0.52 1–3.5 1.95 of trait-affect and depressed mood to predict
Positive trait-affect 3.5 0.51 1.2–5 3.5 sexual functioning in men, we performed a mul-
BDI total 4.04 4.55 0–26 3
IIEF total 65.68 7.07 37–75 68
tiple regression analysis (enter method) using posi-
Erectile function 26.75 4.31 2–30 28 tive and negative trait-affect (measured by
Orgasmic function 9.28 1.25 0–10 10 PANAS-X) and depressed mood (measured by the
Sexual desire 8.81 1.03 5–10 9
Sexual satisfaction 11.73 2.55 0–15 12
BDI) as predictors and male sexual functioning as
Overall satisfaction 8.86 1.26 4–10 9 criterion (measured by the IIEF total score).
SD = standard deviation; BDI = Beck Depression Inventory; IIEF =
The multiple regression analysis showed a sig-
International Index of Erectile Function nificant model (F [3, 171] = 6.875, P < 0.001),
accounting for 9.2% of male sexual functioning
(adjusted R2 = 0.092). According to the standard-
bach’s alpha of 0.88 and 0.85, respectively, and a ized regression coefficients analysis, negative trait-
reliability test–retest of 0.70 and 0.71, respectively. affect (b = -0.17, P < 0.05) and depressed mood
The Portuguese version presents appropriate psy- (b = -0.17, P < 0.05) were significant predictors of
chometric properties, namely adequate values of male sexual functioning (see Table 4).
Cronbach’s alpha for Positive Trait-Affect scale
(a = 0.88) and for Negative Trait-Affect (a = 0.66), Mediator Role of Depressed Mood in the Relation
as well as appropriate test–retest temporal stability Between Trait-Affect and Male Sexual Function
(Positive Trait-Affect—r = 0.76; Negative Trait- In order to test the mediating role of depressed
Affect—r = 47) [46]. mood in the relation between trait-affect and male
sexual functioning, we conducted several regres-
Results sion analyses according to Baron and Kenny’s [49]
procedure for testing mediational hypotheses. The
Trait-Affect, Depressed Mood, and Male following conditions have to be confirmed to grant
Sexual Functioning the effect of mediation: (i) trait-affect (positive and
The means, standard deviation (SD), range, and negative affect) is a significant predictor of
median of the responses to the PANAS-X, BDI,
and IIEF as well as their dimensions are presented
in Table 2. According to the cut-off of the erectile Table 3 Pearson’s correlations between trait-affect,
function domain assessed by the IIEF (<22) depressed mood, and male sexual function (N = 205)
[47,48], 24 men in the sample (11.7%) present Depressed Positive Negative
with some level of erectile difficulty. IIEF indexes mood trait-affect trait-affect
Pearson’s correlation analyses indicated that Sexual desire -0.22** 0.19 -0.15
depressed mood (assessed by the BDI) was signifi- Erectile function -0.14 0.08 -0.21*
cantly correlated with negative trait-affect Orgasmic function -0.18 -0.05 -0.17
Intercourse satisfaction -0.31*** 0.16 -0.23*
(r = 0.41, P < 0.001), but not with positive Overall satisfaction -0.23** 0.12 -0.11
trait-affect (r = -0.15, not significant). Total IIEF -0.27*** 0.14 -0.25**
In order to evaluate the association among trait- *P < 0.05; **P < 0.01; ***P < 0.001
affect, depressed mood, and men’s sexual function- Note: Statistical significance using Bonferroni corrections
IIEF = International Index of Erectile Function
ing, Pearson’s correlation analyses were
performed (see Table 3). Findings showed that
depressed mood was significantly correlated with Table 4 Trait-affect and depressed mood as predictors
the IIEF total score and to most of the sexual of male sexual functioning: multiple regression analysis,
dimensions with the exception of erectile enter method (N = 205)
(r = -0.14, P > 0.05) and orgasmic function Standard
(r = -0.18, P > 0.05). Additionally, negative trait- Predictors B error b
affect was significantly correlated with the IIEF Positive affect 1.69 1.01 0.12
total score and with the dimensions of erectile Negative affect -2.24 1.04 -0.17*
function (r = -0.21, P < 0.05) and intercourse sat- Depressed mood -0.25 0.12 -0.17*

isfaction (r = -0.23, P < 0.05). On the other hand, *P < 0.05

J Sex Med 2012;9:2001–2008

Trait-Affect, Depressed Mood, Male Sexual Functioning
Table 5 Regression analyses for testing depressed mood as mediator variable for the relation between negative
trait-affect and male sexual functioning (N = 205)
Criterion Predictor
Depressed mood Negative trait-affect
Male sexual functioning Negative trait-affect
Male sexual functioning (a) Negative trait-affect
Depressed mood
*P < 0.05; ***P < 0.001
Note: (a) Sobel value, t = 2.17, P < 0.05; percentage of total effect mediated = 29%
depressed mood; (ii) trait-affect (positive and
negative affect) significantly predicts male sexual
functioning; and (iii) depressed mood is a signifi-
cant predictor of male sexual functioning.
The first condition (i) was not met for positive
affect. The regression analysis indicated that posi-
tive affect was not a significant predictor of male
sexual functioning (b = 0.12, P = 0.097) (cf.
Table 4). Therefore, the mediation of depressed
mood in the relationship between positive affect
and sexual functioning was not tested.
Regarding negative affect, the first three condi-
tions for the test of mediation were met. The
regression analysis indicated that when depressed
mood was included in the equation we observed an
increased in R2 value, from 0.06 to 0.09, F (2,
172) = 8.829, P < 0.001. Additionally, the value of
the regression coefficient between negative affect
and male sexual functioning was reduced from
b = -0.25, P < 0.001 to b = -0.18, P < 0.05, when
depressed mood was controlled. In order to deter-
mine if a partial mediation had occurred, we per-
formed a Sobel test of mediation [50], which was
significant (t = 2.17, P < 0.05), and suggested that
about 29% of the total effect of negative trait-
Figure 1 Mediator role of depressed mood in the relationship between negative trait-affect and male sexual functioning
(N = 205); *P < 0.05; ***P < 0.001
2005
F R2 b
36.85*** 0.17 0.41***
11.92*** 0.06 -0.25***
8.83*** 0.09 -0.18*
-0.19*
affect on male sexual functioning was mediated by
depressed mood (see Table 5).
Figure 1 illustrates the mediator role of
depressed mood in the relationship between nega-
tive trait-affect and male sexual functioning.
Discussion
This study was aimed at exploring the relationship
among trait-affect, depressed mood, and sexual
functioning in men. Overall, findings were prelimi-
nary and indicated that male sexual functioning was
significantly associated with negative trait-affect
and with depressed mood. Moreover, results also
showed that depressed mood partially mediated the
relationship between negative trait-affect and male
sexual functioning.
Regarding the association between depressed
mood and sexual functioning, our findings repli-
cated previous studies [3,19,25,51] indicating sig-
nificant correlations between depressed mood
(measured by the BDI) and most dimensions from
the IIEF, particularly sexual desire, intercourse sat-
isfaction, and overall satisfaction. The association
between depressed mood and sexual desire was in
J Sex Med 2012;9:2001–2008
2006
accordance with several studies that consider lack
of sexual desire as the sexual complain more
strongly affected by depressed mood [5,6,22,52].
One unexpected finding was the low and nonsig-
nificant correlation between erectile function and
depressed mood, which is contradictory to previ-
ous studies [1,2,4,6]. This low correlation may be
explained by the low variability of the erectile
function dimension in our sample. In fact, the
mean score for the erectile function domain was
26.75 (SD = 4.31) in a scale ranging from 2 to 30.
Barlow’s model [29] suggests that dysfunctional
men present high levels of negative affect, whereas
functional men reveal high levels of positive affect.
Regarding the association between trait-affect and
sexual functioning, our findings indicate that nega-
tive trait-affect was significantly associated with
sexual functioning. Even after controlling for
depressed mood (BDI), negative trait-affect was
still a significant predictor of male sexual function-
ing, suggesting that negative trait-affect plays a
unique role on sexual functioning, above and
beyond depressed mood. However, we did not
observe the equivalent results for positive trait-
affect. Curiously, this latter result was not consis-
tent with previous findings indicating low positive
affect as strongly related to reduced sexual
response or low levels of sexual functioning
[27,32–37]. Moreover, and contrary to predictions,
positive affect was also not significantly correlated
with depressed mood. These two unexpected find-
ings may be explained by the low variability of
positive affect in our sample. The mean score of
positive affect was 3.5 in a scale ranging from 1 to
5 (SD = 0.51). Additionally, it may be that the
absence of positive affect is related to more severe
forms of depressed mood and sexual dysfunction
and not to mild or moderate levels of these clinical
conditions. In our study, only a small percentage of
men scored at a clinical level of depression (1%)
and sexual dysfunction (11.7%—erectile dysfunc-
tion) using the IIEF and BDI cutoff scores. Studies
testing the Tripartite Model used clinical samples
(depression and anxiety disorders). Moreover,
most studies that have emphasized the role of posi-
tive affect in sexual functioning were conducted in
clinical samples of men and women with sexual
problems [33–37].
With regard to the results of the mediation test,
our findings indicated that depressed mood par-
tially mediated the relationship between negative
trait-affect and sexual functioning. Although the
regression coefficient for negative trait-affect
decreased when depressed mood was controlled, it
J Sex Med 2012;9:2001–2008
Peixoto and Nobre
did not lose statistical significance. We also
observed that 29% of the total effect of negative
trait-affect on male sexual functioning was medi-
ated by depressed mood, which suggests that the
impact of negative trait-affect on sexual function-
ing is independent from the presence of depressive
symptoms. Due to the low association between
positive affect and depressed mood in our sample
we were not able to test the mediator role of
depressed mood in the relationship between posi-
tive trait-affect and male sexual functioning.
The present findings were preliminary and
should be carefully interpreted due to some limi-
tations. First, the sample collection was not based
on random methods and is not representative of
the general Portuguese population, which does not
allow a full generalization of the results. Second,
we did not control for the presence of other poten-
tial confounding variables such as the presence of
medical conditions with known impact on sexual
health or dyadic satisfaction. Third, we did not use
a clinical sample of men with sexual dysfunction,
which prevent us from presenting strong evidence
regarding the impact of trait-affect and depressed
mood on male sexual dysfunction. Fourth, the
psychometric characteristics of the Portuguese
version of the PANAS negative affect scale pre-
sented only medium test–retest reliability, which
could affect to some point the interpretation of the
findings. Finally, the value of the mediation of
depressed mood in the relationship between nega-
tive trait-affect and sexual function, although sta-
tistically significant, was low and may represent a
small phenomenon. One possible explanation for
this small effect is related to the use of a nonclini-
cal sample in our study. Future studies using
samples of men with sexual dysfunction are needed
in order to test this hypothesis.
In summary, despite these limitations, the pre-
liminary results of the present study suggest that
negative trait-affect is an important predictor of
sexual functioning. Although the current design
does not allow testing causal relationships, one
possible explanation for the results is that negative
trait-affect works as a common vulnerability factor
for both depression and sexual dysfunction in men,
explaining the high comorbidity between these
two clinical conditions. Further studies, using lon-
gitudinal or experimental designs, should be con-
ducted in order to test this hypothesis. Moreover,
future investigation may use clinical samples of
men with sexual dysfunction (including specific
diagnoses such as erectile dysfunction, premature
ejaculation, and hypoactive sexual desire), as well
Trait-Affect, Depressed Mood, Male Sexual Functioning
as individuals with depression and anxiety disor-
ders. The inclusion of clinical samples as well as
the use of structural equation models may help
with testing theoretical hypotheses derived from
the Tripartite and Barlow’s models in a more con-
sistent and systematic way.
Corresponding Author: Manuela Peixoto, MA, Ciên-
cias da Educação, Universidade de Aveiro, Campus
Universitário de Santiago, 3810-193, Aveiro, Portugal.
Tel: (351) 234-370-353/234-370-352; Fax: (351) 234-
370-640/234-370-219; E-mail: nelinha.peixoto@gmail.
com
Conflict of Interest: None.
Statement of Authorship
Category 1
(a) Conception and Design
Manuela Peixoto; Pedro Nobre
(b) Acquisition of Data
Manuela Peixoto; Pedro Nobre
(c) Analysis and Interpretation of Data
Manuela Peixoto; Pedro Nobre
Category 2
(a) Drafting the Article
Manuela Peixoto
(b) Revising It for Intellectual Content
Pedro Nobre
Category 3
(a) Final Approval of the Completed Article
Manuela Peixoto; Pedro Nobre
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