This study showed that anxiety symptoms were detected in 17.3% of the study population, and the detection rate of anxiety symptoms in medical staff in China during the COVID-19 period ranged from 12–30%. According to previous study, the detection rate of anxiety symptoms in the general population was 15.8%. The results of this study are consistent with the reported detection rate in the general population[47, 48].
This cross-sectional study on 896 males from the general population found a negative relation between high levels of anxiety and semen parameters (semen volume, sperm concentration, total sperm count and forward motility), which is consistent with the results of the previous survey of infertile men. For example, studies found that male semen quality was negatively associated with anxiety symptoms in azoospermic men . Likewise, another study found that anxiety symptoms are negatively associated with semen volume and the forward motility. Anxiety can affect semen quality, and thus affect male fertility [51, 52].
Current epidemiological data regarding anxiety and male semen quality is limited. Although the prevailing majority of available evidences indicate a negative correlation between anxiety levels and semen parameters. However, such epidemiological study has one shortcoming. Remarkably, all research subjects are infertile people, and thus their psychological and reproductive health conditions are quite different from those of the general population. This type of research is most prone to volunteer selection bias. On the one hand, reproductive problems in this population are inherently heterogeneous, and their fertility tends to be less than that of the general population. On the other hand, it is difficult to distinguish between anxiety as a cause or a consequence of semen quality decline in such subjects.
Therefore, the results of this study provide new evidence for the relationship between anxiety symptoms and male semen quality in ordinary men.
In addition, the impact of the epidemic on economic income cannot be ignored. In today’s society, with the development of social economy, people’s consumption concept is also changing. Many people advocate excessive consumption. However, the sudden onset of the epidemic has cut off many people’s income sources and increased debt pressure, which has been shown to increase mental and physical health burden[54, 55]. The greater the debt burden is, the higher the health risk will be. Debt was found to be related to higher scores on SF-36, a measure of physical and mental health[56, 57]. No study has reported the relationship between debt pressure and semen quality. In the present study, we found that anxiety symptoms and debt pressure had an interactive effect on semen quality in the anxiety group. We also found that the semen quality level of individuals with debt pressure was significantly decreased compared with those without debt pressure, and the difference was statistically significant. Studies have reported that borrowing money is a risk factor for psychological anxiety, which means that the detection rate of anxiety symptoms will be higher in individuals under debt pressure. Studies have reported that economic pressure may be associated with male sexual dysfunction[58, 59].
This study reveals the following three points: 1. Main effect: Anxiety state is negatively related to sperm density; 2. Modification effect: Debt stress can aggravate the negative impact of depression on semen quality. 3. Interaction: If the two states of debt and depression exist at the same time, the negative effect on the quality of individual semen is far greater than the negative effect of debt or anxiety alone.
Our research results show that when major public health incidents occur, it is necessary to pay attention to the mental state of men at childbearing age and to provide timely psychological counseling for those with anxiety symptoms. The results of this study have provided a certain supplement to the research data on the impact of anxiety on the quality of men’s semen, and enriched the results of the population data of such studies at the time of major public health events.
4.1. Strengths and limitations
Our study has several strengths. First, this study involved a large population, including volunteers from seven sperm banks in China, and investigators from about nine provinces, including southern and northern regions. The results of the promotion can be more close to the characteristics of the Chinese male population. Second, in addition to the questionnaire survey, we also obtained the clinical data of the semen quality test of the surveyors, which have not been reported on the COVID-19 population at present. Third, as shown in our data analysis results, the results of this study are stable, and the results of logistic regression are consistent with those of linear regression. Finally, our study took into account the interaction between economic stress and semen quality and adjusted for confounding factors such as age, BMI, occupation, education level, financial stress, and fear of COVID-19 infection.
Several limitations should be noted. First, the study included volunteer sperm donors aged 18 to 42 years, and the results could not be extrapolated to all men. Second, this study is a cross-sectional study, and the results cannot be used for causal explanation. Third, due to the severe period of the epidemic, some areas (such as Wuhan) adopted the crowd management measures. Thus, there were few or no surveyors in the area, which may have a certain influence on the results.