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Jemielita P, Lip GYH, Kurasz A, Święczkowski M, Krepsztul-Jemielita A, Dobrzycki S, Kuźma Ł. Noise and light exposure and cardiovascular outcomes: A review of evidence, potential mechanisms and implications. Trends Cardiovasc Med 2024:S1050-1738(24)00059-8. [PMID: 38977140 DOI: 10.1016/j.tcm.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/23/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
Cardiovascular diseases (CVD) are the leading cause of global non-communicable disease-related deaths. In recent years there has been increasing discussion about the influence of environmental risk factors, including noise and light, on the occurrence and course of these conditions. Recent studies highlight the impact of road traffic noise on an elevated risk of stroke and increased mortality in the course of coronary artery disease (CAD). In the case of threats arising from light pollution, there are more limited published studies; however, these show an increased hospitalization risk associated with CAD. Existing analyses cannot dismiss these environmental factors, highlighting the need for further research. Future studies should investigate not only road traffic noise but also consider railway and aircraft noise. Additionally, research on light pollution should include younger individuals too. In the future, incorporating individual assessments of noise and light pollution exposure, along with the identification of particularly vulnerable groups, could contribute to refining methods of individual risk stratification and implementing new preventive strategies.
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Affiliation(s)
- Piotr Jemielita
- Department of Invasive Cardiology, Medical University of Białystok, Skłodowskiej-Curie 24a, 15-276 Białystok, Poland.
| | - Gregory Y H Lip
- Department of Cardiology, Lipidology and Internal Medicine, Medical University of Bialystok, Poland; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Białystok, Skłodowskiej-Curie 24a, 15-276 Białystok, Poland
| | - Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Białystok, Skłodowskiej-Curie 24a, 15-276 Białystok, Poland
| | | | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, Skłodowskiej-Curie 24a, 15-276 Białystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, Skłodowskiej-Curie 24a, 15-276 Białystok, Poland
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Arregi A, Vegas O, Lertxundi A, Silva A, Ferreira I, Bereziartua A, Cruz MT, Lertxundi N. Road traffic noise exposure and its impact on health: evidence from animal and human studies-chronic stress, inflammation, and oxidative stress as key components of the complex downstream pathway underlying noise-induced non-auditory health effects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:46820-46839. [PMID: 38977550 PMCID: PMC11297122 DOI: 10.1007/s11356-024-33973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/08/2024] [Indexed: 07/10/2024]
Abstract
In heavily urbanized world saturated with environmental pollutants, road traffic noise stands out as a significant factor contributing to widespread public health issues. It contributes in the development of a diverse range of non-communicable diseases, such as cardiovascular diseases, metabolic dysregulation, cognitive impairment, and neurodegenerative disorders. Although the exact mechanisms behind these non-auditory health effects remain unclear, the noise reaction model centres on the stress response to noise. When exposed to noise, the body activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to the secretion of stress hormones like catecholamines and cortisol. Prolonged exposure to noise-induced stress results in chronic inflammation and oxidative stress. This review underscores the role of inflammation and oxidative stress in the progression of noise-induced vascular dysfunction, disruption of the circadian rhythm, accelerated aging, neuroinflammation, and changes in microbiome. Additionally, our focus is on understanding the interconnected nature of these health outcomes: These interconnected factors create a cascade effect, contributing to the accumulation of multiple risk factors that ultimately lead to severe adverse health effects.
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Affiliation(s)
- Ane Arregi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Oscar Vegas
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Aitana Lertxundi
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain
| | - Ana Silva
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Isabel Ferreira
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Ainhoa Bereziartua
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
| | - Maria Teresa Cruz
- Center for Neuroscience and Cell Biology and Institute for Biomedical Imaging and Life Sciences, University of Coimbra, 3000-548, Coimbra, Portugal.
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.
- Faculty of Pharmacy, University of Coimbra, 3000-548, Coimbra, Portugal.
| | - Nerea Lertxundi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008, San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain S/N, 20014, San Sebastian, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029, Madrid, Spain
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Shah BUD, Raj R, Kaur P, Karim A, Bansari RB, Mehmoodi A, Malik J. Association of transportation noise with cardiovascular diseases. Clin Cardiol 2024; 47:e24275. [PMID: 38708862 PMCID: PMC11071170 DOI: 10.1002/clc.24275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
This comprehensive article delves into the intricate and multifaceted issue of noise pollution, shedding light on its diverse sources, profound health implications, and the economic burden it imposes on societies. Noise pollution is an increasingly prevalent environmental challenge, impacting millions of people worldwide, often without their full awareness of its adverse effects. Drawing from a wealth of scientific research, the article underscores the well-established links between noise pollution and a spectrum of health issues, including cardiovascular diseases, sleep disturbances, and psychological stress. While exploring the sources and consequences of noise pollution, the article highlights the urgent need for a holistic and collaborative approach to mitigate its impact. This entails a combination of regulatory measures, technological innovations, urban planning strategies, and public education campaigns. It is increasingly evident that the detrimental effects of noise pollution extend beyond physical health, encompassing mental and social well-being. The article also addresses the synergistic relationship between noise pollution and other environmental stressors, emphasizing the importance of considering noise in conjunction with factors like air pollution and access to green spaces. It examines the potential of green spaces to mitigate the effects of noise pollution and enhance overall health.
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Affiliation(s)
- Badar ud Din Shah
- Department of Cardiovascular MedicineCardiovascular Analytics GroupIslamabadPakistan
| | - Rohan Raj
- Department of MedicineNalanda Medical College and HospitalPatnaIndia
| | - Parvinder Kaur
- Department of MedicineCrimean State Medical UniversitySimferopolUkraine
| | - Ali Karim
- Department of Cardiovascular MedicineCardiovascular Analytics GroupIslamabadPakistan
| | - Raveena Bai Bansari
- Department of Cardiovascular MedicineCardiovascular Analytics GroupIslamabadPakistan
| | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Jahanzeb Malik
- Department of Cardiovascular MedicineCardiovascular Analytics GroupIslamabadPakistan
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Münzel T, Molitor M, Kuntic M, Hahad O, Röösli M, Engelmann N, Basner M, Daiber A, Sørensen M. Transportation Noise Pollution and Cardiovascular Health. Circ Res 2024; 134:1113-1135. [PMID: 38662856 DOI: 10.1161/circresaha.123.323584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Epidemiological studies have found that transportation noise increases the risk for cardiovascular morbidity and mortality, with solid evidence for ischemic heart disease, heart failure, and stroke. According to the World Health Organization, at least 1.6 million healthy life years are lost annually from traffic-related noise in Western Europe. Traffic noise at night causes fragmentation and shortening of sleep, elevation of stress hormone levels, and increased oxidative stress in the vasculature and the brain. These factors can promote vascular (endothelial) dysfunction, inflammation, and arterial hypertension, thus elevating cardiovascular risk. The present review focusses on the indirect, nonauditory cardiovascular health effects of noise. We provide an updated overview of epidemiological research on the effects of transportation noise on cardiovascular risk factors and disease, and mechanistic insights based on the latest clinical and experimental studies and propose new risk markers to address noise-induced cardiovascular effects in the general population. We will discuss the potential effects of noise on vascular dysfunction, oxidative stress, and inflammation in humans and animals. We will elaborately explain the underlying pathomechanisms by alterations of gene networks, epigenetic pathways, circadian rhythm, signal transduction along the neuronal-cardiovascular axis, and metabolism. We will describe current and future noise mitigation strategies. Finally, we will conduct an overall evaluation of the status of the current evidence of noise as a significant cardiovascular risk factor.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Michael Molitor
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Marin Kuntic
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Department Epidemiology and Public Health, University of Basel, Switzerland (M.R., N.E.)
| | - Nicole Engelmann
- Swiss Tropical and Public Health Institute, Department Epidemiology and Public Health, University of Basel, Switzerland (M.R., N.E.)
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (M.B.)
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Mette Sørensen
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark (M.S.)
- Department of Natural Science and Environment, Roskilde University, Denmark (M.S.)
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Basner M, Smith MG. The effects on sleep play a critical role in the long-term health consequences of noise exposure. Sleep 2024; 47:zsad314. [PMID: 38079452 PMCID: PMC10851844 DOI: 10.1093/sleep/zsad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
- Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael G Smith
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sørensen M, Pershagen G, Thacher JD, Lanki T, Wicki B, Röösli M, Vienneau D, Cantuaria ML, Schmidt JH, Aasvang GM, Al-Kindi S, Osborne MT, Wenzel P, Sastre J, Fleming I, Schulz R, Hahad O, Kuntic M, Zielonka J, Sies H, Grune T, Frenis K, Münzel T, Daiber A. Health position paper and redox perspectives - Disease burden by transportation noise. Redox Biol 2024; 69:102995. [PMID: 38142584 PMCID: PMC10788624 DOI: 10.1016/j.redox.2023.102995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/26/2023] Open
Abstract
Transportation noise is a ubiquitous urban exposure. In 2018, the World Health Organization concluded that chronic exposure to road traffic noise is a risk factor for ischemic heart disease. In contrast, they concluded that the quality of evidence for a link to other diseases was very low to moderate. Since then, several studies on the impact of noise on various diseases have been published. Also, studies investigating the mechanistic pathways underlying noise-induced health effects are emerging. We review the current evidence regarding effects of noise on health and the related disease-mechanisms. Several high-quality cohort studies consistently found road traffic noise to be associated with a higher risk of ischemic heart disease, heart failure, diabetes, and all-cause mortality. Furthermore, recent studies have indicated that road traffic and railway noise may increase the risk of diseases not commonly investigated in an environmental noise context, including breast cancer, dementia, and tinnitus. The harmful effects of noise are related to activation of a physiological stress response and nighttime sleep disturbance. Oxidative stress and inflammation downstream of stress hormone signaling and dysregulated circadian rhythms are identified as major disease-relevant pathomechanistic drivers. We discuss the role of reactive oxygen species and present results from antioxidant interventions. Lastly, we provide an overview of oxidative stress markers and adverse redox processes reported for noise-exposed animals and humans. This position paper summarizes all available epidemiological, clinical, and preclinical evidence of transportation noise as an important environmental risk factor for public health and discusses its implications on the population level.
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Affiliation(s)
- Mette Sørensen
- Work, Environment and Cancer, Danish Cancer Institute, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Denmark.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesse Daniel Thacher
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Timo Lanki
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Benedikt Wicki
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Manuella Lech Cantuaria
- Work, Environment and Cancer, Danish Cancer Institute, Copenhagen, Denmark; Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Jesper Hvass Schmidt
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Gunn Marit Aasvang
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Sadeer Al-Kindi
- Department of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Juan Sastre
- Department of Physiology, Faculty of Pharmacy, University of Valencia, Spain
| | - Ingrid Fleming
- Institute for Vascular Signalling, Centre for Molecular Medicine, Goethe University, Frankfurt Am Main, Germany; German Center of Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt, Germany
| | - Rainer Schulz
- Institute of Physiology, Faculty of Medicine, Justus-Liebig University, Gießen, 35392, Gießen, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Marin Kuntic
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Jacek Zielonka
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Helmut Sies
- Institute for Biochemistry and Molecular Biology I, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Katie Frenis
- Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Stem Cell Program, Boston Children's Hospital, Boston, MA, USA
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
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Dzhambov AM. Comments on "The association between road traffic noise and type 2 diabetes: a systematic review and meta-analysis of cohort studies" by Wu, Shan et al., DOI https://doi.org/10.1007/s11356-023-25926-5. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:88235-88237. [PMID: 37466841 DOI: 10.1007/s11356-023-28830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria.
- Research group "Health and Quality of Life in a Green and Sustainable Environment," SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria.
- Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
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Hassan S, Bhatti MI, Habib S, Fatima S, Bhader S, Khan NH, Jiang E. How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness. Front Psychiatry 2023; 14:1049008. [PMID: 37555007 PMCID: PMC10406444 DOI: 10.3389/fpsyt.2023.1049008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness. METHOD An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data. RESULTS Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment. CONCLUSION Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.
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Affiliation(s)
- Sajid Hassan
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Mazhar Iqbal Bhatti
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Shazia Habib
- Department of Applied Psychology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sidra Fatima
- University Gillani Law College, Bahauddin Zakariya University, Multan, Pakistan
| | - Sher Bhader
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Nazeer Hussain Khan
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Department of Animal Sciences, Quaid I Azam University, Islamabad, Pakistan
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
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