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Aymerich C, Pedruzo B, Salazar de Pablo G, Madaria L, Goena J, Sanchez-Gistau V, Fusar-Poli P, McGuire P, González-Torres MÁ, Catalan A. Sexually transmitted infections, sexual life and risk behaviours of people living with schizophrenia: systematic review and meta-analysis. BJPsych Open 2024; 10:e110. [PMID: 38725352 PMCID: PMC11094452 DOI: 10.1192/bjo.2024.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs), along with sexual health and behaviour, have received little attention in schizophrenia patients. AIMS To systematically review and meta-analytically characterise the prevalence of STIs and sexual risk behaviours among schizophrenia patients. METHOD Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO and Cochrane Central Register were systematically searched from inception to 6 July 2023. Studies reporting on the prevalence or odds ratio of any STI or any outcome related to sexual risk behaviours among schizophrenia samples were included. PRISMA/MOOSE-compliant (CRD42023443602) random-effects meta-analyses were used for the selected outcomes. Q-statistics, I2 index, sensitivity analyses and meta-regressions were used. Study quality and publication bias were assessed. RESULTS Forty-eight studies (N = 2 459 456) reporting on STI prevalence (including 15 allowing for calculation of an odds ratio) and 33 studies (N = 4255) reporting on sexual risk behaviours were included. Schizophrenia samples showed a high prevalence of STIs and higher risks of HIV (odds ratio = 2.11; 95% CI 1.23-3.63), hepatitis C virus (HCV, odds ratio = 4.54; 95% CI 2.15-961) and hepatitis B virus (HBV; odds ratio = 2.42; 95% CI 1.95-3.01) infections than healthy controls. HIV prevalence was higher in Africa compared with other continents and in in-patient (rather than out-patient) settings. Finally, 37.7% (95% CI 31.5-44.4%) of patients were sexually active; 35.0% (95% CI 6.6-59.3%) reported consistent condom use, and 55.3% (95% CI 25.0-82.4%) maintained unprotected sexual relationships. CONCLUSIONS Schizophrenia patients have high prevalence of STIs, with several-fold increased risks of HIV, HBV and HCV infection compared with the general population. Sexual health must be considered as an integral component of care.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain; and Neuroscience Department, University of the Basque Country, Leioa, Spain
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Gonzalo Salazar de Pablo
- Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERSAM, Madrid, Spain; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Lander Madaria
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; and Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
| | - Javier Goena
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Vanessa Sanchez-Gistau
- Early Intervention in Psychosis Service, Hospital Universitari Institut Pere Mata, IISPV-CERCA, CIBERSAM, ISCIII, Universitat Rovira i Virgili, Reus, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK; and National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK; and NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Miguel Ángel González-Torres
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; CIBERSAM, Madrid, Spain; and Neuroscience Department, University of the Basque Country, Leioa, Spain
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; CIBERSAM, Madrid, Spain; Neuroscience Department, University of the Basque Country, Leioa, Spain; Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and Department of Psychiatry, University of Oxford, Oxford, UK
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Hortal-Mas R, Moreno-Poyato AR, Granel-Giménez N, Roviralta-Vilella M, Watson-Badia C, Gómez-Ibáñez R, Aguayo-González MP, Giménez-Díez D, Bernabeu-Tamayo MD, Leyva-Moral JM. Sexuality in people living with a serious mental illness: A meta-synthesis of qualitative evidence. J Psychiatr Ment Health Nurs 2022; 29:130-146. [PMID: 33047434 DOI: 10.1111/jpm.12700] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT A serious mental illness influences sexual life and people affected have worries about their sexual health. People living with a serious mental illness can and want to participate in interventions related to sexual health. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE People who suffer a serious mental illness are interested in maintaining an active sex life. People who suffer a serious mental illness experience rejection when they open up and they lose intimate relationships or possibilities of meeting other people because of ignorance and prejudices surrounding mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE Mental health services must respond to this need, that is including sexual needs assessment among routine standard practices or training nurses on sexual education to allow them to advise patients and their families and friends. Health systems should promote awareness programmes and reduce the stigma surrounding mental health and sexuality. ABSTRACT INTRODUCTION: Sexuality-related nursing care is scarce and mainly focuses on biological issues. There is also a lack of knowledge about how serious mental illnesses affect sexuality. AIM To explain how people with a serious mental illness perceive and experience their sexuality. METHOD A meta-synthesis was conducted to integrate qualitative studies. Four databases were used to perform the search, focused in the last ten years. Nine articles were included, and their results analysed thematically. RESULTS Four categories were identified: "Pathologized sexuality," which explains how the disorder and treatment affect sexuality; "Not my sexuality anymore," which describes feelings emerging from the perceived limitations and the role of self-acceptance; "Learning to manage intimate relationships," which explains the desire to establish intimate personal relationships and define their meaning; and "Reconstructing my sexuality," which elucidates the influence of the environment on sexuality. DISCUSSION Sexuality is influenced by several factors, the main ones being: the clinical complications, the side effects of drug treatment, the social support, the relationship with the health sector and stigma. IMPLICATIONS FOR PRACTICE Having a serious mental illness affects sexuality and can provoke suffering and social isolation. Mental health services should address this issue and carry out community interventions to reduce stigma.
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Affiliation(s)
- Roger Hortal-Mas
- Psychiatric Rehabilitation Area, Hermanas Hospitalarias - Hospital Sagrat Cor, Martorell, Catalonia, Spain
| | - Antonio Rafael Moreno-Poyato
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Catalonia, Spain
| | - Nina Granel-Giménez
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Roviralta-Vilella
- Institut de Neuropisquiatria i Addiccions, Parc de Salut Mar de Barcelona, Barcelona, Catalonia, Spain
| | - Carolina Watson-Badia
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.,Knowledge Management Department, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Rebeca Gómez-Ibáñez
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Mariela Patricia Aguayo-González
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - David Giménez-Díez
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.,Partial Home Care Unit, CPB Serveis de Salut Mental, Barcelona, Catalonia, Spain
| | - Maria Dolores Bernabeu-Tamayo
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Juan Manuel Leyva-Moral
- Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.,Centre for Health Sciences Research, Universidad María Auxiliadora, Lima, Peru.,Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Lima, Peru
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Isolated Psychiatric Ward Patients in Southern Israel with Severe Mental Illnesses Describe Their Sexual Needs: A Qualitative Study. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-021-09723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractIntimacy and sexuality are fundamental issues in human nature, but have been neglected in the rehabilitation of mental health patients, particularly those admitted into psychiatric wards. Patients’ sexuality is excluded from the discourse; yet it exists in the daily lives of the patients. The study examines the sexual needs and challenges of people with severe mental illnesses admitted to an isolated psychiatric ward. 13 men were interviewed in a semi-structured interview regarding their sexuality and the challenges they meet when experiencing and expressing their sexuality as patients in an isolated ward. A thematic analysis was conducted. Two principal themes were identified: 1. Challenges in realizing sexuality within the isolated ward. This theme included sub themes: performing sexual acts and exposure to sexuality within the ward; medications' side effects; dialogue with the staff; sexuality in the ward presented as crossing limits; and absence of a space to fulfill sexuality. 2. Suggestions for improvements in the hospital, stemming from the patients' experiences and ideas, such as starting an open dialogue with the staff, supplying patients with measures for protected sex, and more. The findings highlight the lack of healthy expression of sexuality inside the wards, despite its importance for improving patients’ well-being during their rehabilitation. Medical staff and policymakers should be aware of the sexual aspects of hospitalization in a psychiatric ward. The study also indicates the need for national policy that will address patients' sexual needs, including clear instructions that consider the uniqueness of the target population.
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Di Nardo M, Conti C, Di Francesco G, Nicolardi G, Guagnano MT, Porcelli P. What is the "weight" of body mass index on sexual functioning in women? A mediation model. Eat Weight Disord 2021; 26:1801-1811. [PMID: 32920775 PMCID: PMC8292239 DOI: 10.1007/s40519-020-00995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE It is well known that body mass index (BMI) affects how individuals perceive their well-being and that obese individuals tend to report poorer levels of subjective health status. The aim of this study was to compare subjects with and without FSD and to examine the direct and indirect impact of BMI on female sexual dysfunction (FSD) in overweight/obese and normal-weight women. METHODS A cross-sectional study was conducted on 186 overweight/obese and 233 normal-weight women. FSD assessed with the Female Sexual Function Index (FSFI) was investigated in relation to body satisfaction assessed with the Body Uneasiness Test (BUT-A) and self-esteem assessed with the Rosenberg Self-Esteem scale (RSE). RESULTS No difference in the prevalence of FSD was found between overweight/obese (44.4%) and normal-weight women (55.6%), even though significant between-group differences in body image were found. Structural Equation Modelling (SEM) showed that BMI contribute to FSD only through the mediating role of body dissatisfaction and self-esteem. CONCLUSIONS The present results support the notion that sexual functioning is not related directly to BMI in women but to a more complex interactions of body weight, satisfaction with one's own body image, and levels of self-esteem. Clinicians should take into account that for women having a good sexual life seems not related to body weight but to the way their body weight is perceived within the context of self-image. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Maria Di Nardo
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Chiara Conti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Giulia Di Francesco
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Giulia Nicolardi
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
| | - Maria Teresa Guagnano
- Department of Medicine and Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via dei Vestini 31, 66100, Chieti, Italy
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McCann E, Donohue G, de Jager J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:74-125. [PMID: 30629043 DOI: 10.11124/jbisrir-2017-003824] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this systematic review was to synthesize the best available qualitative evidence on the experiences and support needs of people with serious mental illness (SMI) regarding sexuality and intimacy within hospital and community settings. The objectives were to explore intimate relationship experiences of people with SMI, to uncover potential obstacles to the expression of sexuality and to present recommendations for mental health policy, education, research and practice. INTRODUCTION Mental health services worldwide have seen major transformations in recent years through deinstitutionalization programs and more enlightened ways of organizing and providing mental health care. However, in terms of social and emotional wellbeing, issues persist for people with SMI, particularly relating to intimacy and the expression of sexuality. This systematic review may assist service providers to determine ways that they may better support people in establishing and maintaining satisfying intimate relationships and the full expression of their sexuality. INCLUSION CRITERIA This review explored the intimacy and sexuality experiences, perceptions and concerns of people over the age of 18 years who were living with a SMI in hospital or community settings. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS The databases MEDLINE, CINAHL, PsycINFO, Embase and Web of Science were utilised in the review. The search included studies published from 1995 up to and including February 6, 2018 and were limited to those in the English language. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Based on the thematic findings from the 21 studies, three synthesized findings were extracted from 10 categories and 83 findings: 1) the complexity of individual sexual experiences, 2) the clinical constructs of sexuality and 3) family and partner involvement. CONCLUSIONS Having fulfilling and satisfying sexual and relationship experiences is a fundamental human right that can enhance an individual's quality of life. Being aware of the potential stresses and challenges that having a SMI can have on a relationship and involving partners in the treatment, may help to promote intimacy and recovery. Practitioners can use these findings to guide future policy, education and developments in practice. Further research is required to develop and evaluate interventions that target the identified barriers and help people with SMI to fulfil their unmet sexuality and intimacy needs.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Jose de Jager
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Annet Nugter
- Mental Health Service Organization, GGZ Noord-Holland-Noord, The Netherlands
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Manoj MP, Suja MK. Correction to: Sexuality and Reproductive Health in Young People with Disability: A Systematic Review of Issues and Challenges. SEXUALITY AND DISABILITY 2018. [DOI: 10.1007/s11195-018-9523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. WOMEN'S HEALTH (LONDON, ENGLAND) 2018; 14:1745506518762664. [PMID: 29649948 PMCID: PMC5900810 DOI: 10.1177/1745506518762664] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022]
Abstract
Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.
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Affiliation(s)
| | - Thea Gilks
- The University of British Columbia, Vancouver, BC, Canada
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Sexuality and Reproductive Health in Young People with Disability: A Systematic Review of Issues and Challenges. SEXUALITY AND DISABILITY 2017. [DOI: 10.1007/s11195-017-9505-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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