Existential Issues in Sexual Medicine: The Relation Between Death Anxiety and Hypersexuality

Meaning in Life, Death Anxiety, and Spirituality in the Lesbian, Gay, and Bisexual Community: A Scoping Review

The changes in people's way of life through the years raise questions on how they address existential needs and concerns, particularly those related to life and death and spiritual connections. Through a scoping review, we surveyed studies on meaning in life, death anxiety, and spirituality within the lesbian, gay, and bisexual (LGB) community. We determined the extent to which these variables have been studied among LGB participants. A total of 28 eligible articles were reviewed. Six studies were found about meaning in life, five studies about death anxiety, and 16 studies about spirituality. Results suggest that meaning in life was derived from experiences related to parenthood, couplehood, and work satisfaction. Studies on death anxiety among LGB participants, which date back to the 1980 and 1990s, indicated the need to conduct present studies in this area. The review showed that LGB members distinguished between spirituality and religion, giving them more positive recognition of the former than the latter. The forms of spiritual expression were anchored to religious practices, for some, and other expressions of belief and faith outside the confines of formally established religions. Spiritual expressions generally accorded the LGB members direction and satisfaction in life. Not all segments of the LGB community were represented in the studies. The available studies, dominantly quantitative, centered only on the LGB experience. Target age groups varied across the studies. The review indicates that future studies can work on exploring these existential factors considering the emerging contexts and paradigms. Future research can focus on determining what factors contribute to meaning in life, given the changes in time.

Hypersexual Behavior and Depression Symptoms among Dating App Users

The use of Dating Applications (DAs) is widespread, and in some cases could be associated with psychosexological issues. Hence, we decided to investigate hypersexual behavior and depression symptoms among DA users and non-users. We recruited a snowball convenience sample of 1000 subjects through an online platform in 2020 for a cross-sectional study. One hundred and nineteen (11.9%) were classified as DA users and 881 as non-users. All subjects completed a sociodemographic questionnaire, the Hypersexual Behavior Inventory (HBI), to assess hypersexuality, and the Patient Health Questionnaire (PHQ-9) to evaluate depression symptoms. We primarily found higher levels of hypersexual behavior and depression symptoms in DA users compared to non-users. In particular, HBI Total (users = 42.27 ± 16.37 vs. non-users = 31.85 ± 12.06; p < 0.0001), HBI Coping (users = 17.92 ± 8.01 vs. non-users = 13.52 ± 6.03; p < 0.0001), HBI Control (users = 14.73 ± 6.68 vs. non-users = 10.71 ± 4.95; p < 0.0001), HBI Consequences (users = 9.62 ± 4.33 vs. non-users = 7.60 ± 3.37; p < 0.0001), PHQ-9 Depression (users = 12.82 ± 6.64 vs. nonusers = 10.05 ± 5.84; p < 0.0001). On the whole, we found that hypersexual behavior and depression symptoms strongly characterize DAs users; this evidence could represent an important associated factor in DA use for sexual purposes.

Hypersexual behavior and attachment styles in a non-clinical sample: The mediation role of depression and post-traumatic stress symptoms

INTRODUCTION

Hypersexuality is a complex behavioral dysfunction concerning the excess of sexual activities. In this study, we aim to investigate the role of attachment styles, post-traumatic and depression symptoms in hypersexual behavior.

METHODS

We recruited through an online platform a snowball convenience sample of 1025 subjects (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90) and we administered them a sociodemographic questionnaire, with a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the Relationship Questionnaire (RQ) for the attachment styles, the International Trauma Questionnaire (ITQ) to evaluate the trauma and Patient Health Questionnaire (PHQ) for depression.

RESULTS

We found a significant and predictive impact of preoccupied and fearful attachment styles on hypersexual behavior (β=.116; p<.0001 and β=.121p<.0001, respectively). The categorical analysis of RQ confirmed also statistically significant differences between secure attachment style with fearful and preoccupied ones in terms of HBI levels (secure=30.01±10.79; preoccupied=35.50±14.46; fearful=36.57±13.50). Moreover, we found that depression symptoms and the total score of ITQ also resulted predictive for hypersexuality (β=.323; p<.0001 and β=.063; p<.04). However, in our model, depression and post-traumatic symptoms played a mediation role between insecure attachment and hypersexual behavior.

CONCLUSION

This study found a fundamental role of insecure attachment styles, post-traumatic and depression symptoms in the development of problematic sexuality. Hypersexual behavior is related in a causal manner with an insecure attachment style, fearful and preoccupied attachment, particularly. Nevertheless, the traumatic core of personality together with depression symptoms could play a mediation role towards the hypersexual behavior.

Male Sexual Health and Sexual Behaviors during the First National COVID-19 Lockdown in a Western Country: A Real-Life, Web-Based Study

Restriction measures enacted during the COVID-19 pandemic had severe effects on male sexual and reproductive health. We aimed to investigate the real-life impact and perception of sexual function in 2020 in Italy, as the first Western country experiencing a national lockdown by measuring relative search volume for keywords pertaining to sexual health and behaviors provided by Google Trends and sales data for pro-erectile treatments. No significant change was observed for erectile dysfunction and premature ejaculation. Interest towards most phosphodiesterase type 5 inhibitors decreased significantly during lockdown (e.g., sildenafil, p = 0.0002; tadalafil p = 0.0016), then reverted to pre-lockdown levels (e.g., sildenafil, p < 0.0001; tadalafil p < 0.0001), mirroring a concomitant sales decrement (p = 0.0292). A subsequent recovery to previous levels at the end of the social confinement was also found (e.g., after vs. before lockdown, sildenafil, p = 0.8459; tadalafil p = 0.1166). During lockdown, interest towards pornography significantly increased during restrictions (p = 0.0053) and remained high (after vs. before lockdown, p = 0.0004), whereas interest towards paid and casual sex declined (p = 0.0015 and p = 0.049, respectively), then reverted to previous levels (after vs. before lockdown, p = 0.3969 and 0.8373, respectively). During the first Italian lockdown, we observed a transient but measurable decrease of sexual health-seeking behaviors and changes in sexual behaviors, with unknown impact for sexual medicine and public health.

Hypersexuality and Trauma: a mediation and moderation model from psychopathology to problematic sexual behavior

INTRODUCTION

. Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior.

METHODS

. Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis.

RESULTS

. There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior.

CONCLUSION

. We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.

Prevalence and predictors of anxiety among healthcare workers in Saudi Arabia during the COVID-19 pandemic

Background

During pandemics, healthcare workers (HCWs) may be prone to higher levels of anxiety than those of the general population. This study aimed to explore the anxiety levels among HCWs in Saudi Arabia during the COVID-19 pandemic and the predictors of increased anxiety levels.

Method

HCW participants in this cross-section study were solicited by email from the database of registered practitioners of the Saudi Commission for Health Specialties between 15 May and 18 May 2020. Sociodemographic characteristics, work-related factors, and organization-related factors were collected.

Results

Four thousand nine hundred and twenty HCWs (3.4%) responded. Reported levels of anxiety were low anxiety (31.5%; n = 1552), medium (36.1%; n = 1778), and high (32.3%; n = 1590). Participants reporting high anxiety levels were more likely to be unmarried (OR = 1.32, 95% CI: 1.14–1.52); nurses (OR = 1.54, 95% 1.24–1.91); workers in radiology (OR = 1.52, 95% CI: 1.01–2.28); or respiratory therapists (OR = 2.28, 95% CI: 1.14–4.54). Social factors associated with high anxiety levels were: living with a person who is elderly (p = 0.01), has a chronic disease (p < 0.0001), has immune deficiency (p < 0.0001), or has a respiratory disease (p-value <0.0001). Organization-related factors associated with a high level of anxiety were: working in an organization that hosts COVID-19 patients and working with such patients (p-value <0.0001).

Conclusion

Self-reported medium and high levels of anxiety were present in 68.5% of HCWs in the COVID-19 pandemic. This highlights the urgent need to identify high-risk individuals to offer psychological support and provide up to date information on the pandemic. These data should help policymakers drive initiatives forward to protect and prepare HCWs psychological wellbeing.

Testing the High-Risk Behavior Model Among the Students Based on Religious Orientation With the Mediation of Fear of Death

Adolescents are at high-risk for adverse health outcomes associated with high-risk behavior. The present study aimed to test the high-risk behavior model among the students based on religious orientation with the mediation of fear of death. This descriptive correlational study utilized structural equation modeling. The statistical population comprised all senior high school female students in Mashhad. 200 students were selected using cluster random sampling method. Data collection tools included the Iranian Adolescents Risk-taking Scale, Templer Death Anxiety Scale, and Allport and Ross Religious Orientation Scale. The result of a structural equation model suggested that the relationship between religious orientation and high-risk behavior was mediated through fear of death. Furthermore intrinsic religiosity has a negative direct relation with fear of death and high-risk behavior, and extrinsic religious orientation have a positive direct relation with fear of death and high-risk behavior. On this basis, it was concluded that religious orientation influences high-risk behavior indirectly through fear of death.