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Borrajo A, Pérez-Rodríguez D, Fernández-Pereira C, Prieto-González JM, Agís-Balboa RC. Genomic Factors and Therapeutic Approaches in HIV-Associated Neurocognitive Disorders: A Comprehensive Review. Int J Mol Sci 2023; 24:14364. [PMID: 37762667 PMCID: PMC10531836 DOI: 10.3390/ijms241814364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
HIV-associated neurocognitive disorders (HANDs) still persist despite improved life expectancy, reduced viral loads, and decreased infection severity. The number of patients affected by HANDs ranges from (30 to 50) % of HIV-infected individuals. The pathological mechanisms contributing to HANDs and the most serious manifestation of the disease, HIV-associated dementia (HAD), are not yet well understood. Evidence suggests that these mechanisms are likely multifactorial, producing neurocognitive complications involving disorders such as neurogenesis, autophagy, neuroinflammation, and mitochondrial dysfunction. Over the years, multiple pharmacological approaches with specific mechanisms of action acting upon distinct targets have been approved. Although these therapies are effective in reducing viral loading to undetectable levels, they also present some disadvantages such as common side effects, the need for administration with a very high frequency, and the possibility of drug resistance. Genetic studies on HANDs provide insights into the biological pathways and mechanisms that contribute to cognitive impairment in people living with HIV-1. Furthermore, they also help identify genetic variants that increase susceptibility to HANDs and can be used to tailor treatment approaches for HIV-1 patients. Identification of the genetic markers associated with disease progression can help clinicians predict which individuals require more aggressive management and by understanding the genetic basis of the disorder, it will be possible to develop targeted therapies to mitigate cognitive impairment. The main goal of this review is to provide details on the epidemiological data currently available and to summarise the genetic (specifically, the genetic makeup of the immune system), transcriptomic, and epigenetic studies available on HANDs to date. In addition, we address the potential pharmacological therapeutic strategies currently being investigated. This will provide valuable information that can guide clinical care, drug development, and our overall understanding of these diseases.
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Affiliation(s)
- Ana Borrajo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy
| | - Daniel Pérez-Rodríguez
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Facultade de Bioloxía, Universidade de Vigo (UVigo), Campus Universitario Lagoas-Marcosende, s/n, 36310 Vigo, Spain
| | - Carlos Fernández-Pereira
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Area Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | - José María Prieto-González
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Research in Neurological Diseases (ITEN), Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Roberto Carlos Agís-Balboa
- NeuroEpigenetics Lab, Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain; (D.P.-R.); (C.F.-P.); (J.M.P.-G.)
- Translational Research in Neurological Diseases (ITEN), Health Research Institute of Santiago de Compostela (IDIS), Santiago University Hospital Complex, 15706 Santiago de Compostela, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
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Kherghehpoush S, McKeirnan KC. The role of community pharmacies in the HIV and HCV care continuum. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100215. [PMID: 36938123 PMCID: PMC10017415 DOI: 10.1016/j.rcsop.2022.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction In 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. Methods This study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. Results Fifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. Conclusion Individuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.
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Ncitakalo N, Sigwadhi LN, Mabaso M, Joska J, Simbayi L. Exploring HIV status as a mediator in the relationship of psychological distress with socio-demographic and health related factors in South Africa: findings from the 2012 nationally representative population-based household survey. AIDS Res Ther 2023; 20:6. [PMID: 36747255 PMCID: PMC9901137 DOI: 10.1186/s12981-022-00498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psychological distress as measured by mental disorders like depression and anxiety is more prevalent in people living with HIV (PLHIV) than in the general population. However, the relationship between mental disorders and HIV is complex and bidirectional. Improved understanding of the relationship between mental disorders and HIV is important for designing interventions for this group. This paper explores the interrelationships of psychological distress with HIV and associated socio-demographic and health-related factors. METHODS This secondary data analysis used the 2012 South African population-based household survey on HIV collected using a cross-sectional multi-stage stratified cluster sampling design. Generalized structural equation modelling (G-SEM) path analysis was used to explore the direct and indirect relationships of socio-demographic, health and HIV-related factors with psychological distress as measured by Kessler 10 scale using HIV status as a moderator variable. RESULTS A total of 20,083 participants were included in the study, 21.7% reported psychological distress, of whom (32.6%) were HIV positive. In the final path model with HIV status as a moderator, psychological distress was significantly more likely among age group 25-49 years (AOR: 1.4 [95% CI 1.3-1.6]), age 50 years and older, (AOR: 1.4 [95% CI 1.2-1.6]), females (AOR: 1.6 [95% CI 1.4-1.8]), high risk drinkers (AOR: 1.9 [1.6-2.2]) hazardous drinkers (AOR: 4.4 [95% CI 3.1-6.3]), ever tested for HIV (AOR: 1.2 [95% CI 1.1-1.3]). Psychological distress was significantly less likely among the married [AOR: 0.8 (0.7-0.9)], other race groups [AOR: 0.5 (0.5-0.6)], those with secondary level education (AOR: 0.9 [95% CI 0.8-0.9]), and tertiary level education (AOR: 0.7 [95% CI 0.6-0.9]), those from rural informal [AOR: 0.8 (0.7-0.9)], and rural formal [AOR: 0.8 (0.7-0.9)] areas and those who rated their health as excellent/good [AOR: 0.4 (0.4-0.5)]. CONCLUSION The findings highlight the importance of designing tailored interventions targeted at psychological distress among PLHIV especially the elderly, females, those with no education and / or low education attainment and those residing in informal urban areas.
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Affiliation(s)
| | - Lovemore Nyasha Sigwadhi
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Musawenkosi Mabaso
- grid.417715.10000 0001 0071 1142Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - John Joska
- grid.7836.a0000 0004 1937 1151HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Leickness Simbayi
- grid.7836.a0000 0004 1937 1151HIV Mental Health Research Unit, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa ,grid.417715.10000 0001 0071 1142Human Sciences Research Council, Cape Town, South Africa ,grid.7836.a0000 0004 1937 1151Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Yahyavi S, Raisi F, Firoozikhojastefar R, Shahvari Z, Mirsepassi Z. Sex education for patients with severe mental illness in Iran: A qualitative study. PEC INNOVATION 2022; 1:100016. [PMID: 37213718 PMCID: PMC10194151 DOI: 10.1016/j.pecinn.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 05/23/2023]
Abstract
Objective Patients with severe mental illness may experience cognitive deficits, impaired judgment or loss of skills. Therefore, they are prone to sexual health complications. Sex education can promote sexual health, and in many countries, it is integrated into other domains of education. The educational contents taught in western countries are not necessarily appropriate for developing countries.This study aims to address sex educational content for these patients in Iran. Methods We have conducted twenty-three face-to-face, deep and semi-structured interviews with patients, family members, psychiatrists, general practitioners, nurses and psychologists. We used the strategy of maximum diversity in selecting the participants. Results "Improving basic knowledge," "decreasing the risk of unsafe sex", "empowerment" and "persuading to ask for help" should be covered in the education. Conclusions Sexuality is not considered a priority for these patients. It is necessary to develop a training program with simple educational content for this high-risk group. Innovation Raising awareness and knowledge about the possible risks of social media on high-risk behaviours, developing social and behavioural skills, and encouraging patients to talk about their new challenges in sexual life is recommended. Cultural, spiritual and personal beliefs should be considered in designing the educational program.
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Affiliation(s)
- SeyyedTaha Yahyavi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Shahvari
- Department of Nursing and Midwifery, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
| | - Zahra Mirsepassi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author at: Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Lee KW, Ang CS, Lim SH, Siau CS, Ong LTD, Ching SM, Ooi PB. Prevalence of mental health conditions among people living with HIV during the COVID-19 pandemic: A rapid systematic review and meta-analysis. HIV Med 2022; 23:990-1001. [PMID: 35304829 PMCID: PMC9111307 DOI: 10.1111/hiv.13299] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/28/2021] [Accepted: 03/01/2022] [Indexed: 12/24/2022]
Abstract
Background The COVID‐19 pandemic has generated many mental health problems worldwide. People living with HIV (henceforth known as PLHIV) bear a higher mental health burden in comparison with the general population. Therefore, their risk of mental health problems may be elevated during the pandemic. Methods We conducted a systematic review and meta‐analysis to assess the prevalence of depression, anxiety, psychological stress, insomnia and loneliness among PLHIV during the COVID‐19 pandemic. Observational studies in four databases published from 1 January 2020 to 30 April 2021 investigating the prevalence of mental health conditions during the COVID‐19 pandemic were searched, and 197 articles were retrieved. After the processes of duplication removal, eligibility screening and full‐text assessment, 10 articles were included in the systematic review and six articles for meta‐analyses. A random‐effects model was applied to derive the pooled prevalence of mental health conditions. The risk of bias was assessed using the STROBE checklist. Results Overall, the pooled prevalence rates of (moderate‐to‐severe) depression and anxiety among PLHIV were 16.9% [95% confidence interval (CI): 3.8%–30.0%] and 23.0% (95% CI: 12.0%–34.0%), respectively. Conclusions More research is needed to investigate the mechanism by which the pandemic affects the mental health of PLHIV. Support and programmes are needed to ameliorate the mental health problems in this marginalized population.
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Affiliation(s)
- Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia.,Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Chin Siang Ang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sin How Lim
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lai Teik Derek Ong
- Department of Marketing Strategy and Innovation, Sunway University Business School (SUBS), Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Kajang, Malaysia.,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
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Mirsepassi Z, Raisi F, Shahvari Z, FirooziKhojastefar R, Yahyavi ST. Evaluating family knowledge about sexual health in patients with severe mental illness: a qualitative study in Iran. BMC Psychiatry 2022; 22:174. [PMID: 35272647 PMCID: PMC8908587 DOI: 10.1186/s12888-022-03788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/16/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Although paying more attention to sex education in patients with severe mental illness is recommended in the literature, the role of families has not been specifically clarified. AIM: This study aims to explore family knowledge about sexual health in patients with severe mental illness in Iran. METHODS We conducted a total number of 21 interviews with 4 patients, 5 families, 7 psychiatrists, 1 general practitioner, 2 nurses, and 2 psychologists through purposive sampling. The text was analyzed using conventional qualitative content analysis. RESULTS The family knowledge about patients' sexual health is described in three subcategories: 'informal sources for knowledge acquisition', 'common myths, and 'inappropriate reaction to the patients' needs". CONCLUSIONS Family sex education should be integrated into a comprehensive rehabilitation program to promote sexual health in patients with severe mental illness. Family members should be aware of the necessity of accurate information about patients' sexual concerns.
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Affiliation(s)
- Zahra Mirsepassi
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shahvari
- grid.510409.90000 0004 6092 1266Department of Nursing and Midwifery, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
| | - Reihaneh FirooziKhojastefar
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Taha Yahyavi
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults. J Clin Med 2022; 11:jcm11030505. [PMID: 35159957 PMCID: PMC8836347 DOI: 10.3390/jcm11030505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive patients with a diagnosis of acute psychosis or schizophrenia were recruited to the study after obtaining informed consent (n = 46). In addition, healthy control subjects were recruited (n = 52). Sociodemographic and clinical data, psychopathology, and sexual functioning were assessed. Independent sample t-test to determine group differences was obtained. Results: In both the male and female groups, there are significant differences between psychotic individuals and healthy controls in several areas of their sexual functioning: the control group seemed to better perceive Couple sexuality, Self-eroticism, and overall appeared to have a higher Quality of sexual life; on the other hand, the group of patients with psychosis displayed higher scores in Sexual dysfunction. Conclusions: A poor sexual quality of life may be found in patients with psychotic disorders. Assessment of sexual function in these patients is necessary to identify and manage issues and provide support and help to patients in this important area of life.
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Social Support, Relationship Power, and Knowledge of HIV+ Serostatus in Sexual Risk Behavior Among Women in Psychiatric Treatment. J Clin Psychol Med Settings 2021; 28:191-199. [PMID: 32026174 DOI: 10.1007/s10880-020-09701-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study examined social support, perceived relationship power, and knowledge of HIV+ serostatus in relation to frequency of unprotected sex acts and number of partners among women with comorbid psychiatric illness receiving treatment. Data were drawn from an initial assessment of participants enrolled in an HIV risk reduction intervention (N = 284), and two generalized linear models were used to examine the potential associations. Relationship power was significantly associated with fewer unprotected sex acts. This relationship was stronger among those with greater social support. Knowledge of HIV+ serostatus was linked with fewer sexual partners and less unprotected sex. Findings also revealed that the protective nature of support varies by level of perceived relationship power, with higher power indicative of a stronger protective relationship. Study findings suggest that the potential protective benefits of social support may depend on one's perceived relationship power. Implications for HIV prevention intervention for this at-risk group are discussed.
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Memiah P, Nkinda L, Majigo M, Humwa F, Haile ZT, Muthoka K, Zuheri A, Kamau A, Ochola L, Buluku G. Mental health symptoms and inflammatory markers among HIV infected patients in Tanzania. BMC Public Health 2021; 21:1113. [PMID: 34112126 PMCID: PMC8193867 DOI: 10.1186/s12889-021-11064-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/14/2021] [Indexed: 01/22/2023] Open
Abstract
Background HIV and mental disorders are predicted to be the leading causes of illness worldwide by the year 2030. HIV-infected patients are at increased risk of developing mental disorders which are significantly associated with negative clinical outcomes and propagation of new HIV infections. There is little evidence that links inflammation to development of mental disorders among HIV patients. Therefore, the main objective of this study was to evaluate if mental health symptoms were associated with biomarkers of inflammation in HIV infected subjects. Methods A cross-sectional study was conducted in Dar es Salam, Tanzania from March to May 2018. Standardized tools were used to collect data based on the World Health Organisation's (WHO) stepwise approach for non-communicable diseases (NCD) surveillance. A total of 407 HIV+ patients on antiretroviral therapy were recruited. The WHO stepwise approach for NCD surveillance was used to collect data together with anthropometric measurements. Mental health symptoms were determined based on self-reported thoughts of helplessness, suicide ideation, depression, despair, discouragement, and feelings of isolation. Enzyme-linked immunosorbent assay was used to test for inflammatory markers:- C-reactive protein (CRP), Iinterleukin-6 (IL-6), interleukin-18 (IL-18), soluble tumour necrosis factor receptor-I (sTNFR-I), and soluble tumour necrosis factor receptor-II (sTNFR-II). Bivariate and multi-variate analysis was conducted to examine the association between biomarkers and mental health symptoms. Results The prevalence of self-reported mental health symptoms was 42% (n = 169). Participants with self-reported symptoms of mental health had elevated CRP, were less likely to walk or use a bicycle for at least 10 minutes, were less likely to participate in moderate-intensity sports or fitness activities, and had poor adherence to HIV treatment (p < 0.005). CRP remained significant in the sex adjusted, age-sex adjusted, and age-sex-moderate exercise adjusted models. In the fully adjusted logistic regression model, self-reported mental health symptoms were significantly associated with a higher quartile of elevated CRP (OR 4.4; 95% CI 1.3–5.9) and sTNFR-II (OR 2.6; 95% CI 1.4–6.6) and the third quartile of IL-18 (OR 5.1;95% CI 1.5–17.5) as compared with those reporting no mental health symptoms. The significance of sTNFR-II and IL-18 in the fully adjusted model is confounded by viral load suppression rates at the sixth month. Conclusion High CRP and sTNFR II were important contributors to the prevalence of mental health symptoms. This study is among the minimal studies that have examined mental health issues in HIV, and therefore, the findings may offer significant knowledge despite the potential reverse causality. Regardless of the nature of these associations, efforts should be directed toward screening, referral, and follow-up of HIV patients who are at-risk for mental health disorders.
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Affiliation(s)
- Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Room N459, Baltimore, MD, 21201, USA. .,Department of Medicine, University of Maryland Medical Centre Midtown Campus, Baltimore, MD, USA.
| | - Lillian Nkinda
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Felix Humwa
- Global Program for Research Teaching, University of California San Francisco, Nairobi, Kenya
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | | | - Aisha Zuheri
- Infectious Disease Centre, Dar es Salaam, Tanzania
| | - Anne Kamau
- University of Nairobi, Institute for Development Studies, Nairobi, Kenya
| | - Lucy Ochola
- Institute of Primate Research, Nairobi, Kenya
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White R, Haddock G, Campodonico C, Haarmans M, Varese F. The influence of romantic relationships on mental wellbeing for people who experience psychosis: A systematic review. Clin Psychol Rev 2021; 86:102022. [PMID: 33819779 DOI: 10.1016/j.cpr.2021.102022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Whilst it is generally accepted that supportive relationships facilitate recovery from psychosis, much less is known about the role of romantic relationships in people with psychosis. This review aimed to synthesise quantitative literature regarding the impact of romantic relationships on the mental health and general wellbeing of people who experience psychosis. METHOD A systematic review of electronic databases (PsychINFO, PubMed, Web of Science) was carried out using search terms relating to psychosis and romantic relationships. Papers were selected for inclusion by independent reviewers. Quality assessment was completed and a narrative synthesis produced. RESULTS Fifty-eight studies reporting the association between romantic relationships and psychotic symptoms, depression, posttraumatic stress disorder, suicidality, quality of life, satisfaction with life and self-esteem were included. Results were mixed but indicated having a romantic partner may be associated with reduced positive and negative symptoms of psychosis, but increased depressive symptoms. Tentative explanations for these findings, such as functioning prior to onset of psychosis, social support and relationship quality are explored. CONCLUSION Findings highlight the importance of this often-overlooked area in clinical practice. Studies with robust design, which specifically aim to understand the relationship between romantic relationships and wellbeing for people who experience psychosis are needed.
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Affiliation(s)
- Rebecca White
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
| | - Carolina Campodonico
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Maria Haarmans
- Cathie Marsh Institute, Centre on Dynamics of Ethnicity (CoDE), Department of Sociology, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
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Smith HJ, Topp SM, Hoffmann CJ, Ndlovu T, Charalambous S, Murray L, Kane J, Sikazwe I, Muyoyeta M, Herce ME. Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery. Curr HIV/AIDS Rep 2021; 17:438-449. [PMID: 32779099 DOI: 10.1007/s11904-020-00518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA. RECENT FINDINGS Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.
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Affiliation(s)
- Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | | | - Izukanji Sikazwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Monde Muyoyeta
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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12
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Cournos F, Dare C, Hewitt C, Johnson S, Kaur HD, McKinnon K, Mercer C, Nolan F, Walker C, Wainberg M, Watson J. The RESPECT study: a feasibility randomised controlled trial of a sexual health promotion intervention for people with serious mental illness in community mental health services in the UK. BMC Public Health 2020; 20:1736. [PMID: 33203433 PMCID: PMC7673083 DOI: 10.1186/s12889-020-09661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background People with serious mental illness (SMI) have sexual health needs but there is little evidence to inform effective interventions to address them. In fact, there are few studies that have addressed this topic for people with SMI outside USA and Brazil. Therefore, the aim of the study was to establish the acceptability and feasibility of a trial of a sexual health promotion intervention for people with SMI in the UK. Method The RESPECT study was a two-armed randomised controlled, open feasibility trial (RCT) comparing Sexual health promotion intervention (3 individual sessions of 1 h) (I) or treatment as usual (TAU) for adults aged 18 or over, with SMI, within community mental health services in four UK cities. The main outcome of interest was the percentage who consented to participate, and retained in each arm of the trial, retention for the intervention, and completeness of data collection. A nested qualitative study obtained the views of participants regarding the acceptability of the study using individual telephone interviews conducted by lived experience researchers. Results Of a target sample of 100, a total of 72 people were enrolled in the trial over 12 months. Recruitment in the initial months was low and so an extension was granted. However this extension meant that the later recruited participants would only be followed up to the 3 month point. There was good retention in the intervention and the study as a whole; 77.8% of those allocated to intervention (n = 28) received it. At three months, 81.9% (30 I; 29 TAU) and at 6 months, 76.3% (13 I and 16 TAU) completed the follow-up data collection. No adverse events were reported. There was good completeness of the data. The sexual health outcomes for the intervention group changed in favour of the intervention. Based on analysis of the qualitative interviews, the methods of recruitment, the quality of the participant information, the data collection, and the intervention were deemed to be acceptable to the participants (n = 22). Conclusions The target of 100 participants was not achieved within the study’s timescale. However, effective strategies were identified that improved recruitment in the final few months. Retention rates and completeness of data in both groups indicate that it is acceptable and feasible to undertake a study promoting sexual health for people with SMI. A fully powered RCT is required to establish effectiveness of the intervention in adoption of safer sex. Study registration ISRCTN RegistryISRCTN15747739 prospectively registered 5th July 2016.
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Affiliation(s)
- Elizabeth Hughes
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK. .,Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England.
| | - Natasha Mitchell
- Department of Health Sciences, University of York, York, England
| | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, England
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England
| | - Francine Cournos
- New York State Psychiatric Institute and Columbia University, New York, USA
| | | | - Catherine Hewitt
- Department of Health Sciences, University of York, York, England
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, England.,, Camden and Islington NHS Foundation Trust, England
| | | | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University, New York, USA
| | - Catherine Mercer
- Institute for Global Health, University College London, London, England
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, England
| | | | - Milton Wainberg
- New York State Psychiatric Institute and Columbia University, New York, USA
| | - Judith Watson
- Department of Health Sciences, University of York, York, England
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13
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Dare C, Hewitt C, Johnson S, Llewellyn C, Mercer C, Nolan F, Walker C, Watson J. Sexual health promotion in people with severe mental illness: the RESPECT feasibility RCT. Health Technol Assess 2020; 23:1-136. [PMID: 31854292 DOI: 10.3310/hta23650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with serious mental illness have sexual health needs, but there is limited evidence regarding effective interventions to promote their sexual health. OBJECTIVES To develop a sexual health promotion intervention for people with serious mental illness, and to conduct a feasibility trial in order to establish the acceptability and parameters for a fully powered trial. DESIGN A two-armed randomised controlled, open feasibility study comparing usual care alone with usual care plus the adjunctive intervention. SETTING Five community mental health providers in Leeds, Barnsley, Brighton and London. PARTICIPANTS Adults aged ≥ 18 years with serious mental illness and receiving care from community mental health teams. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to usual care plus the RESPECT (Randomised Evaluation of Sexual health Promotion Effectiveness informing Care and Treatment) intervention (three sessions of 1 hour) (intervention arm) or usual care only (control arm). The intervention was an interactive manualised package of exercises, quizzes and discussion topics focusing on knowledge, motivation and behavioural intentions to adopt safer sexual behaviours. MAIN OUTCOME MEASURES Feasibility parameters including establishing the percentage of people who were eligible, consented and were retained in each arm of the trial, retention for the intervention, as well as the completeness of the data collection. Data were collected on knowledge, motivation to adopt safer sexual behaviour, sexual behaviour, sexual stigma, sexual health service use and quality of life. Data were collected at baseline and then at 3 months and 6 months post randomisation. RESULTS Of a target of 100 participants, 72 people participated in the trial over 12 months. Of the 36 participants randomised to the intervention arm, 27 received some of the intervention (75.0%). At 3 months, 59 of the 72 participants completed follow-up questionnaires (81.9%) (30 participants from the intervention arm and 29 participants from the control arm). Only the first 38 participants were followed up at 6 months. However, data were collected on 29 out of 38 participants (76.3% retention): 13 in the intervention arm and 16 in the control arm. No adverse events were reported. Participant feedback confirmed that both the design and the intervention were acceptable. The economic analysis indicated high completion rates and completeness of data among participants who continued the trial. CONCLUSIONS Despite the limitations, the findings suggest that it is both acceptable and feasible to undertake a sexual health promotion study for people with serious mental illness. FUTURE WORK A fully powered randomised controlled trial would be required to establish the clinical effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN15747739. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - Catherine Mercer
- Institute for Global Health, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | | | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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Pinho V, McKinnon K, Cournos F, Pala AN, Zea MC, Le HN, Mattos PE, Pinto D, Mann CG, Wainberg ML. The impact of psychiatric symptoms on condom self-efficacy among people with serious mental illness. Psychiatr Rehabil J 2020; 43:205-213. [PMID: 31999142 PMCID: PMC7390675 DOI: 10.1037/prj0000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine how psychiatric symptoms affect the self-efficacy of people with serious mental illness to protect themselves and their partners from HIV and other sexually transmitted infections (STIs) by using condoms. METHOD As part of a National Institute of Mental Health-Funded study, people with serious mental illness (N = 467) were recruited in public psychiatric outpatient clinics in Rio de Janeiro, Brazil for an HIV prevention intervention. We examined the effects of psychiatric symptom severity on condom self-efficacy at baseline across 4 symptom clusters: affect, positive, negative, and activation. RESULTS Greater activation symptom severity (e.g., elated mood) was related to better condom self-efficacy, whereas greater negative symptom severity (e.g., blunted affect, emotional withdrawal) was related to worse condom self-efficacy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our findings suggest that people living with serious mental illness who exhibit more severe negative symptoms are less likely to perceive themselves as capable of using condoms, condom negotiation, and/or condom acquisition, whereas those with more severe activation symptoms are more likely to express confidence in their capabilities. Interventions to prevent HIV and other STIs among people living with serious mental illness should take into account the effects of these symptom clusters on condom skills acquisition and perceptions of self-efficacy in carrying out needed protective behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Diana Pinto
- Department of Psychiatry and Forensic Medicine
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15
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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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16
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Scanavino MD, Alves LC, Yamaguchi ER, Wainberg ML. Sexual stigma, attachment difficulties, and emotional dysregulation among patients with severe mental illness. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 42:106-108. [PMID: 32022165 PMCID: PMC6986487 DOI: 10.1590/1516-4446-2019-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
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17
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Slack P, Aziz VM. Sexuality and sexual dysfunctions in older people: a forgotten problem. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SUMMARYThis article considers sexuality in older adults and the associated stereotypes and stigmas that lead to this area being underappreciated. Normal physiological changes in ageing are discussed and how they can cause sexual dysfunction. The elderly population has a higher burden of comorbid physical illness and this review considers evidence on the interplay between physical health and sexual health. Mental illness is also strongly linked with sexual functioning and is discussed, as is the evidence on psychotropics and sexual side-effects. Attitudes on sexuality in long-term care settings are highlighted and approaches to managing sexual disinhibition are included.
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18
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Dare C, Hewitt C, Johnson S, Llewellyn C, Mercer C, Nolan F, Walker C, Watson J. Sexual health promotion in people with severe mental illness: the RESPECT feasibility RCT. Health Technol Assess 2019; 23:1-136. [PMID: 31854292 DOI: 10.3310/hta23610.pmid:31670644;pmcid:pmc6843114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND People with serious mental illness have sexual health needs, but there is limited evidence regarding effective interventions to promote their sexual health. OBJECTIVES To develop a sexual health promotion intervention for people with serious mental illness, and to conduct a feasibility trial in order to establish the acceptability and parameters for a fully powered trial. DESIGN A two-armed randomised controlled, open feasibility study comparing usual care alone with usual care plus the adjunctive intervention. SETTING Five community mental health providers in Leeds, Barnsley, Brighton and London. PARTICIPANTS Adults aged ≥ 18 years with serious mental illness and receiving care from community mental health teams. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to usual care plus the RESPECT (Randomised Evaluation of Sexual health Promotion Effectiveness informing Care and Treatment) intervention (three sessions of 1 hour) (intervention arm) or usual care only (control arm). The intervention was an interactive manualised package of exercises, quizzes and discussion topics focusing on knowledge, motivation and behavioural intentions to adopt safer sexual behaviours. MAIN OUTCOME MEASURES Feasibility parameters including establishing the percentage of people who were eligible, consented and were retained in each arm of the trial, retention for the intervention, as well as the completeness of the data collection. Data were collected on knowledge, motivation to adopt safer sexual behaviour, sexual behaviour, sexual stigma, sexual health service use and quality of life. Data were collected at baseline and then at 3 months and 6 months post randomisation. RESULTS Of a target of 100 participants, 72 people participated in the trial over 12 months. Of the 36 participants randomised to the intervention arm, 27 received some of the intervention (75.0%). At 3 months, 59 of the 72 participants completed follow-up questionnaires (81.9%) (30 participants from the intervention arm and 29 participants from the control arm). Only the first 38 participants were followed up at 6 months. However, data were collected on 29 out of 38 participants (76.3% retention): 13 in the intervention arm and 16 in the control arm. No adverse events were reported. Participant feedback confirmed that both the design and the intervention were acceptable. The economic analysis indicated high completion rates and completeness of data among participants who continued the trial. CONCLUSIONS Despite the limitations, the findings suggest that it is both acceptable and feasible to undertake a sexual health promotion study for people with serious mental illness. FUTURE WORK A fully powered randomised controlled trial would be required to establish the clinical effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN15747739. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - Catherine Mercer
- Institute for Global Health, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | | | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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Abstract
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
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20
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McGarry J. 'Hiding in plain sight': Exploring the complexity of sexual safety within an acute mental health setting. Int J Ment Health Nurs 2019; 28:171-180. [PMID: 29963747 DOI: 10.1111/inm.12514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
It is increasingly being recognized that individuals who access acute mental health services are at risk of sexual assault. Assaults may be perpetrated by other patients but also by staff working in mental health environments, although this latter group remain largely under-researched. Following a reported professional sexual assault and review of an acute inpatient mental health setting in the UK, the overall aim of this study was to explore the mechanisms and structures that were put into place following the investigation and in so doing examine the wider questions of sexual safety in acute mental health settings. A qualitative approach was utilized and involved interviews with clinical staff (n = 8). Thematic analysis was used to analyse the data resulting in four main themes: 'Feeling betrayed': The relational context of the ward environment'; 'Doing what we were meant to be doing': Quality of leadership'; 'Covering yourself': Safeguarding practice; 'The subtleties of abuse': Complexities of safeguarding '. The findings of the study highlight the need for clear organizational structures of support, a clearer understanding of 'sexual safety', and education and training which explicitly addresses recognition and complexity of sexual violence.
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Affiliation(s)
- Julie McGarry
- University of Nottingam, School of Health Sciences, Queens Medical Centre Nottingham, Nottingham, UK
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21
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Ecker J, Cherner R, Rae J, Czechowski K. Sexual Intimacy, Mental Illness, and Homelessness. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:131-140. [PMID: 29243831 DOI: 10.1002/ajcp.12213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current article reviews the literature on sexuality among individuals with a severe mental illness (SMI) who have experienced homelessness, a topic that has received little attention in the research literature, particularly from a community psychology perspective. The review begins with a synthesis of the literature on SMI and sexuality, followed by a review of the available literature on SMI, homelessness, and sexuality. It concludes with an interpretation of the findings using community psychology values and principles. The findings highlight the importance of intimate relationships to recovery for many individuals with an SMI who have experienced homelessness. Policy implications for homeless shelters and housing interventions are discussed.
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Affiliation(s)
- John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, ON, Canada
- Centre for Research on Educational & Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Cherner
- Centre for Research on Educational & Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Rae
- Centre for Research on Educational & Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Konrad Czechowski
- Department of Psychology, Centre for Research on Educational & Community Services, University of Ottawa, Ottawa, ON, Canada
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22
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An Exploratory Analysis of Unhealthy and Abusive Relationships for Adults with Serious Mental Illnesses Living in Supportive Housing. Community Ment Health J 2017; 53:679-687. [PMID: 28470461 DOI: 10.1007/s10597-017-0141-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
Individuals living with serious mental illness are at high risk of chronic homelessness, victimization, and intimate partner violence. In recent years, supportive housing programs have emerged as one way to prevent homelessness and victimization for this population, while also expanding social interactions and social networks. In concert with a focal supportive housing program, this research conducted two focus groups with 18 individuals who have a serious mental illness diagnosis. The authors sought to answer the research question, "What are perceptions of healthy and unhealthy relationships among formerly homeless people with serious mental illness?" To this end, the eight-item questionnaire was created around dimensions of power and control, as well as relationship equality. Findings from an inductive thematic analysis reveal three broad families of themes (relationship ideals, lived experiences, and risk/resources in supportive housing), around which smaller themes and subthemes are organized. Implications for policy, practice, and future research are also discussed.
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23
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Boysen GA. Stigma Toward People with Mental Illness as Potential Sexual and Romantic Partners. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2017. [DOI: 10.1007/s40806-017-0089-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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24
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The Role of Metacognitive Self-Reflectivity in Emotional Awareness and Subjective Indices of Recovery in Schizophrenia. J Nerv Ment Dis 2016; 204:903-908. [PMID: 27668353 PMCID: PMC5125882 DOI: 10.1097/nmd.0000000000000599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emotional awareness deficits in people with schizophrenia have been linked to poorer objective outcomes, but no work has investigated the relationship between emotional awareness and subjective recovery indices or metacognitive self-reflectivity. The authors hypothesized that increased emotional awareness would be associated with greater self-esteem, hope, and self-reflectivity and that self-reflectivity would moderate links between emotional awareness and self-esteem and hope-such that significant relationships would only be observed at lower levels of self-reflectivity. Participants were 56 people with schizophrenia spectrum disorders. Correlations revealed that better emotional awareness was significantly associated with increased self-esteem and hope but not self-reflectivity. Self-reflectivity moderated the relationship between emotional awareness and self-esteem but not hope. Overall, findings suggest that emotional awareness may affect self-esteem for those low in self-reflectivity, but other factors may be important for those with greater self-reflectivity. Results emphasize the importance of interventions tailored to enhance self-reflective capacity in clients with schizophrenia.
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25
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Hobkirk AL, Towe SL, Lion R, Meade CS. Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings. Curr HIV/AIDS Rep 2015; 12:406-12. [PMID: 26428958 PMCID: PMC4812670 DOI: 10.1007/s11904-015-0294-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persons with severe mental illness (SMI) have been disproportionately affected by the HIV epidemic, with higher rates of HIV prevalence and morbidity than the general population. Recent research has advanced our understanding of the complex factors that influence primary and secondary HIV prevention for those with SMI. Sex risk in this population is associated with socioeconomic factors (e.g., low income, history of verbal violence) and other health risk behaviors (e.g., substance use, no prior HIV testing). Several interventions are effective at reducing risk behavior, and reviews highlight the need for more well-controlled studies that assess long-term outcomes. Recent research has elucidated barriers that interfere with HIV treatment for SMI populations, including individual (e.g., apathy, substance use), social (e.g., stigma), and system factors (e.g., transportation, clinic wait times). Interventions that coordinate HIV care for individuals with SMI show promise as cost-effective methods for improving medication adherence and quality of life.
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Affiliation(s)
- Andréa L Hobkirk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
| | - Ryan Lion
- Duke Global Health Institute, Duke University, 310 Trent Drive, Trent Hall, Durham, NC, 27708, USA.
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Trent Hall, Durham, NC, 27708, USA.
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