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Krendl AC, Perry BL. Stigma Toward Substance Dependence: Causes, Consequences, and Potential Interventions. Psychol Sci Public Interest 2023; 24:90-126. [PMID: 37883667 DOI: 10.1177/15291006231198193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Substance dependence is a prevalent and urgent public health problem. In 2021, 60 million Americans reported abusing alcohol within the month prior to being surveyed, and nearly 20 million Americans reported using illegal drugs (e.g., heroin) or prescription drugs (e.g., opioids) for nonmedical reasons in the year before. Drug-involved overdose rates have been steadily increasing over the past 20 years. This increase has been primarily driven by opioid and stimulant use. Despite its prevalence, drug dependence is one of the most stigmatized health conditions. Stigma has myriad negative consequences for its targets, including limiting their access to employment and housing, disrupting interpersonal relationships, harming physical and mental health, and reducing help-seeking. However, because research on stigma toward people with substance use disorders (SUDs) is relatively sparse compared with research on stigma toward other mental illnesses, the field lacks a comprehensive understanding of the causes and consequences of SUD stigma. Moreover, it remains unclear how, if at all, these factors differ from other types of mental illness stigma. The goal of this review is to take stock of the literature on SUD stigma, providing a clear set of foundational principles and a blueprint for future research and translational activity.
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Affiliation(s)
- Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - Brea L Perry
- Department of Sociology, Indiana University Bloomington
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Alshehri K, Wen M, Michaud T, Chen B, Li H, Qu J, Chen L, Li J, Zhang D, Li Y, Chen Z, Han X, Shi L, Su D. Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19. JOURNAL OF SEX RESEARCH 2023:1-9. [PMID: 37307401 DOI: 10.1080/00224499.2023.2221673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.
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Affiliation(s)
- Khalid Alshehri
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Ming Wen
- Department of Sociology, University of Utah
| | - Tzeyu Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University
| | - Joshua Qu
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Liwei Chen
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society
| | - Lu Shi
- Department of Public Health Sciences, Clemson University
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
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Brand E, Tham C, Ratsch A, Heffernan E. Sexual knowledge of Queensland forensic mental health patients: A cross-sectional quantitative study. Front Psychiatry 2023; 14:1160277. [PMID: 37113546 PMCID: PMC10126372 DOI: 10.3389/fpsyt.2023.1160277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Forensic patients with serious mental illnesses (SMI) encounter significant challenges including active symptomatology, associated social and interpersonal impairments, psychotropic medication side effects and institutionalization, all of which negatively affect sexual functioning and possibly their acquirement of sexual knowledge. Evidence shows an increased prevalence of high-risk sexual behavior by this group however, there is an absence of literature examining the sexual knowledge of forensic patients. This quantitative cross-sectional study enrolled N = 50 patients currently under the treatment requirements of a Forensic Order and utilized the validated General Sexual Knowledge Questionnaire (GSKQ) to quantify the participants' sexual knowledge over the domains of physiology, sexual intercourse, pregnancy, contraception, sexually transmitted diseases, and sexuality. Male forensic patients scored lower than females on all domains of sexual knowledge. All participants had reasonable knowledge of physiology, sexual intercourse and sexuality; of concern were poor scores on pregnancy, contraception and sexually transmitted diseases. Thirty-five (70%) of the respondents indicated that they had some limited sex education, mostly at school. Only six (12%) received any sexual education from a health professional despite extensive contact with the forensic mental health services across many years. There is a need to assess the deficit in sexual knowledge of forensic patients in order to develop sexual health education, intervention and rehabilitative programmes that cater to the specific needs of this group to improve their sexual knowledge, encourage safe and positive sexual experiences, and enhance their quality of life.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Elnike Brand,
| | - Ching Tham
- Metro South Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
- Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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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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Sandberg LJ, Rosqvist HB, Grigorovich A. Regulating, fostering and preserving: the production of sexual normates through cognitive ableism and cognitive othering. CULTURE, HEALTH & SEXUALITY 2021; 23:1421-1434. [PMID: 32772835 DOI: 10.1080/13691058.2020.1787519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
People with cognitive disabilities are commonly positioned as risky sexual subjects. This article discusses the discursive production of sexual normates in the form of desirable and normative able-minded sexual subjects, in scientific research on the sexuality and cognitive disabilities of younger and older individuals (in particular those with dementia). We identify three interrelated discourses: regulating sexuality; fostering sexuality; and preserving sexuality. The first of these, regulation, pathologises sexuality of people with cognitive disabilities as faulty and in need of restriction. The second discourse, fostering, is more affirmative and argues for educating for a 'healthy' sexuality of people with cognitive disabilities, to mitigate risks of abuse. This discourse is more salient with younger people. The third discourse, preservation, in contrast, is more visible with older people with dementia and affirms sexuality so long as it is consistent with a 'genuine' or 'authentic' sexuality of the past. In conclusion, scientific research reinforces the cultural ideal of the rational and autonomous individual (and as such the mature/adult) capable of making independent decisions and engaging in healthy, good sex, based on stable sexual identities. Findings demonstrate how age intersects with cognitive ableism to intensify the cultural anxiety that exists around the sexualities of people with cognitive disabilities.
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Affiliation(s)
- Linn J Sandberg
- School of Culture and Education, Södertörn University, Huddinge, Sweden
| | | | - Alisa Grigorovich
- The Kite Research Institute-UHN, University of Toronto, Toronto, Canada
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Landi G, Marchi M, Ettalibi MY, Mattei G, Pingani L, Sacchi V, Galeazzi GM. Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach. Behav Sci (Basel) 2020; 10:E125. [PMID: 32756442 PMCID: PMC7464764 DOI: 10.3390/bs10080125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. METHODS Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). RESULTS Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them. CONCLUSIONS RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.
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Affiliation(s)
- Giulia Landi
- Department of Mental Health and Drug Abuse, AUSL Modena, Via San Giovanni del Cantone, 23–41121 Modena, Italy;
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | | | - Giorgio Mattei
- Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Via J. Berengario, 51–41121 Modena, Italy;
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Valentina Sacchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
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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: 24] [Impact Index Per Article: 6.0] [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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8
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Dudeck M. Sexualität von allgemeinpsychiatrischen und Maßregelpatienten. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Urry K, Chur-Hansen A. Who decides when people can have sex? Australian mental health clinicians' perceptions of sexuality and autonomy. J Health Psychol 2018; 25:2188-2199. [PMID: 30035634 DOI: 10.1177/1359105318790026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Sexuality is a central aspect of human experience but there is evidence that this is largely constrained, pathologised or ignored in mental health settings. We conducted in-depth interviews with 22 psychologists, psychiatrists and mental health nurses working across a variety of settings in four Australian cities. Sexuality was most often perceived as relevant in the mental health setting when it was simultaneously constructed as dangerous. Participants located this danger in sexual expression itself or within individuals who, because of mental illness, lacked the autonomy required to successfully engage in 'safe' sex. We discuss these findings and their implications for research and professional practice.
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Corbett R, Elsom S, Sands N, Prematunga R. An exploratory investigation of sexual health screening in the first 12 weeks of case management in populations with severe mental illness. Int J Ment Health Nurs 2017; 26:160-169. [PMID: 27616654 DOI: 10.1111/inm.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/27/2022]
Abstract
The sexual health of people with mental illness is commonly overlooked, neglected or inadequately addressed in mental health care, despite evidence showing that people with severe mental illness are more vulnerable to sexually transmitted infections (including HIV), sexual side-effects, and sexual dysfunction than the general population. This article reports a study that investigated sexual health screening in five community mental health clinics within a large a regional health service in Victoria, Australia. The aim of the study was to examine the extent to which sexual health screening is currently undertaken on newly admitted case-managed consumers, and to identify the types of screening undertaken. An exploratory design using retrospective file audit was used in the study. A total of 186 medical records met the study inclusion criteria. The study found that less than 40% of consumers were provided with sexual health screening during their first 12 weeks of case management. The study also found that sexual side-effects, issues of fertility, sexual self-esteem, safe sexual practices, and sexual dysfunction were rarely screened for. Poor sexual health screening has implications for the safety and quality of mental health care and requires targeted research to improve understandings and approaches to care.
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Affiliation(s)
- Rebecca Corbett
- Mental Health, Drugs and Alcohol Education Team, Barwon Health, Geelong, Victoria, Australia
| | - Stephen Elsom
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natisha Sands
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Roshani Prematunga
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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Quinn C, Happell B. Supporting the Sexual Intimacy Needs of Patients in a Longer Stay Inpatient Forensic Setting. Perspect Psychiatr Care 2016; 52:239-247. [PMID: 26010649 DOI: 10.1111/ppc.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/17/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore perceptions of nurses and patients regarding sexual intimacy in a long-term mental health unit. DESIGN AND METHODS Qualitative exploratory design including in-depth semi-structured individual interviews with 12 registered nurses and 10 long-term patients of a forensic mental health hospital. FINDINGS The theme of supporting sexual intimacy was identified and described in this paper and included the following subthemes for nurses: It depends on the setting, need for guidelines and consent, and for patients-it depends on the setting; and need for support. PRACTICE IMPLICATIONS The findings suggest that current guidelines regarding sexual intimacy in acute inpatient settings may not be appropriate in long-term facilities, with a need for guidelines to specifically address this setting. Furthermore, support for sexual intimacy needs of patients was identified as a strong need for patients and they believed not currently met. Nurses have an important role to play as part of their holistic approach to care and barriers to providing this aspect of care must be overcome to ensure patients' rights are respected.
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Affiliation(s)
- Chris Quinn
- Victorian Centre for Forensic Mental Health (Forensicare), Melbourne, Victoria, Australia.,Central Queensland University, Rockhampton, Queensland, Australia
| | - Brenda Happell
- Research Centre for Nursing and Midwifery Practice, University of Canberra, Faculty of Health and ACT Health, Canberra, Australian Capital Territory, Australia.
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12
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Hunter KM, Ahmed AO. Sexuality and Sexual Health. EVIDENCE-BASED PRACTICES IN BEHAVIORAL HEALTH 2016. [DOI: 10.1007/978-3-319-40537-7_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bonfils KA, Firmin RL, Salyers MP, Wright ER. Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity. Psychiatr Rehabil J 2015; 38:249-55. [PMID: 25664756 PMCID: PMC4530100 DOI: 10.1037/prj0000117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. METHOD A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. RESULTS Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning.
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Affiliation(s)
- Kelsey A. Bonfils
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Ruth L. Firmin
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Michelle P. Salyers
- Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
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14
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Quinn C, Happell B. Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views. J Clin Nurs 2015; 24:2268-76. [DOI: 10.1111/jocn.12860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Quinn
- Victorian Centre for Forensic Mental Health (Forensicare); Fairfield VIC Australia
| | - Brenda Happell
- Synergy, Nursing and Midwifery Research Centre; University of Canberra; Faculty of Health; Canberra ACT Australia
- ACT Health; Canberra Hospital; Garran ACT Australia
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15
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de Boer MK, Castelein S, Wiersma D, Schoevers RA, Knegtering H. The facts about sexual (Dys)function in schizophrenia: an overview of clinically relevant findings. Schizophr Bull 2015; 41:674-86. [PMID: 25721311 PMCID: PMC4393701 DOI: 10.1093/schbul/sbv001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A limited number of studies have evaluated sexual functioning in patients with schizophrenia. Most patients show an interest in sex that differs little from the general population. By contrast, psychiatric symptoms, institutionalization, and psychotropic medication contribute to frequently occurring impairments in sexual functioning. Women with schizophrenia have a better social outcome, longer lasting (sexual) relationships, and more offspring than men with schizophrenia. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships. Although patients consider sexual problems to be highly relevant, patients and clinicians not easily discuss these spontaneously, leading to an underestimation of their prevalence and contributing to decreased adherence to treatment. Studies using structured interviews or questionnaires result in many more patients reporting sexual dysfunctions. Although sexual functioning can be impaired by different factors, the use of antipsychotic medication seems to be an important factor. A comparison of different antipsychotics showed high frequencies of sexual dysfunction for risperidone and classical antipsychotics, and lower frequencies for clozapine, olanzapine, quetiapine, and aripiprazole. Postsynaptic dopamine antagonism, prolactin elevation, and α1-receptor blockade may be the most relevant factors in the pathogenesis of antipsychotic-induced sexual dysfunction. Psychosocial strategies to treat antipsychotic-induced sexual dysfunction include psychoeducation and relationship counseling. Pharmacological strategies include lowering the dose or switching to a prolactin sparing antipsychotic. Also, the addition of a dopamine agonist, aripiprazole, or a phosphodiesterase-5 inhibitor has shown some promising results, but evidence is currently scarce.
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Affiliation(s)
- Marrit K. de Boer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;,*To whom correspondence should be addressed; Department of Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, CC43, 9700 RB Groningen, The Netherlands. tel: +31-50-3616161, fax: +31-50-3611699, e-mail:
| | - Stynke Castelein
- Lentis, Center for Mental Healthcare, Groningen, The Netherlands;,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research center, Groningen, The Netherlands
| | - Durk Wiersma
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Quinn C, Happell B. Consumer sexual relationships in a forensic mental health hospital: perceptions of nurses and consumers. Int J Ment Health Nurs 2015; 24:121-9. [PMID: 25522062 DOI: 10.1111/inm.12112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes 'therapeutic', 'feeling normal', 'restrictions and barriers', and 'lack of support and secrecy'. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required.
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Affiliation(s)
- Chris Quinn
- Victorian Institute for Forensic Mental Health, Australia
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17
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Women Living with Serious Mental Illness: The Impact of Sexual Stigma and Sexual Wellness on Quality of Life. WOMEN & THERAPY 2015. [DOI: 10.1080/02703149.2014.978218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tennille J, Solomon P, Bohrman C. Using the FIELD Model to Prepare Social Work Students and Field Instructors on Sexuality and Intimacy for Persons with Psychiatric Disabilities. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9380-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guimarães MDC, Elkington KS, Gomes ALFM, Veloso C, McKinnon K. HIV sexual risk behavior among emerging adults in psychiatric treatment in Brazil. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2014; 13:451-472. [PMID: 25530731 PMCID: PMC4269266 DOI: 10.1080/15381501.2013.809042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
HIV infection among young populations is increasing worldwide. Adolescents in mental health treatment have demonstrated higher rates of HIV risk behavior than their peers. This first risk behavior study of youth in psychiatric treatment in Brazil reports findings from a cross-sectional national sample of emerging adult psychiatric patients (18-25 years old). The prevalence of lifetime unprotected sex was 65.9%. Multiple logistic regression indicated that being married/in union; sex under the influence of alcohol/drugs; physical violence; earlier sexual debut; and depressive/substance use disorders were associated with unsafe sex. Interventions and services that address these risks during this critical developmental window are urgently needed.
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Affiliation(s)
- Mark D C Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University ,New York, USA
| | - Ana Luiza F M Gomes
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Veloso
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, USA
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Abstract
OBJECTIVE A comprehensive treatment program for schizophrenia needs to include services to women of childbearing age that address contraception, pregnancy, and postpartum issues, as well as safe and effective parenting. To update knowledge in these areas, a summary of the recent qualitative and quantitative literature was undertaken. METHOD The search terms 'sexuality,''contraception,''pregnancy,''postpartum,''custody,' and 'parenting' were entered into PubMed, PsycINFO, and SOCINDEX along with the terms 'schizophrenia' and 'antipsychotic.' Publications in English for all years subsequent to 2000 were retrieved and their reference lists further searched in an attempt to arrive at a distillation of useful clinical recommendations. RESULTS The main recommendations to care providers are as follows: take a sexual history and initiate discussion about intimate relationships and contraception with all women diagnosed with schizophrenia. During pregnancy, adjust antipsychotic dose to clinical status, link the patient with prenatal care services, and help her prepare for childbirth. There are pros and cons to breastfeeding while on medication, and these need thorough discussion. During the postpartum period, mental health home visits should be provided. Parenting support is critical. CONCLUSION The comprehensive treatment of schizophrenia in women means remembering that all women of childbearing age are potential new mothers.
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Affiliation(s)
- M V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Walkup J, Akincigil A, Hoover DR, Siegel MJ, Amin S, Crystal S. Use of Medicaid data to explore community characteristics associated with HIV prevalence among beneficiaries with schizophrenia. Public Health Rep 2011; 126 Suppl 3:89-101. [PMID: 21836742 DOI: 10.1177/00333549111260s314] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap. METHODS We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally. RESULTS Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia. CONCLUSIONS Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
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Affiliation(s)
- James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA.
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Kelly PJ, Deane FP. Do therapeutic homework assignments address areas of need for individuals with severe mental illness? Community Ment Health J 2011; 47:194-200. [PMID: 19568934 DOI: 10.1007/s10597-009-9217-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/09/2009] [Indexed: 11/26/2022]
Abstract
The current study explores the types of homework assignments used in a recovery orientated case management approach. It also examines the relationship between the types of homework used and the clients' area of need as rated on the CANSAS. There were 129 client and mental health case manager dyads that participated in the study. Written copies of all homework assignments administered during the 12-month research period were collected (N = 1,054). The homework assignments were categorised according to the 'type' and the 'need domain addressed by the task'. The majority of these tasks were behavioural in nature. On a group level homework tended to broadly address areas of need for clients in the study. Only 2 of the 1,054 homework assignments administered directly addressed areas of Intimate Relationships or Sexual Expression. The importance of addressing Intimate Relationship and Sexual Expression within mental health case management is discussed.
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Affiliation(s)
- Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia.
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Eklund M, Ostman M. Belonging and doing: important factors for satisfaction with sexual relations as perceived by people with persistent mental illness. Int J Soc Psychiatry 2010; 56:336-47. [PMID: 19617283 DOI: 10.1177/0020764008101635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people's lives, but little is known of factors associated with this phenomenon among people with mental illness. AIM This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations. METHODS Patients with persistent mental illness (N = 103), recruited from an outpatient unit, were assessed regarding the target variables. RESULTS No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation. CONCLUSION Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.
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Affiliation(s)
- Mona Eklund
- Faculty of Health and Society, Malmö University SE-20506, Malmö, Sweden.
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Östman M. Severe depression and relationships: the effect of mental illness on sexuality. SEXUAL AND RELATIONSHIP THERAPY 2008. [DOI: 10.1080/14681990802419266] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wainberg ML, Alfredo González M, McKinnon K, Elkington KS, Pinto D, Gruber Mann C, Mattos PE. Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Soc Sci Med 2007; 65:296-308. [PMID: 17475382 PMCID: PMC2175036 DOI: 10.1016/j.socscimed.2007.03.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Indexed: 11/20/2022]
Abstract
As in other countries worldwide, adults with severe mental illness (SMI) in Brazil are disproportionately infected with HIV relative to the general population. Brazilian psychiatric facilities lack tested HIV prevention interventions. To adapt existing interventions, developed only in the US, we conducted targeted ethnography with adults with SMI and staff from two psychiatric institutions in Brazil. We sought to characterize individual, institutional, and interpersonal factors that may affect HIV risk behavior in this population. We conducted 350 hours of ethnographic field observations in two mental health service settings in Rio de Janeiro, and 9 focus groups (n=72) and 16 key-informant interviews with patients and staff in these settings. Data comprised field notes and audiotapes of all exchanges, which were transcribed, coded, and systematically analyzed. The ethnography identified and/or characterized the institutional culture: (1) patients' risk behaviors; (2) the institutional setting; (3) intervention content; and (4) intervention format and delivery strategies. Targeted ethnography also illuminated broader contextual issues for development and implementation of HIV prevention interventions for adults with SMI in Brazil, including an institutional culture that did not systematically address patients' sexual behavior, sexual health, or HIV sexual risk, yet strongly impacted the structure of patients' sexual networks. Further, ethnography identified the Brazilian concept of "social responsibility" as important to prevention work with psychiatric patients. Targeted ethnography with adults with SMI and institutional staff provided information critical to the adaptation of tested US HIV prevention interventions for Brazilians with SMI.
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