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Fentahun S, Melkam M, Tadesse G, Rtbey G, Andualem F, Wassie YA, Geremew GW, Alemayehu TT, Haile TD, Godana TN, Mengistie BA, Kelebie M, Nakie G, Tinsae T, Takelle GM. Sexual dysfunction among people with mental illness in Africa: A systematic review and meta-analysis study. PLoS One 2024; 19:e0308272. [PMID: 39083558 PMCID: PMC11290669 DOI: 10.1371/journal.pone.0308272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Sexual dysfunction is the most frequent health problem among psychiatric patients. This could be the result of both the nature of the illness itself and the side effects of prescribed psychotropic medications. It also significantly affects an individual's general well-being, interpersonal relationships, self-esteem, and treatment outcomes. Therefore, the current systematic review and meta-analysis was conducted to determine the combined prevalence of sexual dysfunction and its correlated factors among people with mental illness. METHODS We retrieved eligible primary studies using various search databases like PubMed, EMBASE, Science Direct, African Journal Online, Google Scholar, and Psychiatry Online. The report of this systematic review was reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used standardized data extraction checklists and STATA version 14 for data extraction and analysis, respectively. The I-squared statistics test was used to check statistical heterogeneity within the included articles. Publication bias was assessed using a funnel plot and the Egger test. To estimate the overall prevalence and correlated factors of sexual dysfunction, a random effects model meta-analysis was employed. RESULTS In this meta-analysis, a total of 15 primary studies with 2849 psychiatric patients were included. The overall pooled prevalence of sexual dysfunction among psychiatric patients in Africa was 58.42% (95% CI: 49.55, 67.28). Having older age (OR = 1.92, 95% CI: 1.28, 2.87), longer duration of illness (OR = 2.60, 95% CI: 1.14, 5.93), history of relapse (OR = 3.51, 95% CI: 1.47, 8.43), poor quality of life (OR = 3.89, 95% CI: 2.15, 7.05), and antipsychotic medications (OR = 2.99, 95% CI: 1.84, 4.86) were significantly associated with sexual dysfunction. CONCLUSION This meta-analysis revealed that approximately two-thirds of psychiatric patients in Africa are affected by sexual dysfunction. Therefore, the findings of this study recommend that when evaluating psychiatric patients, health professionals should focus more on sexual dysfunction. It is also essential to promote awareness and incorporate sexual health assessment and intervention into mental health services to reduce the overall burden of the problem.
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Affiliation(s)
- Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gebresilassie Tadesse
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremariam Wulie Geremew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tekletsadik Tekleslassie Alemayehu
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Denekew Haile
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmaceutical Chemistry
| | - Tilahun Nega Godana
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar Ethiopia
| | - Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulualem Kelebie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Vargas-Cáceres S, Cera N, Nobre P, Ramos-Quiroga JA. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021; 18:457-466. [PMID: 33504468 DOI: 10.1016/j.jsxm.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual dysfunction among psychotic patients is highly prevalent. However, most research has focused on antipsychotic side effects on sexual functioning. AIM To provide evidence by means of a systematic review of the literature about the impact of psychosis on sexual functioning among unmedicated patients. METHODS Systematic search of MEDLINE (PubMed), Scopus, and Google Scholar for studies that reported sexual functioning among psychotic patients, who were drug-naïve or drug-free for at least 3 weeks before the study. Studies were published in English language between January 1994 and October 2019. We used the approach recommended by PRISMA, and the selection process was carried out by 2 reviewers. OUTCOMES The outcome measures were sexual function and sexual dysfunctions. RESULTS A total of 734 articles were obtained, 658 were obtained after duplicates were removed, 612 were excluded after reading the title and abstract, and 46 were included for a complete review of the articles. 5 papers were finally included. A total of 770 cases were included in the systematic review. The prevalence of sexual dysfunction in psychosis varied from 16.8% to 70% and in ultra-high state was 50%. It is noteworthy that those ultra-high-risk (prodromal) patients who develop psychosis had higher rates of sexual impairment. Therefore, we found higher rates of sexual dysfunction among untreated patients, both psychotic and ultra-high risk patients, than healthy controls. CLINICAL IMPLICATIONS The assessment of sexual behavior should be a part of routine psychiatric examination not only in psychotic but also in ultra-high-risk patients. STRENGTHS & LIMITATIONS This is the first systematic review about the impact of psychosis on sexual functioning among unmedicated patients. However, scarce and heterogeneous studies were identified. CONCLUSIONS Impaired sexual functioning is common in the onset of psychosis (or during ultra-high-risk state) and prior to the beginning of treatment. This suggests that psychotic symptoms and sexual dysfunction may have common etiological pathways at the psychosocial and neurobiological levels. Vargas-Cáceres S, Cera N, Nobre P, et al. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021;18:457-466.
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Affiliation(s)
| | - Nicoletta Cera
- CPUP. Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Pedro Nobre
- CPUP. Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institut, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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Ciocca G, Jannini TB, Ribolsi M, Rossi R, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature. Front Psychiatry 2021; 12:750033. [PMID: 34777053 PMCID: PMC8579023 DOI: 10.3389/fpsyt.2021.750033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Unit of Neurology, Neurobiology, Neurophysiology and Psychiatry, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
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