Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care
Introduction
Sexual dysfunction is common in schizophrenia with negative consequences, such as low quality of life (QOL) and self-esteem, poor interpersonal relationships and treatment adherence [1], [2]. The reasons for sexual dysfunction are complex and may arise from the side effects of psychotropic medications (e.g., sedation and hyperprolactinemia) [3], [4], poor physical health [5] and the effects of the illness itself [6]. The reported prevalence of sexual dysfunction in schizophrenia ranges from 16% to 96% [7]. The large discrepancy in prevalence across studies could be attributed to the differences in the illness course of schizophrenia, the criteria and assessment tools and sampling methods. The commonly reported demographic and clinical correlates of sexual dysfunction in schizophrenia included gender [8], antipsychotics [9], old age [10], psychopathology [11] and other adverse effects of treatment [4]. Most of these findings were obtained in Western settings. Given that sexual dysfunction is closely related to the complex interplay of biopsychosocial factors [12], [13], [14], findings in the Western countries may not be generalizable to Asian patients. Compared to their Western counterparts, Asian schizophrenia patients are less inclined to report sexual dysfunction due to the different perceptions about sexuality in the more traditional Asian societies [15]. Thus, it is necessary to examine the patterns and demographic and clinical correlates of sexual dysfunction in Asian patients.
Sexual function is a sensitive topic both for Asian psychiatric patients and their clinicians. Since many patients are reluctant to talk about their sexuality, clinicians do not raise this topic regularly due to fear of embarrassing or alienating their patients [16], [17]. Clinicians' awareness of sexual dysfunction in schizophrenia has important implications because failure to recognize and address this issue can have far-reaching impact on the patients' physical and social well-being.
There are only approximately 20,000 psychiatrists in China serving a population of 1.4 billion [18]. Due to the limited availability of psychiatric services, primary care physicians commonly provide maintenance treatment for clinically stable psychiatric patients. The patterns and risk factors of sexual dysfunction in the significantly large population of schizophrenia patients managed in primary care have not been studied.
The aim of this study was to examine the frequency of sexual dysfunction in patients with schizophrenia treated by primary care physicians and to determine its socio-demographic and clinical correlates and impact on QOL.
Section snippets
Study design and participants
The study was a cross-sectional survey initiated by Guangdong Mental Health Center and was carried out between August 1, 2013 and July 31, 2014. Inclusion criteria included (1) ICD-10 diagnosis of schizophrenia based on a review of medical record supplemented by a clinical interview, (2) age 18 years or above, (3) treatment provided by primary care physicians and (4) ability to understand the content of the interview. The study protocol was approved by the Ethics Committees of Guangdong General
Results
A total of 656 community-dwelling schizophrenia patients were screened for participation in the study; 634 met study entry criteria. Only 11 (1.7%) did not complete the interview and 16 (2.4%) refused to respond to the ASEX items, yielding a final sample of 607 patients (92.5% participation rate).
Table 1 shows the frequency of different types of sexual dysfunction in the whole sample and by genders. For patients only responding to the two general sexual dysfunction domains, the prevalence of
Discussion
To the best of our knowledge, this was the first study that examined sexual dysfunction in Chinese patients with schizophrenia managed in primary care. Definition and measurement of the different types of sexual dysfunction vary. This study focused on five domains of self-reported sexual dysfunction employing a well-known assessment instrument (ASEX).
The prevalence of any type of sexual dysfunction in male (75.5%) and female (84.8%) patients in this study is consistent with the range (males:
Acknowledgment
The study was supported by the Medical Science and Technology Research Foundation of Guangdong Province (Grant numbers: A2014011; C2014016) and the Start-up Research Grant (SRG2014-00019-FHS) and Multi-Year Research Grant (MYRG2015-00230-FHS) from University of Macau. The authors thank all the clinicians for their contribution to this study.
References (54)
- et al.
A randomized double-blind 12-week study of quetiapine, risperidone or fluphenazine on sexual functioning in people with schizophrenia
Psychoneuroendocrinology
(2006) - et al.
Sexual dysfunction in patients with schizophrenia on antipsychotic medication
Eur Psychiatry
(2007) - et al.
Sexual functioning, psychopathology and quality of life in patients with schizophrenia
Schizophr Res
(2007) - et al.
Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy
Eur Neuropsychopharmacol
(1998) - et al.
Frequency of sexual dysfunction in patients with a psychotic disorder receiving antipsychotics
J Sex Med
(2010) - et al.
Remitted male schizophrenia patients with sexual dysfunction
J Sex Med
(2014) - et al.
Epidemiology/risk factors of sexual dysfunction
J Sex Med
(2004) - et al.
Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors
Urology
(2004) Sexual dysfunction and antipsychotic treatment
Psychoneuroendocrinology
(2003)- et al.
Sexual dysfunction in Japanese patients with schizophrenia treated with antipsychotics
Prog Neuropsychopharmacol Biol Psychiatry
(2010)
The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study
Eur Neuropsychopharmacol
Prevalence of subjectively assessed symptoms of sexual disorders in schizophrenia. Preliminary report
Arch Psychiatry Psychother
A comparative study of the sexual function of institutionalized patients with schizophrenia
J Sex Med
Sexual dysfunction in schizophrenia: focus on recent evidence
Hum Psychopharmacol
Sexual dysfunction: overview of prevalence, etiological factors, and treatments
J Sex Res
Sexual dysfunction in male schizophrenic patients
J Clin Psychiatry
Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study
Shanghai Arch Psychiatry
Nithsdale Schizophrenia Surveys 24: sexual dysfunction. Case–control study
Br J Psychiatry
An empirical evaluation of the Arizona Sexual Experience Scale for assessing antipsychotic-related sexual dysfunction in outpatients with schizophrenia and schizoaffective disorder
Stud Sex
Sexual dysfunction in patients with schizophrenia treated with conventional antipsychotics or risperidone
Neuropsychiatr Dis Treat
Response and relapse in patients with schizophrenia treated with olanzapine, risperidone, quetiapine, or haloperidol: 12-month follow-up of the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study
J Clin Psychiatry
Influence of religion on sexual self-perception and sexual satisfaction in patients suffering from schizophrenia and depression
Int J Psychiatry Med
Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors
Int J Clin Pract
The low frequency of reported sexual dysfunction in Asian patients with schizophrenia (2001–2009): low occurrence or ignored side effect?
Hum Psychopharmacol
Survey on sexual function in schizophrenia inpatients (in Chinese) Chinese
J Behav Med Sci
China–Australia–Hong Kong tripartite community mental health training program
Asia Pac Psychiatry
Practice guideline for the treatment of patients with schizophrenia
Cited by (0)
Disclosure/Conflicts of Interest: The authors had no conflicts of interest in conducting this study or preparing the manuscript.
- 1
These authors contributed equally to the paper.