Elsevier

Comprehensive Psychiatry

Volume 65, February 2016, Pages 116-121
Comprehensive Psychiatry

Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care

https://doi.org/10.1016/j.comppsych.2015.11.002Get rights and content

Abstract

Purpose

Sexual dysfunction in schizophrenia patients is common. In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. Illness- or treatment-related sexual dysfunction in this patient population has been never studied. This study describes the prevalence and correlates of sexual dysfunction and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China.

Method

A total of 607 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. Patients' socio-demographic and clinical characteristics including sexual function and QOL were recorded using a standardized protocol and data collection.

Results

Sexual dysfunction was present in 69.9% of all patients; 60.7% in males and 80.6% in females. Multiple logistic regression analysis revealed that female gender, being single, older age and use of first-generation antipsychotics were independently and significantly associated with more sexual dysfunction accounting for 23.5% of its variance (P < 0.001). Unexpectedly, sexual dysfunction was not associated with lower QOL.

Conclusions

High rate of sexual dysfunction was reported in the majority of patients with schizophrenia treated in primary care in China. Given its negative impact on social adjustment, QOL and treatment adherence, efforts should be made to address sexual dysfunction in this patient population.

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.

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    Disclosure/Conflicts of Interest: The authors had no conflicts of interest in conducting this study or preparing the manuscript.

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    These authors contributed equally to the paper.

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