Elsevier

Psychiatry Research

Volume 216, Issue 3, 30 May 2014, Pages 340-345
Psychiatry Research

Low satisfaction with sex life among people with severe mental illness living in a community

https://doi.org/10.1016/j.psychres.2014.02.009Get rights and content

Abstract

Research on the sex lives of people with severe mental illness (SMI) most often focuses on dysfunction and the side-effects of medication. We wished to determine how people with SMI experience sex and assess satisfaction with it in a broader evaluation of quality of life. Data were gathered using mixed methods, including a reliable psychometric quality of life instrument, and in-depth interviews. Sex life showed the lowest rating of all quality of life domains, with men indicating lower satisfaction in this area than women. Low satisfaction also correlated with lower scores on the total quality of life index. Sexuality and intimate relations were generally experienced as out of reach or something of secondary importance that had to be controlled, according to many of those suffering from SMI. Programs such as patient disorder-specific or partner assisted interventions, to increase the possibility of sustaining a sex life might need to be added to existing recommendations for people with SMI living in a community.

Introduction

Sexuality is a fundamental aspect of everyday life, even for a person suffering from a somatic or psychiatric illness. Some researches have been done on different aspects of sexuality in people with severe mental illness (SMI), including the psychopathology of sexuality and sexual partnerships. However, such studies have mostly been quantitative in nature, focusing on the dysfunctional effects that antipsychotic medication have on sexuality (Wesby et al., 1996, Bobes et al., 2003, Baggaley, 2008); or, if qualitative, concerned with the impact of SMI on an existing relationship (Östman, 2008, Östman and Björkman, 2014). Clinicians tend to be reluctant to address sexual issues when treating people with SMI (Nnaji and Friedman, 2008), although it is known that a majority of such people experience a dysfunctional sex life (Macdonald et al., 2003, McCann, 2010a). People with SMI point to a lack of counseling on intimate relationships and sex as a serious unmet treatment need (Sullivan and Lukoff, 1990, Segraves, 1998, Bengtsson-Tops and Hansson, 1999). Patients with a clinical diagnosis of schizophrenia or other SMIs require a comprehensive medical assessment, followed by treatment of their health and social needs, including social isolation. They also require access to services such as occupational therapy and vocational rehabilitation in order to return to a state of social inclusion in society (NICE, 2009). However, assessments and recommendations on matters related to sex as part of the total recovery process often do not exist for them. Thus, examining satisfaction with these aspects of life is needed.

The reality of the sex lives of people with SMI living in the community is an under-researched area. Assessing satisfaction with sexual relations as part of other life domains might help us to better understand some of the circumstances under which these people must live. To the best of our knowledge, the everyday experiences of sexuality and sex life have not been studied by a qualitative approach with in-depth interviews of people with SMI, although it would be of importance for developing methods supporting the recovery process.

Our objective was to learn how people with SMI living in a community experience satisfaction with their sex lives in comparison to other life domains measured by the Manchester Short Assessment of Quality of Life (MANSA). An additional aim was to use in-depth interviews to illuminate the everyday sexuality and sex lives of this special needs population.

Section snippets

Design

This article is part of a larger examination of support and treatment facilities for people with SMI who live in a community (Nordström et al., 2009). It investigates the resources available and the experiences of individuals who use those resources. Our particular concern is with problems in the sex lives of those with SMI. We hope to contribute to research in the area of SMI and sexuality by assessing satisfaction with sex life as a component of the larger measure of quality of life. Mixed

MANSA satisfaction with sex life and other domains of quality of life

In the sample as a whole, satisfaction with sexual relations registered a mean of 3.7. As indicated in Table 2, this item yielded the lowest rating of all the quality of life domains measured.

Men showed lower satisfaction with sexual relations than women (3.4 versus 4.3, p=0.04). There was no difference between men and women in quality of life in the total mean score on MANSA.

When divided into low or high satisfaction with sexual relations, 70% of the participants reported low and 30% high

Discussion

Research on schizophrenia and other SMIs and sexuality has found dysfunction among such patients far beyond levels in the general population (Friedman and Harrison, 1984, Kastier et al., 1997, Macdonald et al., 2003). Moreover, conventional antipsychotic medications have been implicated in most of the problems with libido, arousal, and orgasm in people with SMI (Wesby et al., 1996, Bobes et al., 2003, Byerly et al., 2004).

The participants in our study gave sex life their lowest experienced

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