The Antipsychotics and Sexual Functioning Questionnaire (ASFQ): Preliminary evidence for reliability and validity

Abstract

The aim of this study is to describe the psychometric properties of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). Internal reliability, test–retest reliability, inter-rater reliability, validity and sensitivity to change were calculated in a sample of 30 patients with schizophrenia or a schizophrenia spectrum disorder using antipsychotics. The ASFQ is a semistructured interview, with good face validity and content validity, that takes on average about 10 min to complete. The ASFQ has good internal reliability (Cronbach's alpha 0.84) and good test–retest reliability (mean Spearman's rho = .76). The inter-rater reliability is good for questions about libido, orgasm, erection and ejaculation. Correlation coefficients for calculating convergent validity were modest to good when comparing the ASFQ with the corresponding items on the Subject's Response to Antipsychotics (SRA) questionnaire and the Arizona Sexual Experience Scale (ASEX). Based on preliminary evidence, it can be concluded that the Antipsychotics and Sexual Functioning Questionnaire has reasonable reliability and is available for clinical use and research.

Introduction

Sexual dysfunction in patients with schizophrenia may be related to the disease itself, as well as to psychosocial factors, physical health and the use of psychotropic medications (Aizenberg et al., 1995, Dickson and Glazer, 1999). Antipsychotics have been associated with sexual dysfunction, such as decreased libido, erectile dysfunction, anorgasmia, and delayed or retrograde ejaculation (Smith, 2003, Knegtering et al., 2008). Besides postsynaptic dopamine antagonism, prolactin elevation may be a factor in the pathogenesis of antipsychotic induced sexual dysfunction (Knegtering et al., 2008).

Sexual side effects have a considerable impact on quality of life and are a major factor in non-adherence to prescribed antipsychotic drugs (Olfson et al., 2005). Sexual dysfunction is rarely reported spontaneously, leading to underestimation of its prevalence. In contrast, studies using structured interviews or questionnaires show that 16 to 60% of the patients experience sexual dysfunction (Knegtering et al., 2008, Serretti and Chiesa, 2011).

Several questionnaires on the sexual side effects of antipsychotics have been developed but psychometric properties have been reported for only a few instruments, namely the Antipsychotic Non-neurological Side Effects Rating Scale (ANNSERS) (Ohlsen et al., 2008, Mahmoud et al., 2011), the Arizona Sexual Experience Scale (ASEX) (Byerly et al., 2006), the Changes in Sexual Function Questionnaire-14 (CSFQ-14) (Garcia-Portilla et al., 2011), the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) (Montejo and Rico-Villademoros, 2008) and the Nagoya Sexual Function Questionnaire (NSFQ) (Kikuchi et al., 2011). Because of the scarcity of validation and standardization, there is no gold standard to evaluate antipsychotic-induced changes in sexual functioning. This makes it difficult to compare studies and may partly explain why results vary.

At the start of our studies, no instruments on this topic had been validated. We felt that a new instrument was needed in order to evaluate antipsychotic-induced changes in sexual functioning. Therefore, the Antipsychotics and Sexual Functioning Questionnaire (ASFQ) was developed (see Appendix A) (Knegtering, 2003). To increase reliability and to take account of the cognitive abilities of patients with a psychotic disorder, a semi-structured interview was constructed with questions phrased in a non-leading and easily understandable way. Items for men and women were included, covering the main areas of sexual functioning. Furthermore, both improvement and deterioration of sexual functioning could be scored. The interview was intended to help clinicians discuss sexual side effects with their patients more easily. The aim of this study is to describe the psychometric properties of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ).