Sexual Dysfunctions and Suicidality in Patients with Bipolar Disorder and Unipolar Depression

Abstract

Introduction Impairment in sexual function is frequent and underestimated in patients with mental disorders, particularly in those with mood disorders. Few studies have examined the relationship between sexual dysfunctions and the clinical characteristics of mood disorders. Aim The aim of the present study was to explore the frequency of sexual dysfunctions in patients with bipolar I disorder (BD) and unipolar depression (UD) with respect to control subjects, as well as their relationship with suicidality. Main Outcome Measures Assessments included: the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (SCID-I/P), the 24-item Brief Psychiatric Rating Scale and the Mood Spectrum Self-Report, a questionnaire exploring lifetime mood spectrum symptomatology including symptoms of sexual functioning and suicidality. Methods A consecutive sample of 142 patients (60 BD and 82 UD) and a comparison group of 101 control subjects were recruited in a multicenter study involving 11 academic departments of psychiatry. Results Lifetime impairment in the sexual response cycle, including desire, excitement, and ability to achieve orgasm, was significantly more common in patients with mood disorders compared with control subjects. Increase in sexual activity and promiscuity were significantly more common in patients with BD vs. the other two groups. Lifetime dysfunctions in all three phases of the sexual response cycle explored were significantly associated with lifetime suicide attempts in patients with BD and with thoughts of death in patients with UD. In BD patients, the lifetime presence of periods with frequent changes of sexual partners was significantly associated with thoughts of death. Conclusions Our findings suggest the importance of assessing sexual dysfunctions in patients with either BD or UD, as they may be clinically helpful in identifying phenotypes of mood disorders characterized by high suicidality.

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

“…Sexual dysfunction is a common residual symptom in euthymic patients with bipolar disorder, and has a significant negative impact on quality of life, similar to that of residual depressive symptoms and occupational stigma 122 . Moreover, impairment in desire, excitement and ability to achieve orgasm is significantly associated with suicide plans or a feeling that life is not worth living 123 . In addition, sexual dysfunction has been identified as a predictor of poor medication adherence 124 .…”

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology

“…The presence of a shared transdiagnostic spectrum means that a history or current presentation of depressive or anxiety symptoms acts as an indicator to screen for distressing low sexual function. As mentioned earlier, this is a particularly important pattern of comorbidity to screen for, as it is associated with more chronic and severe symptoms across the board, more distress, resistance to treatment, poor long-term outcomes, and higher rates of suicidality (Bossini et al, 2014; Dell’Osso et al, 2009; Dobkin et al, 2006; Laurent & Simons, 2009; Michael & O’Keane, 2000). If our nosologies explicitly recognized the shared liability between low sexual function and other indicators of the internalizing spectrum, this could formalize the screening process and overcome some of the discomfort associated with initiating a conversation about sexual difficulties in primary care (Bossini et al, 2014).…”

“…For example, comorbidity between sexual dysfunctions and emotional disorders is associated with higher rates of suicidality, as well as increased chronicity and severity of the disorders, relative to either cluster of disorders alone (e.g., Dell’Osso et al, 2009; Michael & O’Keane, 2000; Rajkumar & Kumaran, 2015). When the disorders are not treated together, this comorbidity is also associated with worse long-term treatment outcomes, such as higher dropout, poorer response, and poorer adherence (e.g., Bossini et al, 2014; Dobkin, Leiblum, Rosen, Menza & Marin, 2006; Laurent & Simons, 2009).…”

Significados sobre la prevención del riesgo de VIH en cibernautas con trastorno bipolar

“…Un trabajo realizado en personas con TAB encontró que las alteraciones en su vida sexual se asociaron de forma significativa con los intentos suicidas. 4 Los y las participantes de la comunidad virtual buscaron respuestas dentro del foro frente a sus necesidades y a la ausencia de información que debiera ser proporcionada por los profesionales de la salud mental. Existe evidencia empí-rica de que éstos discuten poco o nunca aspectos tales como las posibles alteraciones en la sexualidad y sobre la prevención del VIH/SIDA con pacientes que padecen TMS; 24 la mayoría de los participantes en investigaciones al respecto señalan que obtuvieron más información de otras fuentes.…”