Sexual distress and quality of life among women with bipolar disorder Sørensen, Thea; Giraldi, A; Vinberg, M Published in: International Journal of Bipolar Disorders DOI: 10.1186/s40345-017-0098-0 Publication date: 2017 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Sørensen, T., Giraldi, A., & Vinberg, M. (2017). Sexual distress and quality of life among women with bipolar disorder. International Journal of Bipolar Disorders, 5, [29]. https://doi.org/10.1186/s40345-017-0098-0 Download date: 29. sep.. 2021 Sørensen et al. Int J Bipolar Disord (2017) 5:29 DOI 10.1186/s40345-017-0098-0 RESEARCH Open Access Sexual distress and quality of life among women with bipolar disorder Thea Sørensen1,2, A. Giraldi2,3 and M. Vinberg1,3* Abstract Background: Information on the association between bipolar disorder (BD), sexual satisfaction, sexual function, sexual distress and quality of life (QoL) is sparse. This study aims, in women with BD, to (i) investigate sexual dysfunc- tion, sexual distress, general sexual satisfaction and QoL; (ii) explore whether sexual distress was related to afective symptoms and (iii) investigate whether QoL was associated with sexual distress. The study is a questionnaire survey in an outpatient cohort of women with BD using: Changes in Sexual Functioning Questionnaire, Female Sexual Distress Scale, Altman Self-Rating Mania Scale (ASRM), Major Depression Inventory (MDI) and The World Health Organisation Quality of Life-Brief. Results: In total, 61 women (age range 19–63, mean 33.7 years) were recruited. Overall, 54% reported sexual distress (n 33) and 39% were not satisfed with their sexual life (n 24). Women with BD were signifcantly more sexually distressed= in comparison with Danish women from the background= population but they did not have a higher preva- lence of impaired sexual function. Better sexual function was positively associated with ASRM scores while MDI scores were associated with more distress. Finally, the group of non-sexually distressed women with BD reported higher QoL scores compared with the sexually distressed group. Conclusions: Women with BD exhibited a high prevalence of sexual distress and their sexual function seemed asso- ciated with their actual mood symptoms and perception of QoL. Keywords: Sexual distress, Sexual functioning, Quality of life, Bipolar disorder Background 2008; Eplov et al. 2007), menopause (Ornat et al. 2013) Sexual dysfunction is defned as an impaired sexual func- and the side efects of psychotropic treatment (Bergh and tion that causes distress. Te defnition has changed sev- Giraldi 2014; Serretti and Chiesa 2011a; Zemishlany and eral times over the course of time but a division into four Weizman 2008). A Danish study (n = 4415) concluded categories overall has remained: desire/interest, arousal, that mental health problems and poor self-rated health orgasm and pain disorders (Basson et al. 2000, 2004, problems were strongly associated with female sexual 2010; McCabe et al. 2016). Sexual dysfunction is caused dysfunction (Christensen et al. 2011b). by biological, psychological and social interactions and Information on the association between bipolar disor- factors with negative infuence on human well-being. der, quality of life, sexual satisfaction, sexual function and Additionally, the risk of sexual dysfunction is increased distress is sparse. It is well known that depression and by factors such as socio-economic status (Christensen antidepressants afect sexual function negatively (Clayton et al. 2011a), psychiatric disorders (Brotto et al. 2011), et al. 2014), but only a few studies include women with partner status and the length of relationship (Hayes et al. BD. Besides, the studies have small study populations and diferent questionnaires, none of which include sex- ual distress (Dell’Osso et al. 2009; Ghadirian et al. 1992; *Correspondence: [email protected] 1 Copenhagen Afective Disorder Clinic, Psychiatric Centre Copenhagen, Grover et al. 2014). In an Italian study (Dell’Osso et al. Copenhagen University Hospital, Rigshospitalet, Dep. 6233, Blegdamsvej 2009) comparing 142 patients (60 with BD and 82 with 9, 2100 Copenhagen, Denmark unipolar depression) with 101 healthy controls, patients Full list of author information is available at the end of the article © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Sørensen et al. Int J Bipolar Disord (2017) 5:29 Page 2 of 9 with BD reported more sexual dysfunction compared to civil status, sexual orientation, length of relationship, healthy control persons. Patients with BD had increased employment and information about children) and life- sexual desire in comparison with patients with unipolar style (alcohol, smoking and weight). Te other part of the disorder in the Italian study. Also, the presence of peri- questionnaire included is described below. ods characterised by frequent sexual partners was signif- icantly associated with the feeling that life is not worth Participants living and sexual dysfunction was associated with life- Te inclusion criteria were as follows: being women with time suicide attempts. Finally, a Dutch study in the gen- a clinical diagnosis of BD, aged 18–70 years, reading and eral population of the Netherlands showed an association understanding Danish and willing to participate in the between BD and sexual dissatisfaction (Vanwesenbeeck study. Participants were included in analyses independ- et al. 2014). ent of their answers, sexual preference, civil status, age Episodes of depression or mania can be trigged by and sexual activity. Tey were excluded from analysis stress. Patients with BD are probably more easily dis- when not diagnosed with BD according to their elec- tressed, and therefore, sexual distress could be a potential tronic hospital records. trigger for depression and/or mania. Te possible rela- Te control group consisted of a group of Danish tionship between sexual distress and afective symptoms women from a previous study conducted by our group in patients with BD has not been evaluated previously. (Giraldi et al. 2015) describing sexual function. In sum- Further, quality of life (QoL), the general well-being and mary, these data were collected from a cross-sectional observed life satisfaction in many aspects—for example, study of a large, broadly sampled, non-clinical population physical and psychological health, education, employ- cohort of Danish women (573 women participated). Tey ment, wealth, fnance, environment, social relations and were drawn randomly from the Danish Central National sexual function—are important aspects of QoL. Patients Register and invited to participate by letter. Te Danish with afective disorders have a lower score of QoL com- women were included if they were sexually active with a pared to the general population (Nørholm 2008; Yatham partner within the 4 weeks prior (n = 429). As the con- et al. 2004; Nørholm and Bech 2001). When measuring trol group had a signifcant higher mean age, we con- QoL, according to World Health Organisation, sexual sat- ducted an age-matched analysis between women with isfaction is included as part of the total score (WHOQOL BD and a subsample of age-matched women from the Group 1998). To improve treatment and QoL clinically control group (n = 122). in patients with BD, it is thus important to also focus on and include sexual function. Te aim of the present study Sexual function was, in a cohort of women with BD, to (i) investigate sex- Te Female Sexual Function Index (FSFI) and Female ual function, sexual distress, general sexual satisfaction Sexual Distress Scale (FSDS) were used to describe sexual and QoL; (ii) explore whether sexual distress was related function among the Danish women in the background to afective symptoms and (iii) investigate whether QoL population. Tey were categorised as having female was associated to sexual distress. sexual dysfunction (FSD) when FSFI score was ≤26.55 (impaired sexual function) and FSDS score ≥15 (Giraldi Methods et al. 2015). In the present cohort, female sexual dysfunc- Study design tion was defned as a CSFQ-14 score ≤41 (impaired sex- Women with BD were recruited to the questionnaire ual function) and FSDS score ≥15 (distress). survey from the waiting room at the Copenhagen Afec- tive Disorder Clinic, Psychiatric Centre Copenhagen. Questionnaires Te included sample was derived from 1 March to 9 May WHOQoL‑BREF, Quality of Life measure 2015 from patients attending a region-wide secondary Quality of life was assessed using an abbreviated ver- service for patients with primary bipolar disorders. Te sion of the World Health Organisation Quality of Life patients received written and oral information about the Assessment brief version, WHOQoL-BREF (WHOQOL project before deciding whether to participate. Further, at Group 1998), Danish version. Te WHOQoL-BREF is a the time the questionnaire was answered and diagnosis 26-item questionnaire developed from the original 100- confrmed, medication was assessed from the patients’ item questionnaire the WHOQoL-100. Te WHOQoL- medical records. BREF covers four diferent subscales