Evidence for the Impact of Stress and Trauma on Sexual Function in Women: Review and Clinical Recommendations.

Stressors occur in a spectrum, ranging from daily hassles to life-threatening experiences, and can significantly impact sexual functioning. Thus, this review summarizes the intricate relationship between trauma spectrum experiences and women's sexual functioning. Biological mechanisms are described to elucidate the physiologic complexity that manifests because of trauma-related experiences. Additionally, both psychological and social implications are discussed. Treatment recommendations for practitioners working with women are discussed, underscoring the importance of adopting a trauma-informed care model.

Perinatal Depression Screening Among Sexual Minority Women.

Importance: A substantial number of births in the US are to sexual minority women (17% based on a nationally representative survey), yet there is little research on perinatal depression screening rates or symptom endorsement among sexual minority women (including women who identify as lesbian, bisexual, queer, pansexual, asexual, demisexual, and kinky as well as other-identified women who have sex with women). High rates of risk factors for perinatal depression (eg, intimate partner violence and history of mental illness) among sexual minority individuals magnify this gap in the literature. Objective: To describe the prevalence of female-identified sexual minority people giving birth in an academic medical center and compare perinatal depression screening rates and scores among sexual minority women and heterosexual cisgender women. Design, Setting, and Participants: This retrospective cohort study used deidentified medical record review of 18 243 female-identified individuals who gave birth at an academic medical center in Chicago, Illinois, between January 1 and December 31, 2019. Data were analyzed from April 5, 2021, to August 1, 2022. Main Outcomes and Measures: Proportion of women identified as having sexual minority status in the medical record, rates of standard care administration of the 9-item Patient Health Questionnaire between sexual minority women and heterosexual women, and depression screening scores and rates of positive depression screening results for sexual minority and heterosexual women. Results: Among 18 243 women (mean [SD] age, 33.8 [5.1] years; 10 453 [57.3%] of non-Hispanic White race and ethnicity), only 280 (1.5%; 95% CI, 1.3%-1.7%) were identified as having sexual minority status in the medical record. Significantly more sexual minority women vs heterosexual women attended at least 1 prenatal care visit (56 [20.0%] vs 2459 [13.7%]; P = .002) and at least 1 postpartum care visit (52 [18.6%] vs 2304 [12.8%]; P = .004). Sexual minority women were more likely to be screened for depression during postpartum care (odds ratio, 1.77; 95% CI, 1.22-2.52; P = .002) and more likely to screen positive for depression during the postpartum period (odds ratio, 2.38; 95% CI, 0.99-5.02; P = .03) than heterosexual women. Conclusions and Relevance: In this cohort study, sexual minority women identified in the medical record were highly engaged in obstetric care yet at high risk of postpartum depression. In addition, their sexual orientation was largely undocumented in medical records. These results highlight the need for investigations that include strategies for measuring sexual orientation because medical record review is unlikely to reliably capture these sexual identities during the perinatal period.

Stress and Depression Are Associated with Sexual Function and Satisfaction in Young Men Who Have Sex with Men.

Prior research suggests that better mental health and higher relationship quality are associated with better sexual function and satisfaction. Such insights can inform intervention development for mental, relationship, and sexual health concerns. This study examined the interactions among these variables in a racially and ethnically diverse group of young men who have sex with men (YMSM) in serious relationships (N = 348). Data were drawn from wave 5 of a longitudinal cohort study. We examined cross-sectional associations between depression and stress (predictors) and sexual function, sexual satisfaction, and anal discomfort (outcomes) and to what extent these associations were moderated by relationship quality. Higher endorsement of depression and stress was associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. We also found that fewer negative interactions, stronger commitment, and higher relationship satisfaction were associated with better sexual functioning and higher sexual satisfaction. Higher relationship satisfaction and commitment were found to attenuate the association between stress and sexual satisfaction. Contrary to expectations, higher relationship satisfaction also showed a trend toward exacerbating the association between depression and sexual functioning. These results suggest that, for YMSM, high relationship satisfaction and commitment may protect sexual satisfaction from being negatively impacted by high stress. However, YMSM in highly satisfying relationships may experience poor sexual functioning associated with depression as particularly distressing. This study addressed a major gap in the literature by focusing on mental, relationship, and sexual health in a diverse sample. Future research should examine a wider range of sexual functioning outcomes and include minority stress in study design.

Are empathic processes mechanisms of pregnancy's protective effect on smoking? Identification of a novel target for preventive intervention.

BACKGROUND: Spontaneous cessation and reduction in smoking by pregnant women suggest that concern about others, or empathy, could be a malleable target for intervention. We examined various empathy-related processes in relations to reported and biochemically assessed smoking during pregnancy. METHODS: Participants were 154 pregnant women (M = 12.4 weeks gestation, SD = 4.6) who were smoking cigarettes immediately prior to pregnancy recognition (85 had quit and 69 were still smoking at enrollment). Empathy-related processes were measured with performance-based paradigms (affect sharing, empathic concern, and theory of mind) and a speech sample (expressed emotion). Smoking was assessed with timeline follow back interviews and urine cotinine assays. Using zero-inflated Poisson regression models, we tested direct and interactive effects of empathy-related processes with respect to biologically verified smoking cessation (zero portion); and mean cigarettes/day smoked after pregnancy recognition among persistent smokers (count portion). RESULTS: Affect sharing was inversely related to post-recognition cigarettes/day (B(SE) = -0.17(0.07), 95%C.I. -0.30,-0.04, p = .011) and moderated the relationship between pre-recognition smoking and post-recognition smoking consistent with a buffering effect (B(SE) = -.17(0.05); 95%C.I. - 0.28,-0.06; p = .002). Other empathy related processes showed neither direct nor interactive effects on smoking outcomes. CONCLUSIONS: Further research is recommended to clarify the role of empathy in pregnancy smoking.

Measuring the Frequency of Inner-Experience Characteristics.

Inner experience is widely accepted by psychologists and lay people as being straightforwardly observable: Inner speech, visual images, feelings, and so on are understood to be directly apprehendable "before the footlights of consciousness." Many psychologists hold that such characteristics of inner experience play substantial theoretical roles and have applied significance across a wide range of cognitive, affective, performance, and clinical situations. If so, the frequency of occurrence of these characteristics is of fundamental importance. Such frequencies are usually estimated by questionnaires or by questionnaire-based experience sampling. However, there are reasons to wonder about the accuracy of such questionnaire-based estimates. We present three studies that compared, head-to-head, questionnaire-based experiential frequencies with frequencies discovered using descriptive experience sampling (DES), a method for random sampling in the natural environment that aspires to apprehend inner experience with as high fidelity as the state of the art allows. Together, they suggest that estimates of inner-experience frequency produced by questionnaires and DES are irreconcilably discrepant: Questionnaire-based methods produced dramatically higher (from 2 to 4 times as high) frequencies than did DES. These results suggest caution when interpreting questionnaire-based experiential results and the importance of additional high-fidelity studies of inner experience.

Neuropsychiatric Impact of Androgen Deprivation Therapy in Patients with Prostate Cancer: Current Evidence and Recommendations for the Clinician.

CONTEXT: Although substantial literature examining the neuropsychiatric consequences of androgen deprivation therapy (ADT) exists, there are no clinical guidelines to inform providers about the specific risk of depression, suicide, and dementia for prostate cancer patients receiving chronic ADT. OBJECTIVE: To evaluate the strength of the evidence and interpret the literature describing the association between ADT and psychological outcomes in men with prostate cancer. EVIDENCE ACQUISITION: NIH/NCBI PubMed database, EMBASE, and PsychINFO were searched for articles published indexed through December 16, 2019. Results from a total of 48 recent and highly relevant articles are summarized here. EVIDENCE SYNTHESIS: ADT increased the risk of depression (relative risk [RR] 1.51, p = 0.0002), which in turn magnifies the impact of ADT-related side effects on masculine identity. ADT may be associated with increased risk of cognitive impairment, including the risk of Alzheimer's dementia in American population-based cohorts and the risk of all-cause dementia in non-American cohorts (RR 1.45, p = 0.024). Statin use and higher levels of physical activity may be protective against ADT-associated dementia. CONCLUSIONS: ADT increases the risk of worsening and incident depression, and may increase the risk of dementia in men with prostate cancer. Brief baseline mood and cognitive screening assessments, with re-evaluation at 6-12 mo is strongly recommended when initiating ADT. Patients exhibiting new or worsening symptoms of depression or dementia may benefit from referral for formal evaluation and possible treatment. PATIENT SUMMARY: Patients initiating androgen deprivation therapy (ADT) should have brief baseline mood and cognitive screening assessments, with re-evaluation at least 6-12 mo after initiating therapy. All patients starting ADT should be counseled regarding possible neuropsychiatric side effects, and prescribers should counsel patients regarding the potential negative sexual side effects of antidepressant medications before prescribing them. Patients exhibiting new or worsening symptoms of depression or dementia may benefit from referral for formal evaluation and possible treatment. TAKE HOME MESSAGE: Androgen deprivation therapy (ADT) increases the risk of depression, which in turn magnifies the impact of ADT-related side effects on masculine identity and psychological distress in men with prostate cancer. ADT may be associated with an increased risk of cognitive impairment.

Measuring the Frequency of Inner-Experience Characteristics by Self-Report: The Nevada Inner Experience Questionnaire.

Descriptive experience sampling has suggested that there are five frequently occurring phenomena of inner experience: inner speaking, inner seeing, unsymbolized thinking, feelings, and sensory awareness. Descriptive experience sampling is a labor- and skill-intensive procedure, so it would be desirable to estimate the frequency of these phenomena by questionnaire. However, appropriate questionnaires either do not exist or have substantial limitations. We therefore created the Nevada Inner Experience Questionnaire (NIEQ), with five subscales estimating the frequency of each of the frequent phenomena, and examine here its psychometric adequacy. Exploratory factor analysis produced four of the expected factors (inner speaking, inner seeing, unsymbolized thinking, feelings) but did not produce a sensory awareness factor. Confirmatory factor analysis validated the five-factor model. The correlation between an existing self-talk questionnaire (Brinthaupt's Self-Talk Scale) and the NIEQ inner speaking subscale provides one piece of concurrent validation.

Pristine Inner Experience and Descriptive Experience Sampling: Implications for Psychology.

Pristine inner experience is that which is directly present in awareness before it is distorted by attempts at observation or interpretation. Many psychological methods, including most introspective methods, attempt to measure some aspect of pristine inner experience (thoughts, feelings, mental imagery, sensations, etc.). We believe, however, that these methods produce unspecifiable combinations of pristine inner experience, beliefs about the self, beliefs about what inner experience should be like, inaccurate recollections, miscommunications, and other confounding influences. We argue that descriptive experience sampling (DES) can produce high fidelity descriptions of pristine inner experience. These descriptions are used to create idiographic profiles, carefully crafted, in-depth characterizations of the pristine inner experience of individuals. We believe these profiles, because they are built from moments apprehended via a method that confronts the challenges inherent in examining inner experience, are uniquely valuable in advancing the science of inner experience and psychology broadly. For example, DES observations raise important questions about the veracity of results gathered via questionnaires and other introspective methods, like casual introspection. DES findings also provide high fidelity phenomenological data that can be useful for those developing psychological theories, such as theories of emotional processing. Additionally, DES procedures may allow clinicians and clients to practice valuable skills, like bracketing presuppositions and attending to internal experiences. This paper will describe difficulties inherent in the study of pristine inner experience and discuss implications of high fidelity descriptions of pristine inner experience for psychological research, theory development, and clinical practice.

The development and implementation of a brief intervention for medically admitted suicide attempt survivors.

OBJECTIVE: The current study endeavored to establish the feasibility and acceptability of a brief intervention for medically admitted suicide attempt survivors. METHOD: Fifty patients admitted to a Level 1 trauma center were recruited following a suicide attempt. The first 10 patients provided information on what constituted usual care, which in turn informed the creation of the intervention manual and research design. The next 10 patients informed refinement of the intervention and research procedures. The final 30 patients were randomized in a pre-post research design to receive the teachable moment brief intervention plus usual care or usual care only. Patients were assessed prior to randomization and 1 month later by blinded research assistants. Outcomes included patient satisfaction, readiness to change problematic behaviors, reasons for living, and suicidal ideation. RESULTS: Patients rated the brief intervention as "good" to "great" on all items related to client satisfaction. Significant group × time interactions were observed for readiness to change (ß=9.02, S.D.=3.73, P=.02) and reasons for living (ß=29.60, S.D.=10.22, P=.004), suggesting greater improvement for those patients who received the brief intervention. CONCLUSIONS: Patients admitted to an acute inpatient medical setting may benefit from a brief intervention that complements usual care by focusing specifically on the functional aspects of the suicide attempt in a collaborative, patient-centered manner.

Correlates of suicidal ideation in physically injured trauma survivors.

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre-injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury-related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital-based screening and intervention procedures.