Indian Journal of Health Social Work
SEXUAL DYSFUNCTION AND PSYCHOLOGICAL WELL BEING IN PERSONS
WITH ALCOHOL DEPENDENCE
Mohit Shukla1, Narendra Kumar Singh2, Sanjay Kumar Munda3
1Junior research fellow, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, 2Psychiatric Social Worker, Department of Psychiatric Social Work, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, 3Associate Professor & In-charge of Addiction Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand.
Correspondence: Mohit Shulka, email id: firstname.lastname@example.org
Background: Alcohol abuse/dependence is known to lead to sexual dysfunction. Sexual dysfunction has been reported in 40-95.2 per cent of alcohol-dependent persons, the rates being consistently higher than in the healthy controls or social drinkers. The common sexual dysfunctions reported are erectile dysfunction, followed by premature ejaculation, retarded ejaculation and decreased sexual desire among men. Keeping the above background in mind,this study is planned to assess sexual dysfunction and psychological well-being in persons with alcohol dependence in Indian setting because number of previous studies evaluated sexual dysfunction in alcohol dependence with other variables and predictors but this study would be noble work to explore association between psychological wellbeing and sexual dysfunction in alcohol dependence Objectives: To examine the sexual dysfunction and psychological well-being in persons with alcohol dependence and control group controls. Methodology: The present study was conducted at Out and Inpatient department at the Centre for Addiction Psychiatry at the Central Institute of Psychiatry, Kanke, Ranchi. The sample consisted of 30 persons diagnosed with alcohol dependence and 30 control group controls. This was a hospital based cross sectional study and purposive sampling was used for data collection. Only married men taking alcohol for more than two years were included. Age, income and education of the individual were matched with control group controls. After obtaining basic socio-demographic and clinical details on a predesigned datasheet, Psychological General Well-Being Index and The International Index of Erectile Function were applied. Result &Conclusion: Finding of present study revealed persons with alcohol dependence have lower level of psychological well-being but there was no significant difference of International Index of Erectile Function (among all domains) between persons with alcohol dependence and control group. Also, significant positive correlations were seen between the scores obtained by the persons with alcohol dependence in various domains of Psychological general well- being Index and domains of International Index of Erectile Function.
Keywords: Sexual dysfunction, well –being, alcohol.
Alcohol dependence has been emerged as a major public health problem in modern world. India is not also free from this menace. Alcohol dependence is thought to be influenced by plethora of psychological, sociocultural and socio-economic factors and some innate biological/genetic factors. Earlier substance addiction, including Alcohol dependence was referred as the sign of marked “social deviation”, but later the medical model or the disease model was applied on this problem to understand its facets more accurately. It is often termed as “family illness”, owing to its tremendous impact on the overall structure and functions of the family system (Fox, 1968). Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty. This, in turn, is known to worsen the alcohol abuse. Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcohol-related disease or due to a multitude of psychological forces related to the alcohol use (Gelder et al., 1996). The spectrum of sexual dysfunction encompasses: Decreased sexual desire, Sexual aversion disorder, Difficulty in erection, Difficulty in achieving orgasm and Premature ejaculation (Arackal et al., 2007). Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction (Mendelson et al., 1979). Although the frequency of sexual intercourse declines with age, sexual activity remains an important part of the lives of the majority of middle-aged and elderly people throughout the world. In some men, the psychosocial distress associated with erectile dysfunction may develop into ‘‘secondary’’ depression or aggravate depressive tendencies (Nicolosi et al., 2004). ED and loss of erection hardness have a profoundly adverse effect on their emotional well-being (Litwin et al., 1998).The emotional consequences of ED include depression, anxiety, and loss of self-esteem. ED has positive effects on a man’s mood, self-esteem, self-confidence, and quality of sex life (Steidle et al., 2006). At the same time, the loss of self-esteem and associated feelings of inadequacy may have an impact on a man’s day-to-day relationships with friends and work colleagues. Many men feel too embarrassed to confide in their male friends about their erectile problems and report feeling that they are ‘‘the only one’’ affected by ED or that they are ‘‘old before their time (Tomlinson et al . 2004). The present study was undertaken with the aim of assessing the sexual dysfunction in persons with alcohol dependence syndrome and to explore the relationship between amount of alcohol consumed as well as severity of alcohol dependence and sexual dysfunction. We also aimed to find the association of sexual dysfunction and psychological wellbeing in person with alcohol dependence and control group controls in the Indian context.
MATERIALS & METHOD
This study was a cross-sectional one and aimed to examine the sexual dysfunction and psychological well-being in persons with alcohol dependence and control group controls. This study was conducted at the Out and Inpatient department at Centre for Addiction Psychiatry at the Central Institute of Psychiatry, Kanke, Ranchi. Jharkhand, India. The samples of the study were recruited through purposive sampling method and diagnoses were made by the consultant psychiatrists of the institute as per the standard diagnostic guidelines, e.g., ICD-10-DCR [WHO, 1996]. The samples consisted of 30 persons with alcohol dependence diagnosed by the consultant psychiatrists as per the ICD-10-DCR [WHO, 1996] and 30 control group persons.
Only married men taking alcohol for more than two years were included. Age, income and education of the individual were matched with control group controls. But respondents with others co-morbidities like major psychiatric illness, substance abuse and comorbid general medical illness were excluded in the study.
The samples consisted of 30 Persons with alcohol dependence diagnosed by the consultant psychiatrists as per the ICD-10-DCR [WHO, 1996] and 30 control group persons were selected after matching them with study group with three parameters (e.g. age, occupation, education and income of the family).
Persons with alcohol dependence and control group persons were briefed about the purpose of the study. After that written informed consent was taken from the both groups and necessary data instruments i.e specially designed socio-demographic data sheet, Psychological general well- being index (Dupuy ,1984) and International Index of Erectile Function (IIEF) (Rosen et al., 1997) were applied on both group.
The measure used in the present study included Socio-demographic data sheet, Psychological general well- being Index (Dupuy,1984) and International Index of Erectile Function (IIEF) (Rosen et al., 1997).
The Psychological General Well-Being Index (PGWBI) is a measure of the level of subjective psychological well-being. In detail, it assesses self-representations of intrapersonal affective or emotional states reflecting a sense of subjective well-being or distress and thus captures what we could call a subjective perception of well-being. Consisting of 22 standardized items (6 items for the short form), the tool produces a single measure of psychological well-being. The full measure also provides subscales to assess the following domains: anxiety, depression, positive well-being, self-control, general health, and vitality. The validity of the PGWBI was evaluated in a large number of studies. In the 1971 NHANES, the PGWB Schedule was significantly correlated with the items that assessed the needs and utilization of mental health services, with the sociodemographic variables and the items of medical history. Cronbach’s alpha, was calculated for each study. The smallest value was 0.80 and the highest 0.92, indicating that the summary measure showed good internal reliability.
The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in persons with erectile dysfunction.
Descriptive statistics (mean and standard deviation) were used to describe sample characteristics. Inferential statistics like the Chi-square and t-test and were used to compare the sexual dysfunction and psychological wellbeing of the two groups. Correlation-coefficient was used to see the relationship Psychological General Well Being Index and International Index of Erectile Function (IIEF).
The Table-1 and 1.1 shows the comparison of two groups (e.g. Study and Control Group) in different socio-demographic parameters. After statistical analysis it was noted that both these groups were comparable to each other and there was no difference in any socio-demographic parameter.
The Table-2 is showing the clinical profile of the persons with alcohol dependence syndrome. The mean age of onset of alcohol addiction was found to be 22.86±4.99 years. The average spending for procuring alcohol in a given month was found to be Rs. 3030.40±1564.19 and maximum amount spending for alcohol was found Rs. 4516.00±2051.24. The duration of taking alcohol was found 11.80±5.15.