This Rehab Science Spotlight describes a recent study comparing multiple factors associated with decline or stability in self-reported sexual functioning following TBI as compared to a control group.
Citation
Fraser, E. E., Downing, M. G., Ponsford, J. L. (2020). Understanding the multidimensional nature of sexuality after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 101(12), 2080-2086. doi: 10.1016/j.apmr.2020.06.028
Summary
This article evaluated the associations of biopsychosocial factors with self-reported sexuality after TBI by comparing questionnaire results from a sample of 84 consecutively admitted adults from a TBI inpatient rehabilitation program with an age-, sex-, and education-matched group of 88 control participants. Results indicate that participants with TBI were more likely to report reduced sexual functioning than the control participants, with 73% of the TBI sample reporting a decline compared to 40% of the control group. In the TBI sample, age, anxiety, depression, fatigue, and pain interference were negatively correlated with self-reported sexuality; self-esteem, participation, independence, processing speed, verbal initiation, and inhibition were positively correlated with self-reported sexuality. These correlations were not observed in the control group. Gender, education, injury severity, and time since injury were not correlated with self-reported sexuality in the TBI sample. In multiple regression of data from the TBI sample, age, depression, self-esteem, participation, and fatigue accounted for 47% of the variability in sexuality outcomes; younger age, lower depression, and higher self-esteem were significantly associated with higher self-reported sexuality. Mediation analyses revealed that the effect of social participation on sexuality was partially mediated by depression and the effect of fatigue on sexuality was fully mediated by depression. The authors concluded that psychological factors are more relevant to changes in sexuality following TBI than are medical or physical factors. Although the cross-sectional study design limits interpretation of causal inferences, this research highlights the frequency of sexuality decline post-TBI and several factors that are associated with these declines, most significantly age and depression.
I chose this article because it addresses an aspect of post-TBI functioning that is often overlooked but can have major impacts on post-injury quality of life: sexuality. Rehabilitation professionals and mental health providers who work with individuals after TBI may wish to incorporate evaluation of changes in sexuality into their assessments, particularly with older adults and those experiencing symptoms of depression. Interventions to address declines in sexuality after TBI should also be considered when treatment planning. Development and evaluation of accessible and effective interventions for improved sexuality is an important area for future rehabilitation research.
THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Callie Tyner, Ph.D., a Research Assistant Professor in the Center for Health Assessment Research and Translation at the University of Delaware. Dr. Tyner is a member of the APA Division 22 Science Committee.