Jhon Alexander Moreno

Sexuality after traumatic brain injury: a critical review.

Brain injury can directly and indirectly affect important aspects related to sexuality and sexual function. In this critical review of the literature, traumatic brain injury (TBI) and sexuality are examined. A general review of the concept of sexuality and the neurological correlates of sexual function are proposed as a framework to understand the cognitive, behavioral and physical effects of TBI on sexuality and sexual function. Studies are then classified according to the participants enrolled and findings are presented from the professionals, the survivors, the patient/partners, and the non-injured spouses perspectives. Results are discussed taking into account methodological limitations and knowledge gaps. Next, implications for sexual rehabilitation for individuals with TBI are discussed. Finally, suggestions for future research and their pertinence for improving rehabilitation outcomes are considered.

Caregiving in Dementia and its Impact on Psychological Functioning and Health-Related Quality of Life: Findings from a Colombian Sample

Existing published studies about health-related quality of life (HRQOL) in caregivers of dementia patients living in Latin American countries are very limited. However, cultural aspects, personal values, and social structure may affect the way caregivers experience their role in different societies. The current study investigated the relationship between HRQOL and psychological factors using a cross-sectional design. The sample consisted of 102 informal caregivers of patients with dementia from Bogotá, Colombia, South America. Measures included the Patient Health Questionnaire (PHQ-9) for depression, the Satisfaction with Life Scale (SWLS), the Zarit Burden Interview, and the Short Health Questionnaire (SF36) for HRQOL. Canonical correlations revealed that there was a significant relationship between caregivers’ mental health and HRQOL, such that caregivers with better satisfaction with life and less symptoms of depression had more vitality and better general health. There is a strong relationship between mental health and health-related quality of life in Colombian caregivers of dementia patients living in their country of origin. Specific aspects of mental health, including satisfaction with life and depression, need to be addressed in order to improve caregivers’ quality of life. Given that mental health care resources may be scarce in Latin American countries, culturally appropriate interventions should focus on preventing/treating depression and promote life satisfaction, as a way to improve their quality of life.

Translating knowledge into practice: content analysis of online resources about sexual difficulties for individuals with traumatic brain injury

For many individuals with traumatic brain injury (TBI), the Internet is the only available source of information regarding their sexual problems following TBI. This study aimed to evaluate the content and the quality of patient or carer information that is readily available on the Internet about specific aspects of sexuality after TBI. A purposive (non-exhaustive) sample of eight leaflets available on the Internet related to sexuality following TBI was analysed using content analysis. Decreased desire was reported as the main sexual difficulty following TBI (87.5%), followed by inappropriate sexual behaviour (62.5%). Among the strategies to overcome these difficulties, all leaflets recommended seeking help from healthcare professionals; 42.8% were centred on the carer or the family, and only 28.5% was directly addressed to the individual with TBI. The information available overemphasises disinhibition, underscores other aspects of sexuality (e.g. sexual risk and inability to fantasise), and is conceived mainly for carers and families. A bias assuming that most individuals with TBI are involved in a romantic relationship was also present. Adolescents, women, older people, single people, and non-heterosexual individuals were not adequately represented. There is a need for Internet resources to provide specific recommendations for these groups.

Relationships between risky sexual behaviour, dysexecutive problems, and mental health in the years following interdisciplinary TBI rehabilitation

ABSTRACT Little is known about the long-term consequences of traumatic brain injury (TBI) regarding risky sexual behaviour. The objectives of the study were (1) to compare risky sexual behaviour in a sample of individuals with TBI having received interdisciplinary rehabilitation with that of healthy controls, and (2) to explore the relationships between risky sexual behaviour, executive functions, and mental health in individuals with TBI. The study group consisted of 42 individuals with TBI with a mean age of 37.9 years (SD = 9.7), 12.8 years of education (SD = 3.3), and 3.3 years post-injury (SD = 4.3). Healthy controls consisted of 47 participants, with a mean age of 37.6 years (SD = 10.7), and 13 years of education (SD = 3). Risky sexual behaviour was measured with the Sexual Risk Survey and executive function with the Dysexecutive Questionnaire. Mental health measures included the Generalised Anxiety Disorder Scale, and the Patient Health Questionnaire for depression. Compared to healthy controls, individuals with TBI reported more dysexecutive and mental health problems, without differences in risky sexual behaviour. In individuals with TBI, risky sexual behaviour was associated with behavioural, cognitive and emotional dysexecutive problems, but not with anxiety or depression. It was concluded that special attention should be given to individuals with TBI showing difficulties in executive functions given their association with risky sexual behaviour.

Differences according to Sex in Sociosexuality and Infidelity after Traumatic Brain Injury

Objective. To explore differences according to sex in sociosexuality and infidelity in individuals with TBI and in healthy controls. Participants. Forty-two individuals with mild, moderate, and severe TBI having completed a postacute TBI rehabilitation program, at least six months after injury, and 47 healthy controls. Main Measures. Sociosexual Orientation Inventory-Revised (SOI-R) and Attitudes toward Infidelity Scale. Results. Overall, men score significantly higher than women in sociosexuality. However, there was a nonsignificant trend towards a reduction of sociosexuality levels in men with TBI. Infidelity levels were comparable in healthy controls and individuals with TBI. In individuals with TBI, less acceptance of infidelity was significantly associated with an unrestricted sociosexual orientation, but not in healthy controls. Conclusions. As documented in previous cross-cultural studies, men have higher levels of sociosexuality than women. However, men with TBI showed a tendency towards the reduction of sociosexuality. The possibility of a latent explanatory variable is suggested (e.g., post-TBI neuroendocrinological changes). TBI does not seem to have an impact on infidelity, but individuals with TBI who express less acceptance of infidelity also report a more promiscuous mating strategy regarding their behavior, attitudes, and desire. Theoretical implications are discussed in terms of evolutionary theories of human sexuality and neuropsychology.

Towards a taxonomy of sexuality following traumatic brain injury: A pilot exploratory study using cluster analysis

INTRODUCTION Clinicians need to understand the heterogeneity of sexual problems following traumatic brain injury (TBI) for their adequate identification and treatment. OBJECTIVE To systematically identify groups of individuals with TBI showing similar patterns of sexual functioning. METHODS Forty-two individuals with TBI with a mean age of 37.9 years (SD = 9.7) and an average of 3.3 years post-injury (SD = 4.3). We included four primary measures in the cluster analysis (sexual quality of life questionnaire, sexual desire inventory, generalized anxiety disorder scale, and the patient health questionnaire for depression) and two secondary measures for cluster validation (post-concussion symptom scale and dysexecutive questionnaire). RESULTS A hierarchical cluster analysis using the Ward method revealed the existence of two groups of individuals with TBI: a) with sexual problems who were older, showed lower levels of sexual quality of life and sexual desire, with significant symptoms of anxiety and depression, and b) without sexual problems who were younger, showed high levels of sexual quality of life and sexual desire, as well as low complaints of anxiety and depression. CONCLUSIONS Clinicians must be more proactive in assessing sexual concerns, mostly when emotional and cognitive difficulties are present in older individuals with TBI, regardless of gender, chronicity and injury severity.