Sex talks-experiences with and barriers to communication about sexuality with healthcare staff among patients with anxiety disorder in Denmark.

BACKGROUND: Previous research among diverse patient populations suggests that healthcare staff routinely do not talk about sexuality with their patients even when such talks are highly indicated and relevant. AIM: In this study we sought to investigate how patients at outpatient anxiety clinics in Denmark experience sexual communication with healthcare staff and what barriers they encounter in this connection. METHODS: We employed a survey design from January 1, 2018, to June 30, 2019. In collaboration with 11 outpatient anxiety clinics in Denmark, patients with a primary diagnosis of panic disorder, social phobia, generalized anxiety, or obsessive-compulsive disorder were invited to participate in the study. The final sample included 272 patients. Survey questions were related to sociodemographic characteristics, sexual activity and dysfunctions, pharmacological treatment adherence, anxiety and depression symptoms, and experience with and barriers to sexual communication. For each participant, clinicians at the clinics provided the International Classification of Diseases, 10th revision, diagnostic codes, medications, and dosage. Study inclusion criteria were not having an organic disorder that may cause anxiety, not having a previous diagnosis of bipolar affective disorder or schizophrenia, and the ability to speak and read Danish. OUTCOMES: Outcomes included patients' experiences with and barriers to sexual communication with healthcare staff. RESULTS: In total, 61% of the patients in this sample group found it relevant to talk to healthcare staff about sexuality but only 28% of the study patients had done so, of whom 83% reported this communication to be a positive experience. The most frequently reported patient barriers to communication with healthcare professionals regarding sexual concerns were a belief that if sexual matters were relevant, the healthcare staff would bring it up (94%), fear of transgressing their own boundaries (94%), embarrassment (92%), and lack of knowledge as to how to start a conversation about sex (91%). CLINICAL IMPLICATIONS: The study results indicated a need for healthcare staff to routinely map out and address sexual matters in their clinical work with anxiety patients while bearing in mind the common patient barriers for this topic. STRENGTHS AND LIMITATIONS: This study included a large clinical outpatient sample of anxiety patients and an extensive survey. However, the results may not be generalizable across all anxiety patients or patients in general. CONCLUSION: The results of this study strongly indicate that a majority of anxiety patients find it both relevant and beneficial to discuss sexual matters with healthcare staff in connection with their anxiety treatment, and therefore healthcare staff should be educated and equipped to routinely address these matters while bearing in mind the most common patient barriers for conversations about sexuality.

Mental health trajectories after juridical divorce: Does personality matter?

INTRODUCTION: This study investigated whether the Big Five personality dimensions were associated with mental health trajectories and/or intervention effects of a digital divorce intervention from juridical divorce to 12 months following juridical divorce. The study utilized a randomized controlled trial study design (N = 676) and measured mental health outcomes (anxiety, depression, somatization, and stress) at study inclusion (i.e., at juridical divorce) and 3-, 6-, and 12 months after juridical divorce. Big Five personality dimensions were measured 1 month post study inclusion. RESULTS: The study found that neuroticism is the personality dimension most predictive of post-divorce mental health outcomes. Specifically, divorcees with higher neuroticism scores indicated worse mental health immediately following divorce, but their symptom levels decreased more rapidly over a 12 months period after juridical divorce compared with lower neuroticism divorcees. It is also notable that their mean scores for the mental health outcomes remained higher at all time points (3, 6, and 12 months post baseline), relative to those lower in neuroticism. CONCLUSION: Findings are discussed in light of divorce-adjustment-theory and the stress-buffering model.

Symptoms of anxiety and depression in Denmark during the first year of the COVID-19 pandemic: A two-wave matched-control study.

Subsequent to the restriction measures taken to curb the COVID-19 infection rate, researchers theorized these would have detrimental mental health consequences. This two-wave matched-control study investigates depression and anxiety symptoms during the first 12 months of the pandemic (March 2020-March 2021) in Denmark with data from the I-SHARE and Project SEXUS studies. The I-SHARE study includes 1,302 (Time period 1 only n = 914, Time period 2 only n = 304, both time periods 1 and2 n = 84) Danish participants, and the sex and birth year-matched control participants from the Project SEXUS study comprise 9,980 Danes. During the first year of the pandemic, the study populations' anxiety and depression symptom mean levels did not significantly differ from pre-pandemic matched controls. Younger age, female gender, fewer children in the same household (depression only), lower education level, and not being in a relationship (depression only) were associated with increased anxiety and depression symptom scores. The key COVID-19-related variable linked with significantly higher anxiety and depression symptom scores was COVID-19-related loss of income. Contrary to initial concerns, we did not find a significant effect of the pandemic on anxiety and depression symptom scores. However, the results underscore the importance of structural resources to prevent income loss to safeguard mental health during crises such as a pandemic.

Anxiety, depression and associated factors among recently divorced individuals.

BACKGROUND: In divorce research, studies using large samples, very recently divorced individuals and validated measures of depression and anxiety with available background populations for comparison are missing. AIMS: This study aimed to investigate symptoms of depression and anxiety among recently divorced Danes and assess the explanatory power of relevant sociodemographic- and divorce-related variables on these symptoms. METHODS: The study utilized an online cross-sectional design and a total of 1856 Danish citizens recruited through the Danish State Administration. Average scores for depression and anxiety were compared to the Danish background population and regression analyses were conducted to assess the explanatory power of sociodemographic- and divorce characteristics on symptoms of depression and anxiety. RESULTS: Divorcees reported significantly higher levels of both depressive and anxiety symptoms than the background population with a large proportion of the sample scoring equal to or higher than generally recommended cut-off values for risk of suffering from a psychiatric diagnosable case of depression or anxiety. Both sociodemographic- and divorce characteristics were predictive of symptoms of depression and anxiety. CONCLUSION: The findings underline the relevance of public health intervention targeting symptoms of depression and anxiety among recently divorced individuals.

Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress.

INTRODUCTION: Appearance dissatisfaction is a sensitive issue and has been tied to depression, dissatisfaction in romantic relationships, and reduced sexual satisfaction. AIM: This study sought to examine associations between appearance satisfaction and specific sexual problems and related distress, testing also the moderating role of relationship satisfaction. METHODS: A large web-sample of Norwegians in romantic relationships (N = 2,903) completed a one-time survey. OUTCOMES: Participants reported on their experience of five different sexual problems and associated level of distress. RESULTS: We found that appearance satisfaction was associated with reporting fewer sexual problems, and specifically, with a smaller likelihood of experiencing problems with lack of enjoyment, lack of excitement, and lack of climax. Furthermore, appearance satisfaction was unrelated to overall sexual problem-related distress, but was associated with feeling less distress about lack of excitement and lack of climax. Relationship satisfaction did not serve as a moderator of the associations. CLINICAL TRANSLATION: These findings suggest the importance of attending to appearance satisfaction when working with clients with multiple sexual problems, particularly those related to excitement and enjoyment. STRENGTHS AND LIMITATIONS: Strengths of the study include a large sample of partnered adults and assessment of specific sexual problems and associated distress. A limitation is that outcomes were assessed using single items, rather than multi-item scales. CONCLUSION: The study highlights the importance of examining the presence of sexual problems and associated distress separately, and to consider appearance satisfaction as a predictor of sexual functioning. Øverup CS, Strizzi JM, Cipric A, et al. Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress. J Sex Med 2021;18:1532-1544.

"I Had Not Seen Star Wars" and Other Motives for Divorce in Denmark.

A total of 2,371 Danish residents participating in the Cooperation After Divorce randomized controlled trial study indicated the motives for their divorce. The most frequently given motives were lack of love/intimacy, communication problems, lack of sympathy/respect/trust, and growing apart. The least reported motives were violence, addiction, accident or illness, and personality. The results support global trends regarding an increased importance of emotional and psychological aspects of relationships. A factor analysis seeking to identify clusters in the motives did not yield statistically or theoretically strong results. This may indicate that experiences with and motives for divorce are heterogeneous and multifactorial.

Birth weight and quality of life in midlife: a 50-year follow-up study of 2079 individuals in Denmark.

PURPOSE: Low birth weight has been associated with a higher risk of reduced quality of life (QoL) in children, adolescents, and young adults, but the influence seems to diminish over time. However, previous studies have mainly focused on health-related QoL and compared individuals with low birth weight with individuals without low birth weight. The purpose of the present cohort study was to investigate the influence of the entire range of birth weights on three distinct measures of QoL in midlife. METHODS: The study population consisted of all live-born singletons from the Copenhagen Perinatal Cohort (CPC, 1959-1961) who participated in a 50-year follow-up examination in 2009-2011 (N = 2079). Birth weight was measured by three pediatricians at birth. QoL was measured at the follow-up by the participants' scores on three QoL self-report measures: The Satisfaction With Life Scale, the Vitality Scale of the Medical Outcomes Study 36-Item Short-Form Health Survey, and a single-item QoL measure based on the question: "How is your quality of life at the moment?". General linear regression and binary logistic regression were used to estimate the association between birth weight and QoL in midlife. RESULTS: Small, curvilinear associations of birth weight with life satisfaction, vitality, and the single-item QoL measure were found, suggesting that both low and high birth weights increase the risk of low satisfaction with life, low vitality and low QoL. CONCLUSION: The study findings suggest that low and high-range birth weight exert a lasting influence on distinct, but complementary aspects of QoL in midlife.

Using Pornography, Paying for Sex, and Violence: A Danish National Survey Study.

Only a few national cohort studies on using online pornography and buying sex have been published. The overall aim of this study, which analyzed data from a representative Danish national survey, was to provide an overview of incidence and associated population characteristics. The key aims were: first, to analyze frequencies of using online pornography and buying sex stratified by gender and other background characteristics; and, second, to investigate if and how using online pornography and buying sex were associated with sexual satisfaction, sexual activity, and violence. The findings revealed that having ever paid for sex and higher use of pornography were each associated with being male, younger, and not being in a relationship. Further, among men, having ever paid for sex and higher use of pornography were associated with not being sexually satisfied and, in part of the analysis, having committed violence to another person in the last year; however, these particular relationships were not statistically significant in the appropriately controlled regression analysis. We discuss gender, age, sexual aggression, and sexual satisfaction as factors associated with higher pornography use and buying sex.

BDSM: Does it Hurt or Help Sexual Satisfaction, Relationship Satisfaction, and Relationship Closeness?

This national web-population study from Norway (N = 4,148) assessed 1) the prevalence of BDSM and role-play interests and behaviors, 2) the socio-demographic characteristics of the BDSM-oriented participants, and 3) the associations between a) BDSM and b) role-play interests and behaviors, and sexual satisfaction, relationship satisfaction, and relationship closeness. Over one in three study participants endorsed at least one BDSM interest or behavior variable. There were no gender nor educational level differences between the BDSM-oriented participants and their traditional "vanilla" (non-BDSM-oriented) counterparts, though BDSM and interests were more common among younger and self-identified LGBQ+ participants. Sexual satisfaction was positively associated with role-play and BDSM behaviors while interest in role-play (but not having previously engaged in it) was negatively associated with this outcome. Lower relationship closeness was associated with an interest in role-play (but not having tried it). No BDSM-related variables were significantly associated with relationship closeness. The findings suggest that BDSM interests and behaviors are relatively common and are linked with sexual and relationship satisfaction.

Examining gender effects in postdivorce adjustment trajectories over the first year after divorce in Denmark.

Research into gender and postdivorce mental and physical health has been highly inconsistent. The Gender Similarities Hypothesis suggests there are more similarities than differences and the Divorce Stress Adjustment Perspective suggests that structural inequalities may contribute to adverse postdivorce outcomes. We conducted secondary analyses from an RCT study to investigate if there were gender-specific trajectories and whether gender was associated with outcomes (self-perceived stress, symptoms of anxiety, depression, and somatization, general hostility, and overall mental and physical health) after controlling for effects of the intervention, income, and number of children using linear mixed-effect regression modeling, and whether number of children and income influenced these outcomes. Participants were 1,239 women and 617 men from the Cooperation after Divorce (CAD) study, conducted in Denmark, a country with less income disparity, high gender equality, shared childrearing by men and women, and societal acceptance of divorce. The analyses assessing the relationship between gender and 12-month postdivorce adjustment in terms of physical and mental health outcomes revealed that for self-perceived stress, symptoms of anxiety, depression, and somatization, hostility, and overall mental and physical health in this sample postdivorce adjustment trajectories were not gender-specific, and gender was only significantly associated with stress and somatization as a time-invariant additive effect. These findings suggest gender similarities in postdivorce adjustment and contribute to the Gender Similarities Hypothesis and the Divorce-Stress-Adjustment-Perspective by assessing individuals' postdivorce adjustment in a low-stigma and relatively egalitarian setting, providing a clearer assessment of the role of gender without potentially confounding issues of structural inequalities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The future of divorce support: Is "digital" enough in presence of conflict?

Divorce conflict is the main driver of adverse postdivorce health adjustments among divorcing families. Despite the growing potential of online divorce support programs, there is concern that such solutions might not be sufficient to impact health-related disparities among high-conflict divorcees. The present study examined the effectiveness of the digital "Cooperation after Divorce" intervention as a function of conflict among 1856 recently divorced Danish residents. Linear mixed-effect regression modeling suggested that, although higher levels of divorce conflict at judicial divorce predicted worse health outcomes up to 1 year following divorce, the effectiveness of the digital divorce intervention did not vary as a function of the initial level of divorce conflict. Individuals in the intervention group with higher conflict in divorce still reported worse health at 12 months follow-up than those with lower levels of divorce conflict; however, much lower than the control group.

Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections.

BACKGROUND: We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS: A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS: There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS: Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.

The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave.

BACKGROUND: The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. RESULTS: Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSION: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

"Divorce burnout" among recently divorced individuals.

Traditionally, the concept of burnout has been applied to the workspace but recent research suggests its applicability to more general contexts such as the family sphere. The present study applies burnout to the divorce context and (a) proposes and statistically tests the Divorce Burnout Model (DBM), (b) investigates the contribution of sociodemographic variables and divorce characteristics to burnout scores, and (c) investigates the relationship between burnout scores and the number of sick days and days of absence from work. Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s good fit to data. Using this model, for men, it was found that fewer previous divorces, former spouse initiation of divorce, not having a new partner and a higher degree of conflict significantly predicted higher levels of divorce burnout. For women, lower income, former spouse divorce initiation, not having a new partner, and a higher level of conflict significantly predicted higher levels of divorce burnout. Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms.

When Love Hurts - Mental and Physical Health Among Recently Divorced Danes.

The last decades of research have consistently found strong associations between divorce and adverse health outcomes among adults. However, limitations of a majority of this research include (a) lack of "real-time" research, i.e., research employing data collected very shortly after juridical divorce where little or no separation periods have been effectuated, (b) research employing thoroughly validated and population-normed measures against which study results can be compared, and (c) research including a comprehensive array of previously researched sociodemographic- and divorce-related variables. The current cross-sectional study, including 1,856 recently divorced Danes, was designed to bridge these important gaps in the literature. Mental and physical health were measured using the Short Form 36 (SF-36)-2. Analyses included correlational analyses, t-test comparisons, and hierarchical multiple regression analyses. The study found that the health-related quality of life of Danish divorcees was significantly worse than the comparative background population immediately following divorce. Across gender, higher levels of divorce conflict were found to predict worse mental health, and worse physical health for women, even when controlling for other socio-demographic variables and divorce characteristics. Among men, lower age and higher income predicted better physical health, while more children, more previous divorces, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. Among women, higher income, fewer previous divorces, new partner status, and lower levels of divorce conflict predicted better physical health while higher income, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. The findings underscore the relevance of providing assistance to divorcees who experience higher levels of divorce conflict immediately following divorce, in seeking to reduce potential long-term negative health effects of divorce.

A Randomised Controlled Trial Study of the Effects of a Digital Divorce Platform on Mental and Physical Health.

BACKGROUND: Two decades of divorce research has consistently documented adverse mental and physical health effects of divorce. Responding to calls for evidence-based online divorce interventions, this study tests effects of the "Cooperation after Divorce" (CAD) digital intervention platform on divorcees' mental and physical health. METHODS: Randomised control trial 12-month longitudinal study using a sample of 1,856 newly divorced Danes. Mental and physical health were measured using the SF-36 at baseline and 3, 6, and 12 months from baseline. Intervention effects were investigated using linear mixed effect models and Cohen's (d) for effect sizes. RESULTS: The study found significant treatment effects of the CAD intervention on mental and physical health. These effects were evident across all eight health domains constituting the mental and physical health components. The study also found that the intervention group had significantly better mental health than the control group at subsequent 6- and 12-month assessments from baseline while for physical health, the intervention group had significantly better physical health at the 6-month assessment from baseline only. CONCLUSION: The results indicate that digital solutions allowing for individually tailored user experiences may hold great potential in reducing well-known adverse health effects of divorce. PRACTITIONER'S POINTS: The study finds highly significant treatment effects of the "CAD" digital divorce intervention on mental and physical health indicating that online interventions may be successfully integrated into help offered to divorcees post-divorce.

Randomized controlled trial study of the effects of an online divorce platform on anxiety, depression, and somatization.

Divorce is associated with a range of negative psychological consequences, including increased symptoms of anxiety, depression, and somatization. The current study presents the results of a 1-year longitudinal randomized controlled trial study of the Cooperation After Divorce online intervention platform for adults going through a divorce. Participants included 1,856 Danish divorcees who, on average, began the intervention within 1 week of legal divorce and responded to the Symptom Checklist-90-Revised anxiety, depression, and somatization subscales at baseline, 3, 6, and 12 months after juridical divorce. Data analyses consisted of linear mixed-effect model analyses, mean group comparisons, and 1-sample t tests to compare the 12-month follow-up with national normative data. The study found that the intervention platform significantly reduced anxious, depressive, and somatization symptoms among divorcees in the intervention group over a 1-year period and that the magnitude of these effects was large in effect size (Cohen's d > .78). Further, it was found that at 1 year after divorce, symptom levels of all 3 outcomes were close to the population norms for participants in the intervention group but still considerably elevated for participants in the control group. The findings suggest that online intervention platforms may be effective in reducing adverse mental health related effects of divorce and thereby offer long-term human and public health benefits. (PsycInfo Database Record (c) 2020 APA, all rights reserved).