An empirical evaluation of the Arizona sexual experience scale and a simple one-item screening test for assessing antipsychotic-related sexual dysfunction in outpatients with schizophrenia and schizoaffective disorder
Introduction
Sexual side effects are common among antipsychotic-treated persons with schizophrenia (Cutler, 2003, Ghadirian et al., 1982, Kotin et al., 1976). Until recently, however, the clinical relevance of these sexual side effects was unclear. Two current lines of investigation now indicate (a) an association between antipsychotic-related sexual side effects and quality of life and treatment satisfaction in schizophrenia (Byerly et al., submitted for publication) and (b) that some second-generation antipsychotics (e.g., quetiapine) may possess a reduced sexual side effect liability compared to other antipsychotic medications (e.g., first-generation agents and the second-generation agents risperidone and olanzapine) (Byerly et al., submitted for publication, Bobes et al., 2003, Knegtering et al., 2004).
Since antipsychotic-associated sexual side effects are linked to quality of life outcomes, and the risk of these side effects may depend on the specific antipsychotic agent, there is a need for efficient, sensitive screening tools which can be easily administered by clinicians for initial detection of sexual dysfunction and for valid, reliable instruments to evaluate sexual dysfunction in schizophrenia patients. To date, however, no multi-item instruments that specifically evaluate sexual dysfunction have been validated in patients with schizophrenia and no screening tool has been developed or tested in these patients.
The 5-Item Arizona Sexual Experience Scale (ASEX) is commonly used to assess sexual dysfunction (McGahuey et al., 2000). The ASEX was designed to be self- or clinician-administered. It can be used in heterosexual and homosexual populations and it is appropriate for use in those with and without sexual partners. These attributes are important for persons with schizophrenia who are less likely to have a sexual partner at time of cross-sectional assessment compared to controls (Fortier et al., 2003, Miller and Finnerty, 1996). Unlike the more traditional and lengthy scales for assessing sexual dysfunction (Reynolds et al., 1988, Taylor et al., 1994), the ASEX can be completed fairly quickly. Based on our experience, the ASEX usually requires approximately 5 min to complete in persons with schizophrenia. Based on samples of patients with depressive or anxiety disorders (McGahuey et al., 2000) or end-stage renal disease (Soykan, 2004), the ASEX has good internal reliability and construct validity. The ASEX is a logical choice as a tool to evaluate sexual dysfunction in schizophrenia patients, but it has not yet been tested in patients with schizophrenia.
The purpose of the current study was (1) to examine the reliability and validity of the ASEX in outpatients with schizophrenia and schizoaffective disorder, and (2) using the ASEX as a “gold standard,” to independently evaluate the sensitivity, specificity, and positive and negative predictive values of two simple 1-item screening questions to detect sexual dysfunction in the same outpatients with schizophrenia and schizoaffective disorder.
Section snippets
Study design and subjects
A cross-sectional design with data from 247 participants was used to address the research objectives of this study. Data were collected over a 4-year period from December 2000 to November 2003, by a one-time, cross-sectional survey of sexual functioning. Subjects were recruited from the Dallas County public mental health outpatient clinics. Most patients were recruited through study flyers and a small portion of patients was referred by treating clinicians. When potential patients initially
Subject characteristics
Patient characteristics were as follows: Average Age: 40.8 years (SD = 9.4). Gender: 125 males (50.6%) and 122 females (49.4%). Gender/Average Age: male = 40.7 years (SD = 9.4), female = 40.8 years (SD = 9.5); Males and females did not differ on age (t = 0.04, df = 236, p = 0.96).
ASEX: reliability and validity
Internal reliability estimates using Cronbach's coefficient α were very high for the ASEX for the schizophrenia-based sample in the current study (overall sample, α = 0.90; for females, α = 0.91; for males, α = 0.88). The Principal
Discussion
The current study examined the reliability and construct and convergent validity of the ASEX. It also reported the sensitivity, specificity, and positive and negative predictive values for each of two screening questions for sexual dysfunction using the ASEX as the “gold standard.” The results indicate that the internal reliability of the ASEX for the schizophrenia-based sample in the current study was very high (α ranged from 0.88 to 0.91), and consistent with reports in patients with
Acknowledgements
This research was supported in part by NIMH K-Award grant #5 K23 MH064930-03.
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