Jepsen Dennis, Luck Tobias, Heckel Christian, Niemann Jana, Winter Kristina, Watzke Stefan
Institute of Medical Sociology, Interdisciplinary Center of Health Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Faculty of Applied Social Sciences, University of Applied Sciences Erfurt, Erfurt, Germany.
Front Psychol. 2024 Dec 4;15:1423690. doi: 10.3389/fpsyg.2024.1423690. eCollection 2024.
Sexual problems relevant to psychotherapy, such as compulsive sexual behavior (CSB) and sexual functioning problems (SFP), have been related to harmful substance use in several studies. Substance use is prevalent among medical students (MS) and is often considered a maladaptive coping strategy for stress, as well as a risk factor for mental health issues. Sexual problems and substance use share trauma exposure and post-traumatic symptoms as risk factors for their development. This study aimed to explore the interaction effects between problematic sexual behaviors, substance use, and trauma among German MS. A cross-sectional study ( = 359; 69% women, 29% men) was conducted using an online questionnaire. MS at a German university were recruited via email. CSB (CSBD-19), SFP (SBQ), harmful alcohol (AUDIT) and drug use (DAST), childhood trauma exposure (CTQ), and current post-traumatic symptoms (IES-R) were assessed. Multivariate linear and ordinal regressions, as well as path analyses, were conducted to investigate associations between the study variables. CSB was identified in 3% of all MS. The most commonly reported SFPs were decreased sexual desire and difficulties achieving orgasms among women and premature ejaculation among men. Higher CSBD scores were predicted by male sex, elevated AUDIT scores, and increased frequencies of hyperarousal (IES-R). Path analyses revealed associations between the severity of emotional/sexual abuse, the intensity of post-traumatic symptoms, and both CSBD and AUDIT scores. Among female MS, less severe emotional abuse and more severe physical abuse in childhood predicted higher frequencies of orgasmic difficulties. The frequency of SFPs was correlated with the use of benzodiazepines among female MS, with cannabis and MDMA/ecstasy among male MS, and with cocaine/crack, speed, and AUDIT among both sexes. No interaction effects were found between SFPs, substance use, or trauma-related factors in the path analyses. To some extent, there appears to be a relationship between substance use, childhood trauma exposure, and currently persisting post-traumatic symptoms with problematic sexual behaviors among MS. However, further research is required to explore these relationships in greater depth and to identify the underlying pathways. Mental health support measures should incorporate the factors of sexuality, substance use, and trauma while also exploring their relationships with workload, career-related anxieties, and other curriculum-related factors.
在多项研究中，与心理治疗相关的性问题，如强迫性行为（CSB）和性功能问题（SFP），已被证明与有害物质使用有关。物质使用在医学生（MS）中很普遍，通常被认为是应对压力的一种适应不良策略，也是心理健康问题的一个风险因素。性问题和物质使用都将创伤暴露和创伤后症状作为其发展的风险因素。本研究旨在探讨德国医学生中有问题的性行为、物质使用和创伤之间的相互作用。使用在线问卷进行了一项横断面研究（n = 359；69%为女性，29%为男性）。通过电子邮件招募了德国一所大学的医学生。评估了强迫性行为（CSBD - 19）、性功能问题（SBQ）、有害酒精使用（AUDIT）和药物使用（DAST）、童年创伤暴露（CTQ）以及当前的创伤后症状（IES - R）。进行了多变量线性和有序回归以及路径分析，以研究研究变量之间的关联。在所有医学生中，3%被确定有强迫性行为。最常报告的性功能问题是女性性欲下降和难以达到性高潮，男性则是早泄。男性、AUDIT评分升高以及过度觉醒频率增加（IES - R）可预测更高的CSBD评分。路径分析揭示了情感/性虐待的严重程度、创伤后症状的强度与CSBD和AUDIT评分之间的关联。在女性医学生中，童年时期不太严重的情感虐待和更严重的身体虐待预示着性高潮困难的频率更高。性功能问题的频率与女性医学生中苯二氮䓬类药物的使用、男性医学生中大麻和摇头丸/摇头丸的使用以及两性中可卡因/快克、安非他明和AUDIT评分相关。在路径分析中，未发现性功能问题、物质使用或创伤相关因素之间的相互作用。在一定程度上，医学生中物质使用、童年创伤暴露以及目前持续存在的创伤后症状与有问题的性行为之间似乎存在关联。然而，需要进一步研究以更深入地探讨这些关系并确定潜在途径。心理健康支持措施应纳入性、物质使用和创伤等因素，同时也应探索它们与工作量、职业相关焦虑以及其他课程相关因素之间的关系。
