Kelebie Mulualem, Kibralew Getasew, Tadesse Gebresilassie, Nakie Girum, Medfu Girmaw, Ali Dawed, Gashaw Fanuel, Gobezie Melese, Fentahun Setegn
Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
J Affect Disord. 2025 Apr 1;374:99-108. doi: 10.1016/j.jad.2025.01.021. Epub 2025 Jan 8.
Individuals, who suffer from severe mental illnesses (SMI), such as bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD), are more likely to engage in risky sexual behavior. A severe mental illness can lead to a decrease in impulse control, a reduction in cognitive function and memory, and a psychosocial impairment that increases risky sexual behavior. Risky sexual behavior (RSB) can lead to health problems such as sexually transmitted infections, including HIV/AIDS, early pregnancy, and unplanned pregnancies. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence of risky sexual behavior and factors among individuals with severe mental illness in Africa.
A systematic review of observational studies: cross-sectional and prospective cohort studies published between 2009 and 2022 that reported relative risks (RR) and odd ratios (OR) that had explicit the prevalence of RSB. We conducted primary article searches in PubMed/MEDLINE, Scopus, African Journal Online, PsycINFO, EMBASE, Psychiatry Online, CINAHL, Science Direct, and the Cochrane Library. This review's included studies were critically appraised, and those with scores >5 were included in the meta-analysis. Meta-regression was used to investigate other reasons for heterogeneity in the dataset.
This systematic review and meta-analysis includes twelve main studies with a total of 3625 participants, of whom 1605 were male and 2020 were female. The pooled prevalence of RSB among people with severe mental illness in Africa was 43.4 % (95 % CI 34.56-52.23). Being male OR = 2.83 (95 % CI 1.96-4.08), having active mania symptoms OR = 2.07(95 % CI 1.35-3.18), young adults OR = 2.79 (95 % CI 1.27-6.16), and current use of alcohol OR = 2.55 (95 % CI 1.71-3.79) were significantly associated with risky sexual behavior in this review.
This systematic review and meta-analysis revealed a high prevalence of risky sexual behavior (RSB) among individuals with severe mental illness in Africa, highlighting a critical public health concern. Several important factors were significantly associated with RSB in this population: being male, having active mania symptoms, young adults, and current alcohol use. These findings emphasize the need for targeted interventions and comprehensive support systems to address the behavioral and environmental risk factors that contribute to RSB in individuals with severe mental illness. Preventive strategies, including gender-sensitive approaches, integrated mental health and substance use services, and age-specific interventions, are essential to mitigate the risks associated with RSB and improve overall well-being in this vulnerable population.
患有严重精神疾病（SMI）的个体，如双相情感障碍（BD）、精神分裂症（SCZ）和重度抑郁症（MDD），更有可能从事危险的性行为。严重精神疾病会导致冲动控制能力下降、认知功能和记忆力减退，以及社会心理障碍，从而增加危险的性行为。危险的性行为（RSB）会导致健康问题，如性传播感染，包括艾滋病毒/艾滋病、早孕和意外怀孕。本系统评价和荟萃分析的目的是确定非洲严重精神疾病患者中危险的性行为及其相关因素的合并患病率。
对观察性研究进行系统评价：2009年至2022年间发表的横断面和前瞻性队列研究，报告了明确危险的性行为患病率的相对风险（RR）和比值比（OR）。我们在PubMed/MEDLINE、Scopus、非洲期刊在线、PsycINFO、EMBASE、精神病学在线、CINAHL、科学Direct和Cochrane图书馆进行了原始文献检索。对本评价纳入的研究进行严格评估，得分>5的研究纳入荟萃分析。采用荟萃回归分析数据集异质性的其他原因。
本系统评价和荟萃分析纳入了12项主要研究，共3625名参与者，其中男性1605名，女性2020名。非洲严重精神疾病患者中危险的性行为的合并患病率为43.4%（95%CI 34.56 - 52.23）。在本评价中，男性（OR = 2.83，95%CI 1.96 - 4.08）、有躁狂发作症状（OR = 2.07，95%CI 1.35 - 3.18）、年轻人（OR = 2.79，95%CI 1.27 - 6.16）以及当前饮酒（OR = 2.55，95%CI 1.71 - 3.79）与危险的性行为显著相关。
本系统评价和荟萃分析显示，非洲严重精神疾病患者中危险的性行为（RSB）患病率很高，凸显了一个关键的公共卫生问题。该人群中，有几个重要因素与危险的性行为显著相关：男性、有躁狂发作症状、年轻人以及当前饮酒。这些发现强调需要有针对性的干预措施和全面的支持系统，以解决导致严重精神疾病患者危险的性行为的行为和环境风险因素。预防策略，包括性别敏感方法、综合心理健康和物质使用服务以及针对特定年龄的干预措施，对于降低与危险的性行为相关的风险以及改善这一弱势群体的整体健康状况至关重要。
