Sexual functioning and self-reported depressive symptoms among college women

Journal of Sex Research, Nov, 2002 by Penny Frohlich, Cindy Meston

An association between depression and sexual dysfunction in women is frequently reported in the literature. Sexual problems noted among depressed women include loss of sexual desire (Clayton, McGarvey, Clavet, & Piazza, 1997; Gitlin, 1995; Graziottin, 1998; Hirschfeld, 1999; Kennedy, Dickens, Eisfeld, & Bagby, 1999), sexual arousal difficulties (Graziottin, 1998; Hirschfeld, 1999; Kennedy et al., 1999), orgasm difficulties (Graziottin, 1998; Hirschfeld, 1999; Kennedy et al., 1999), reduced sexual satisfaction (Gitlin, 1995), reduced sexual pleasure (Clayton et al., 1997), sexual aversion (Graziottin, 1998), and sexual pain (Meana, Binik, Khalife, & Cohen, 1998). With regard to sexual desire, some studies have linked depressive symptoms to decreases in sexual desire (Davidson, Krishnan, France, & Pelton, 1985; Kennedy et al., 1999) while others have noted an increase (Mathew & Weinman, 1982).

Most studies noting a relationship between depression and sexual dysfunction are confounded by pharmacological treatment for depression (e.g., Meston & Gorzalka, 1992; Rosen, Lane, & Menza, 1999). The few studies that have examined sexual functioning in depressed patients not receiving antidepressant medication often are limited by a lack of appropriate control groups, and/or have combined male and female data. Moreover, different operational definitions of sexual dysfunctions make comparisons across studies difficult. For example, Kennedy et al. (1999) evaluated sexual drive using fantasies, masturbation, and interest in erotic media, while Clayton et al. (1997) evaluated sexual drive by frequency of sexual activity and desire for and interest in sex.

The present study is an exploratory analysis of the relationships between various dimensions of sexual functioning and self-reported depressive symptoms in women. One of the fundamental characteristics of depression is a loss of interest in previously enjoyed activities, suggesting that the process by which pleasurable behaviors are reinforced becomes altered or disrupted. Sexual activity, along with eating and drinking, is considered to be a primary reinforcer. Examining sexual functioning among women with depressive symptoms may help elucidate the role of reinforcement in the pathogenesis and maintenance of depression. This study extends previous studies of this nature by (a) excluding participants who are receiving antidepressant medication treatment, (b) using an age-matched control group, and (c) measuring a wide range of self-reported sexual difficulties (desire, arousal, orgasm, pain, pleasure, and satisfaction).

METHOD

Participants

Participants for the present study were drawn from a large database of standard screening measures administered to research participants in the Human Sexuality Laboratory at the University of Texas at Austin. This database contained data drawn from 2,159 female undergraduate psychology students. The Beck Depression Inventory (BDI; Beck & Beamesderfer, 1974), a widely used 21-item self-report inventory for assessing depressive symptomology, was used as a screening device for participant classification. Although BDI scores alone do not provide sufficient information to diagnose major depression, in a sample of 17 to 18 year olds, a BDI cutoff score of 16 was shown to be sensitive and specific to major depression (Canals, Blade, Carbajo, & Domenech-Llaberia, 2001). Steer, Brown, Beck, and Sanderson (2001) found that mean BDI scores of 18, 27, and 34 were associated with mild, moderate, and severe major depressive episodes, respectively.

In the present study, only those participants whose BDI scores were greater than or equal to 20 were considered for the depressive symptom group, and only those participants whose BDI scores were less than or equal to 3 were considered for the control group. In addition, only those participants who indicated being in a sexually active relationship were considered for the study. Any participant who indicated use of antidepressant medication within the past 6 months was not considered for inclusion in the study.

The final depressive symptom group consisted of 47 women with BDI scores ranging from 20 to 38 with a mean of 24.55 (SD = 5.12). We selected control participants semirandomly from a larger group of participants who met criteria for the control group by randomly matching control participants to depressive symptom participants by age ( /- 3 years). The final control group consisted of 47 women with BDI scores ranging from 0 to 3 with a mean of .36 (SD = .85). The final depressive symptom group and the control group did not differ significantly in average age (depressive symptom group average age = 19.2 years, range 18 to 25; control group average age = 19.0 years, range 18 to 24 years).

Measures and Procedures

All measures and procedures used to obtain the data for the present study were approved by the ethics committee at the University of Texas. All prospective participants completed questionnaires on the computer by entering an assigned code number into the computer. They were instructed to skip any items that they did not feel comfortable completing. Prospective participants completed the BDI, a Medical Information form, and selected sections of the Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, & Leiblum, 1994). The BISF-W is a 22-item questionnaire that was validated on a sample of 269 women aged 20 to 73. The questionnaire contains three factors: sexual interest, sexual activity, and sexual satisfaction. Test-retest reliability ranged from .68 to .78 and internal consistency ranged from .39 to .83 (Taylor et al., 1994). Concurrent validity was demonstrated by comparing the BISF-W with the Derogatis Sexual Functioning Index (DSFI; Derogatis & Melisaratos, 1979). In a placebo-controlled study of the effects of transdermal testosterone treatment on sexual function in 75 oophorectomized women, the BISF-W was sensitive to detecting differences between treatment groups (Shiffrin et al., 2000). For the present study, we drew questions regarding sexual desire, sexual arousal, orgasm, sexual pain, sexual satisfaction, and sexual pleasure from the BISF-W. We assessed sexual desire as (a) the desire to engage in sexual activity alone ("How frequently have you felt a desire to engage in masturbation?"; 0 = not at all to 4 = more than once a day), and (b) the desire for sexual activity with a partner ("How frequently have you felt a desire to engage in kissing? Foreplay? Vaginal penetration?"; 0 = not at all to 4 = more than once a day; coefficient alpha for the present sample was .814). We assessed sexual arousal using the item "How frequently have you experienced lack of vaginal lubrication?" (0 = not at all to 4 = always). We assessed orgasm functioning with the item "How frequently have you experienced difficulty reaching orgasm?" (0 = not at all to 4 = always). We assessed sexual pain with the item "How frequently have you experienced painful penetration or intercourse?" (0 = not at all to 4 = always). We assessed sexual satisfaction with the item "How satisfied have you been with your sexual relationship with your partner?" (1 = very dissatisfied to 5 = very satisfied). Finally, we assessed sexual pleasure with the item "Have you felt pleasure from any forms of sexual experience?" (1 = have not felt any pleasure to 5 = always felt pleasure).