BJPsych Open (May 2024)

Sexually transmitted infections, sexual life and risk behaviours of people living with schizophrenia: systematic review and meta-analysis

  • Claudia Aymerich,
  • Borja Pedruzo,
  • Gonzalo Salazar de Pablo,
  • Lander Madaria,
  • Javier Goena,
  • Vanessa Sanchez-Gistau,
  • Paolo Fusar-Poli,
  • Philip McGuire,
  • Miguel Ángel González-Torres,
  • Ana Catalan

DOI
https://doi.org/10.1192/bjo.2024.49
Journal volume & issue
Vol. 10

Abstract

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Background Sexually transmitted infections (STIs), along with sexual health and behaviour, have received little attention in schizophrenia patients. Aims To systematically review and meta-analytically characterise the prevalence of STIs and sexual risk behaviours among schizophrenia patients. Method Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO and Cochrane Central Register were systematically searched from inception to 6 July 2023. Studies reporting on the prevalence or odds ratio of any STI or any outcome related to sexual risk behaviours among schizophrenia samples were included. PRISMA/MOOSE-compliant (CRD42023443602) random-effects meta-analyses were used for the selected outcomes. Q-statistics, I2 index, sensitivity analyses and meta-regressions were used. Study quality and publication bias were assessed. Results Forty-eight studies (N = 2 459 456) reporting on STI prevalence (including 15 allowing for calculation of an odds ratio) and 33 studies (N = 4255) reporting on sexual risk behaviours were included. Schizophrenia samples showed a high prevalence of STIs and higher risks of HIV (odds ratio = 2.11; 95% CI 1.23–3.63), hepatitis C virus (HCV, odds ratio = 4.54; 95% CI 2.15–961) and hepatitis B virus (HBV; odds ratio = 2.42; 95% CI 1.95–3.01) infections than healthy controls. HIV prevalence was higher in Africa compared with other continents and in in-patient (rather than out-patient) settings. Finally, 37.7% (95% CI 31.5–44.4%) of patients were sexually active; 35.0% (95% CI 6.6–59.3%) reported consistent condom use, and 55.3% (95% CI 25.0–82.4%) maintained unprotected sexual relationships. Conclusions Schizophrenia patients have high prevalence of STIs, with several-fold increased risks of HIV, HBV and HCV infection compared with the general population. Sexual health must be considered as an integral component of care.

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