Internet Discussion Boards Research Articles

Experiences of women who have planned unassisted home births in high-resource countries: a qualitative systematic review.

The aim of this review was to identify, appraise, and synthesize the qualitative evidence about the experiences of women in high-resource countries who have planned unassisted home births. Unassisted birth occurs when a woman chooses to give birth without the assistance of health care providers. These births are planned and usually occur in a woman's home. It is difficult to know the prevalence of unassisted birth because it occurs at the margins of health care systems, making data difficult to collect. Based on its lack of visibility in society, we assume that unassisted birth is not a common birth choice. Women who choose planned unassisted birth may face stigma for their decision and their experience of birth, which challenge accepted norms. Synthesizing qualitative evidence about women's experiences of planned unassisted birth can improve our understanding about women's birthing values and provide important clues about aspects of birthing care that may be missing in mainstream birthing services. Studies that explored the experiences of women who had planned unassisted home births without the support of health care providers in high-resource countries were included. Unassisted home births were defined as those that were planned not to be assisted by health care professionals. Study designs that focused on qualitative data were eligible for inclusion. MEDLINE (Ovid), Embase, CINAHL (EBSCO), Scopus, Web of Science, Sociological Abstracts (ProQuest), ProQuest Dissertations and Theses (ProQuest), and Nursing and Allied Health Database (ProQuest) were searched in 2022. Studies published in English since the databases' inception were considered for inclusion. A search of relevant websites for unpublished and gray literature was also undertaken in 2022. Two independent reviewers assessed the methodological quality of papers identified for inclusion. Qualitative research findings were extracted from papers that met the inclusion criteria and critical appraisal standard. Findings were extracted and categorized based on similarity of meaning. The categories were synthesized to create 2 synthesized findings, and the ConQul approach was used to grade the findings to establish confidence in the synthesized findings. Six studies were included in the review. All the studies used interviews for data collection; other methods included surveys, email correspondence, posts on internet discussion boards and forums, and websites. The total sample size for interviews was 103 participants. Total survey sample size for surveys was 87 participants. Total sample size for email correspondence was 5. Internet data sources included more than 100,000 individual and forum posts and 127 birth stories. A total of 17 findings were extracted and grouped into 4 categories. The 4 categories were then synthesized into 2 synthesized findings: i) navigating tensions within self, and between self and systems, and ii) integrating and transcending physical experiences of birth. More research is needed to better understand the experiences of women who have planned unassisted births. Improving understanding and increasing the awareness of planned unassisted birth are necessary steps for promoting inclusive, relational, and person-centered birthing experiences for everyone. Reflection about the differences between planned unassisted births and mainstream births may support needed reorientations of perinatal services. PROSPERO CRD42019125242. A French-language version of the abstract of this review is available [ http://links.lww.com/SRX/A9 ].

Most Patients With Bone Sarcomas Seek Emotional Support and Information About Other Patients' Experiences: A Thematic Analysis.

Online discussion forums allow individuals who otherwise may be strangers to create a community where they can seek and share information. Patients with bone sarcomas and their support networks use discussion forums dedicated to cancer support. There is a paucity of published reports regarding the care experience of patients with bone sarcomas because studies on online discussion groups have primarily focused on some of the more common cancers, including breast and prostate cancer. Understanding commonly discussed themes among patients with bone sarcomas would allow treating physicians to have a better understanding of patient concerns when providing patient education and counseling. We performed this study to review posts from bone sarcoma internet discussion boards to establish common themes related to the care experience of patients with sarcomas. Online discussion forums were identified using the search term "sarcoma discussion forum." After identifying 12 websites, we excluded closed forum groups, websites with missing or invalid links to forums, and nonpublic forums, such as groups on Facebook. These websites include profiles and photos that are personal, and sufficient author anonymity could not be achieved for this study. Posts written between January 1, 2012, and May 1, 2022, posted on five discussion boards were reviewed and collected until we reached a point of data saturation in which we agreed that the collection of additional posts would not reveal new themes. Discussion threads were filtered to identify posts pertaining to the most common bone sarcomas: chondrosarcoma, Ewing sarcoma, and osteosarcoma. Grounded theory-the methodology of repeated analyses of qualitative data to identify recurring themes or concepts-was used to analyze posts. Caregiver posts were delineated from patient posts and categorized separately for subgroup analysis. Grounded theory, although a qualitative method, endeavors to integrate the strengths inherent in quantitative methods with qualitative approaches. Grounded theory categorizes words, language, and the meanings these imply and seeks to organize and reduce the data gathered into themes or essences, which, in turn, can be fed into descriptions, models, or theories. Our analysis used three reviews of text to assign and group codes based on repeating ideas or concepts. The first review (open coding) aims to assign codes based on the verbatim text included by the author to capture the specific thoughts and ideas of the post. The second review (axial coding) aims to consolidate the ideas of posts by applying broader concepts to each post. The third and final review (selective coding) aims to further consolidate the themes of each post by trying to embody the main message contained in a post. A total of 570 posts from 139 threads were collected and analyzed using grounded theory. Twenty-five axial codes and four selective codes were created. We defined data saturation by the absence of a new open code in the analysis of a block of 50 posts to ensure that signals of saturation were not accepted too early in the analysis. The four selective codes included emotional aspects or connecting with others, information support: diagnosis, information support: treatment, and information support: recovery. Of these four codes, emotional aspects and connecting with others was the most prevalent theme (78% [445 of 570] of posts) followed by information support: treatment (49% [282 of 570] of posts). Information support: diagnosis and information support: recovery were each captured in 15% of posts. Analysis of posts reveals that the two most common themes involve seeking out emotional support and information about the experiences of others with various treatment modalities. Although most of the posts we assessed contained experiential information and emotional support rather than directed medical advice, future studies should assess the accuracy of information shared among online sarcoma forums. Physicians caring for patients with sarcomas should not only address patient concerns related to medical care, but also provide emotional support directly and assist patients by providing resources to peer support outlets, including online discussion forums. Although we cannot ascertain the proportion of patients who use online sites given the anonymity of posts included, these findings suggest common experiential themes across patients with sarcomas outside their doctors' offices. It is important that providers be aware of reputable forums to provide as resources for their patients. The Musculoskeletal Tumor Society may further benefit from endorsing one or more of these forums and providing physician oversight to monitor misinformation.

Thematic analysis of online discussion forums for soft tissue sarcomas

Background and ObjectivesAs there is an increasing reliance on the internet for medical information, patients diagnosed with rare diseases have turned to online community forums to share information about their diagnoses. These forums help patients to gather and share information about their experience with disease. Additionally, these platforms enable patients to build unique connections based on their shared experiences. The objective of this study was to review shared posts in online community forums by individuals with soft tissue sarcomas to better understand commonly discussed themes. This information may improve the physicians’ understanding of patients’ concerns and feelings at the time of diagnosis and treatment. MethodsWe entered “sarcoma discussion forum” in search engines to identify internet discussion boards. Four major discussion forums were analyzed, and posts written between January 1, 2017 through May 1, 2022 addressing soft tissue sarcomas present in the upper and lower extremities were collected. Each post was analyzed by the two investigators in three steps (open coding, axial coding, and selective coding). ResultsA total of 506 posts were included in the final analysis. We used twenty-seven axial codes and four selective codes. Emotional Aspects/Connecting with Others was the most common theme (77 % of posts) followed by Information Support: Treatment (38 % of posts), Information Support: Diagnosis (24 % of posts) and Information Support: Recovery (21 % of posts). ConclusionsThe most prevalent theme was centered on emotional aspects of these patients’ journeys, highlighting the importance of providing resources to address emotional support for patients with soft tissue sarcoma and their families. Level IVQualitative research study

Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum.

The removal of non-pathogenic foreskin from the penis of healthy neonates and infants for non-religious reasons is routinely practiced in many parts of the world. High level data from well-designed randomized controlled trials of circumcision in neonates and infants does not guide clinical practice. Reliable counts of immediate and short term circumcision complications are difficult to estimate. Emerging evidence suggests routine neonatal circumcision could lead to long term psychological, physical, and sexual complications in some men. The stigma associated with discussing circumcision complications creates a prevalence paradox where the presence of significant circumcision complications is higher than reported. Prior to the Internet, there were very few forums for men from diverse communities, who were troubled about their circumcision status, to discuss and compare stories. To investigate the long term consequences of circumcision, we reviewed 135 posts from 109 individual users participating in a circumcision grief subsection of Reddit, an internet discussion board. We identified three major categories of complications: physical such as pain during erections and lost sensitivity, psychological such as anxiety and violation of autonomy, and sexual such as feeling that the sexual experience was negatively altered or being unable to complete a sexual experience. We also identified a "discovery process" where some men described coming into awareness of their circumcision status. These findings suggest that neonatal circumcision can have significant adverse consequences for adult men. The removal of normal foreskin tissue should be limited to adult men who choose the procedure for cosmetic reasons or when medically indicated.

Japanese te iu ka as a sentence-final expression in writing

The present study explores cases of the use of the Japanese expression te iu ka in the sentence-final position in internet blogs and discussion boards. The analysis shows that there are two types of sentence-final te iu ka: one used for adding supplementary information and the other for mitigating the preceding statement. The present study also discusses processes through which te iu ka is placed in the sentence-final position. When sentence-final te iu ka is used to add supplementary information, the placement of te iu ka in the sentence-final position is caused by right dislocation. When sentence-final te iu ka is used for mitigation, it is caused by the omission of the B component in A te iu ka B. The present study contributes to the existing literature by offering the notion of two different formation processes of sentence-final te iu ka, which also affect its pragmatic functions.

The video gamer 500: Performance-enhancing drug use and Internet Gaming Disorder among adult video gamers

BackgroundPerformance-enhancing drug (PED) use has been reported among various populations. Despite anecdotal reports of stimulant use among video gamers, only limited data is known regarding overall PED use. The objectives of this study were to determine: 1) prevalence of PED use and Internet Gaming Disorder (IGD) among adult gamers, and 2) if factors could place an individual at higher risk for IGD. Materials and methodsBetween May–July 2019, adult gamers were recruited from 16 Internet discussion boards or social forums and three in-person video game tournaments. The Video Gamer 500 was a 40-item Internet-based survey assessing demographics, video gaming behaviors/patterns, PED use, psychiatric diagnoses, and IGD. The Internet Gaming Disorder Scale-Short Form (IGDS9-SF) questionnaire screened for IGD. ResultsA total of 526 respondents completed the survey with approximately 75% from the United States. Approximately two out of five gamers (42.6%) used a PED, averaging 1.2 PEDs. The most commonly reported PEDs were caffeine drinks (33.8%) and energy drinks (19.2%). Prescription drugs were used by 6.1% of gamers to enhance performance; 4.9% used a prescription stimulant. IGD criteria were met by 2.3% of gamers and associated factors included a diagnosis of attention-deficit/hyperactivity disorder (ADHD) (OR 3.6, 95% CI 1.0–12.5) or use of prescription PEDs (OR 5.5, 95% CI 1.3–23.1). ConclusionPEDs are commonly used by video gamers. Factors associated with IGD include an ADHD diagnosis and prescription drug PED use.

REDRESSIVE ACTIONS FOLLOWING COMMISERATIONS IN ONLINE DISCUSSIONS

In Brown and Levinson’s (1978) seminal classification of positive politeness strategies, commiserating is listed in the subgroup referred to as human-relations wants. The qualitative and quantitative ana­lysis of a corpus consisting of five Internet discussion boards has shown that it is also one of the most frequent positive politeness strategies used there. All the threads under examination are dedicated to the so-called women’s topics, such as dieting, pregnancy, infertility or mothering. The members of these close-knit communities formed upon the boards find it necessary to express sympathy in order to enhance each other’s (positive) face and avoid face-threatening acts arising from the sensitive nature of these topics. However, the analysis of the corpus has also revealed that to commiserate merely by saying they are sorry is not enough. The interlocutors find it necessary to add often complex redressi­ve actions to boost the illocutionary force of their statements. Thus the aim of the paper is to explore the formulaic character of commiserations and categorise the numerous redressive actions following them, taking into account their two main functions, i.e. building rapport and facilitating smooth communication within online communities.

A Thematic Analysis of Online Discussion Boards for Vasectomy

To examine posts on Internet discussion groups related to vasectomies, and identify common ideas through a structured theme analysis. Internet discussion boards were identified using the search term "vasectomy." Three discussion boards were identified as having the most posts and were chosen for analysis. Using an iterative and structured analysis process, each post was analyzed using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. A total of 129 posts were analyzed. The most common posts related to changes in sexual function after vasectomy. The second most common theme was pain after vasectomy. There were also posts about considerations before vasectomy, planning for postvasectomy care, what to expect after vasectomy, potential issues after vasectomy and how to manage these, and feelings about vasectomy. Some of the information present did not have a factual basis. Posts dedicated to postvasectomy pain and sexual dysfunction were of the highest quantity. There was no medical provider input to these discussion boards. Educational efforts should be targeted to these areas and should include a health-care professional.

The elusive cyber beasts: How to identify the communication of pro-Russian hybrid trolls in Latvia’s internet news sites?

The research described here was performed on the background of the geopolitical fluctuations in Eastern Europe and the annexation of Crimea by Russia. These events caused fear of pro-Russian propaganda particularly in the so-called Internet hybrid-trolls, i.e., commentators who are on the payroll of Russian state agencies who disrupt internet discussion boards with massive pro-Russian information and opinions. This paper describes methodology of identifying possible hybrid-trolls, data gathering from the biggest Latvian online news sites delfi.lv, apollo.lv, tvnet.lv that provide information in Latvian and Russian language, and analysis of the data by means of quantitative analysis as well as qualitative, that included content analysis and a case study. The analysis shows that the presence of pro-Russian hybrid trolls is inconclusive. However, following the outlined methodology some cases were recorded. Quantitative as well as qualitative analyses demonstrate that the overall presence and exposure of the alleged trolls in the given period was insignificant and the influence of trolls on public opinion highly questionable.

A Thematic Analysis of Online Discussion Boards for Brachial Plexus Injury

Patients with brachial plexus injury (BPI) and their family members contribute to Internet discussion groups dedicated to BPI. We hypothesized that a thematic analysis of posts from BPI Internet discussion groups would reveal common themes related to the BPI patient experience, providing topics for patient education and counseling. Internet discussion boards were identified using the search term "brachial plexus injury support group" in Google, Bing, and Yahoo! search engines. Two discussion boards had substantiallymore posts than other Web sites and were chosen for analyses. Posts from January 1, 2015, through January 1, 2016, were examined. Using an iterative and established process, 2 investigators (M.T.M. and C.J.D) independently analyzed each post using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes. In this process, each post was reviewed 3 times. A total of 328 posts from the 2 leading discussion boards were analyzed. Investigators reached a consensus on themes for all posts. One central theme focused on emotional aspects of BPI. Four other central themes regarding information support were identified: BPI disease, BPI treatment, recovery after BPI treatment, and process of seeking care for BPI. Examination of posts on Internet support groups for BPI revealed recurring concerns, questions, and opinions of patients and their family members. The most common themes related to disease information, treatment, recovery, and the emotional element of BPI. These findings provide a helpful starting point in refining topics for patient education and support that are targeted on patients' interests and concerns.

The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors.

Fear of cancer recurrence, although distinct from distress continues to be under-evaluated, captured, or treated when standard distress scales are used to assess concerns of cancer survivors. We tested a model assessing the association of demographic and clinical factors, illness representations, and perceived risk with fear of cancer recurrence in breast cancer survivors. We recruited 117 breast cancer survivors at least one year after completing breast cancer treatment from Internet discussion boards for this cross-sectional, descriptive, correlational study. Participants completed a survey that assessed their level of fear of cancer recurrence as well as their illness representations, perceived risk of recurrence, and demographic and medical characteristics. Our model explained 62% of the variance in fear of cancer recurrence. Emotional representations (β = .46, p < .01), symptom attribution (β = .21, p < .01), timeline (β = .23, p < .01), and consequences (β = .16, p < .03) were significantly related to fear of recurrence. By contrast, the majority of clinical and demographic variables were not significant contributors to fear of recurrence. Upon completion of cancer treatment, survivors with more emotional representations of the experience and those who attribute unrelated symptoms to their breast cancer have a higher level of fear of recurrence. Evaluation of these factors during treatment may help mitigate fear of recurrence in the survivorship phase of the breast cancer trajectory. Copyright © 2016 John Wiley & Sons, Ltd.

The Rhetoric of Gaydar Research: A Critical Discourse Analysis

As dozens of countries around the world actively enforce antigay legislation or conduct antigay crackdowns, interest grows about research on “gaydar,” using nonverbal behavior to identify sexual orientation. Identifying sexual orientation based on perceptual cues is replete with social implications. Empirical evidence may add more fuel to the fire of hatred, discrimination, and punishment based on sexual orientation. This article addresses the highly charged debate on the ethics of research on identifying in‐group and out‐of‐group membership in an increasingly polarized world of lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights through critical discourse analysis (CDA) of text appearing on a public Internet discussion board in response to gaydar research. Analysis at the macro level placed the narrative in the broader social context. Analysis at the meso level focused on logistics and audience. The micro level of analysis revealed language used to convey thoughts and beliefs about gaydar research and its implications.

Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

Background: Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. Objectives: To identify facilitators of self-treatment by online buprenorphine/naloxone users. Methods: A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Results: Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a “bad-tasting” medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely “substance-free.” The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. Conclusions/Importance: The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.

How people with diabetes integrate self-monitoring of blood glucose into their self-management strategies.

The benefit of self-monitoring of blood glucose by patients has been questioned, and UK policy is generally not to support this, although it is identified that there may be unidentified subgroups of people who would benefit from being supported to self-monitor. The purpose of this paper is to explore the self-management approaches of people with diabetes, and how self-testing of blood glucose contributes to self-management strategies. This qualitative study of patients' experiences drew data from contributors to online discussion boards for people living with diabetes. The principles of qualitative content analysis were used on posts from a sample of four Internet discussion boards. Contributors described how they were using self-testing within their self-management strategies. Most saw it as a way of actively maintaining control of their condition. The amount of testing carried varied over time; more testing was done in the early days, when people were still learning how to stay in control of their diabetes. Some people had experienced a lack of support for self-testing from healthcare professionals, or had been expected to change their self-management to fit national policy changes. This was seen as unhelpful, demotivating, stressful, and harmful to the doctor-patient relationship. The Internet is a valuable source of information about peoples' self-management behaviours. Patients who are using, or who wish to use, self-testing as part of their self-management strategy are one of the subgroups for whom self-testing is beneficial and who should be supported to do so.

Supporting a person-centred approach in clinical guidelines. A position paper of the Allied Health Community - Guidelines International Network (G-I-N).

A person-centred approach in the context of health services delivery implies a biopsychosocial model focusing on all factors that influence the person's health and functioning. Those wishing to monitor change should consider this perspective when they develop and use guidelines to stimulate active consideration of the person's needs, preferences and participation in goal setting, intervention selection and the use of appropriate outcome measures. To develop a position paper that promotes a person-centred approach in guideline development and implementation. We used three narrative discussion formats to collect data for achieving consensus: a nominal group technique for the Allied Health Steering Group, an Internet discussion board and a workshop at the annual G-I-N conference. We analysed the data for relevant themes to draft recommendations. We built the position paper on the values of the biopsychosocial model. Four key themes for enhancing a person-centred approach in clinical guidelines emerged: (i) use a joint definition of health-related quality of life as an essential component of intervention goals, (ii) incorporate the International Classification of Functioning, Disability and Health (ICF) as a framework for considering all domains related to health, (iii) adopt a shared decision-making method, and (iv) incorporate patient-reported health outcome measures. The position statement includes 14 recommendations for guideline developers, implementers and users. This position paper describes essential elements for incorporating a person-centred approach in clinical guidelines. The consensus process provided information about barriers and facilitators that might help us develop strategies for implementing person-centred care.

Thermal behavior and decomposition kinetics of ETN and its mixtures with PETN and RDX

Erythritol tetranitrate (butane-1,2,3,4-tetrayl tetranitrate, ETN) has become one of the most synthesized improvised explosives nowadays as it can be found on public internet discussion boards. However, the low melting point, nitrocellulose gelling ability, high energy content, and availability of its precursor make the substance potentially useful in industry as an energetic component or additive in certain gun propellants. Mixtures of ETN with other high explosives are also frequently discussed on web pages dealing with improvised explosives. This article describes thermal behavior and decomposition kinetics of pure ETN and its mixtures with pentaerythritol tetranitrate and cyclonite (1,3,5-trinitro-1,3,5-triazinane, RDX). The thermal behavior and decomposition kinetics of such mixtures are described using non-isothermal DSC and TG techniques. Kissinger method, Soviet manometric method, and modified Kissinger–Akahira–Sunose method were used for data evaluation.

Phantom Cinema: Illuminating the Structuring Absences of Film History

When rumors on various Internet discussion boards started circulating sometime around mid-2007 that Samuel Fuller's White Dog (1982) was finally going to be released on home video in the United Sta...

What E-patients Want From the Doctor-Patient Relationship: Content Analysis of Posts on Discussion Boards

BackgroundPeople with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards.ObjectiveThe aim of this study was to ascertain what people with diabetes who use Internet discussion forums want from their doctors. The study objectives were to identify what people with diabetes (1) consider their role in condition management, (2) consider their doctor’s role in managing their condition, (3) see as positive elements of their interactions with medical staff, and (4) find problematic in their interactions with medical staff.MethodsThe study used qualitative methodology to explore the experiences, views, and perceptions of individuals participating on 4 Internet message boards. Posts made on the discussion boards were analyzed using the principles of qualitative content analysis. The meanings of sections of data were noted using codes that were developed inductively; those with similar codes were merged into subcategories and related subcategories were combined to form categories.ResultsThe key themes identified in the study were ownership of condition management, power issues between people with long-term conditions and doctors, and ways in which people seek to manage their doctors.ConclusionsPeople with diabetes valued doctors who showed respect for them and their knowledge, and were willing to listen and openly discuss their options. Patients felt that they could and should take responsibility for and control of their day-to-day disease management. They saw doctors as having a role in this process, but when this was lacking, many people felt able to use alternative means to achieve their goal, although the doctor’s function in terms of gatekeeping resources could create difficulties for them in this respect.

‘CONGRATS!! You had an orgasm’: Constructing orgasm on an internet discussion board

Drawing on insights from conversation analysis, this article explores a discussion about orgasm on an internet forum. Critical of sex education for failing to address young women as sexual subjects with embodied desires, some feminists believe the internet offers alternative spaces for young women to discuss pleasure. I argue that the micro-political work done by offering ‘congratulations’ on one such site serves to mark young women’s orgasms as both ‘newsworthy’ and ‘good news’ in ways which simultaneously disrupt the idea that sexuality is inappropriate for young women while paradoxically reaffirming conventional ideas about the centrality of orgasm to sexuality.

Psychological and Physical Impact of Anabolic‐Androgenic Steroid Dependence

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. Subanalysis of data from the Anabolic 500, a cross-sectional survey. One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009. Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users. Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.