Psychosocial Variables In Patients Research Articles

The impact of methamphetamine on psychosocial variables in patients from Iraq.

The current work reviews the psychosocial factors associated with different urinary methamphetamine concentration levels. From April to November 2023, 243 participants from Baghdad's Al-Ataa Hospital were the subjects of a cross-sectional descriptive analysis study. We included 73 patients in this study. The urinary methamphetamine concentration levels were from 3 to 92,274 ng/ml, with a mean ± SD of 10,873.6 ± 18,641. Patients diagnosed with major depression disorder exhibited higher scores on GHQ-30, UCLA, MOAS, and BDI-II with a significant P-value of 0.0001, 0.001, 0.0001, and 0.0001, consequently with an effect size of 0.015, 0.001, 1.05, and 3.24, respectively. The multi-screening test can produce a false positive. It frequently interferes with other drugs, especially antidepressants. This will result in patients being stigmatized and accused. On the other hand, those who accidentally come into contact with crystal smoke will experience the same withdrawal symptoms as the addicted patients. Their urinary methamphetamine level (titer) could have negative results. Urinary methamphetamine levels should be zero in healthy patients. In this situation, screening tests, expert opinion, and urine methamphetamine testing are strongly recommended.

Association of perceived social support with sociodemographic, clinical, and psychosocial variables in patients with first-episode psychosis

Patients with first-episode psychosis (FEP) report deficits in social support (SS) and diminished and less satisfactory social networks than healthy controls (HC). These SS difficulties are linked with symptomatology. The study objectives were to: (a) compare perceived SS between patients with FEP and HC; (b) study sex differences regarding perceived SS in patients with FEP and HC; and (c) explore which sociodemographic, clinical and psychosocial variables are related to perceived SS in the onset of FEP. A total of 146 participants were included: 76 patients with FEP (24 females, 52 males) and 70 HC (20 females, 50 males). Perceived SS was assessed with the DUKE-UNK instrument, which is divided into two subscales: confidant support (CS) and affective support (AS). Significant differences regarding perceived SS were observed between the samples. No sex differences were found concerning perceived SS in each group. For the group with FEP, more years of education, less anxiety/depressive symptoms and better functioning were the most relevant variables for more overall perceived SS and perceived CS. Also, less suicidal risk was the only important indicator for more perceived AS. Interventions in perceived SS could contribute to a good evolution of FEP.

Effect of psychological interventions on psychosocial variables in patients with colorectal cancer: a narrative review of the literature

To describe the effects of psychological interventions on anxiety, depression, emotional distress and/or quality of life (QoL) of patients with colorectal cancer. Narrative literature review in MEDLINE, PsycINFO, CINAHL and Cochrane Library, 2011-2021. A total of 553 articles were obtained, of which twelve were included. Most were brief, individual, face-to-face interventions. Cognitive Behavioral Therapy was the most reported intervention, showing positive effects on QoL, specifically in stoma patients; Acceptance and Commitment Therapy and solution-focused therapy also identified improvements in QoL. Reminiscence therapy and a self-efficacy intervention reported significant improvements in anxiety and depression. Relaxation and writing training were not proven effective; psychoeducation showed inconsistent effects. There is a paucity of studies conducted during the last years, which do not evidence a consensus of the therapeutic model that produces consistent improvements in psychological well-being.

Psychosocial profile of candidates for bariatric surgery and its association with Binge-Eating Disorder

Objective: To describe the psychosocial profile of candidates for bariatric surgery, verify the prevalence of Binge-Eating Disorder (BED) and analyze the correlation between psychosocial variables in patients with or without BED. Methods: Cross-sectional study. Data collection was based on information from 125 patients, and the Periodic Binge-Eating Scale (BES) was applied by the Psychology section of a general hospital in southern Minas Gerais from July 2019 to March 2020. Candidates were separated into groups with and without BED, and psychosocial variables were correlated with groups. Results: The BED prevalence was 41.6% (52). Most patients were women (101; 80.8%), between 30 and 49 years (68; 54.4%), had a paid job (80; 64%), had completed or incomplete high school (51; 48.8%), reported memories of "remarkable facts" in the child's family environment (78; 62.4%). Anxiety disorders were reported in 37.6% (47) and depressive disorders in 17.6% (22) of the sample. As for weight-loss treatments, 62.4% (78) tried at least three types; 58.4% (73) reported the perception of weight gain in childhood or adolescence. A statistically significant association was observed between BED and a low education (p = 0.009). Conclusion: It was possible to characterize the studied population. It was observed that education can be considered a protective factor for the occurrence of BED.

Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study

BackgroundPatients with pulmonary arterial hypertension (PAH) present impairments in muscle strength and exercise capacity. There is growing evidence about the benefits of neuromuscular electrical stimulation (NMES) in patients with respiratory diseases, except in patients with PAH. The aim of this study was to investigate the effects of NMES on muscle strength, and other physical and psychosocial variables in patients with PAH. MethodsPatients with PAH were randomly divided into two groups as NMES and control. The NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks for the NMES group. Muscle strength, muscle cross-sectional area and thickness, arterial stiffness, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were assessed at baseline and after 8 weeks by blinded assessors. ResultsThere was no significant difference in the demographic and clinical characteristics between the patient groups (p > 0.05). The improvements in muscle strength, muscle cross-sectional area and thickness, pulse wave velocity, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were significantly higher in the NMES group compared to the control group (p < 0.05). ConclusionsThis study suggests that NMES intervention is safe and effective for patients with PAH.

Weight cycling in adults with severe obesity: A longitudinal study.

Although weight cycling is a common phenomenon in treatment-seeking patients with obesity, its consequences on health outcomes have not yet been completely clarified. We therefore aimed to investigate the effect of one cycle of intentional weight loss and regain on energy expenditure, body composition, cardiovascular risk factors and psychosocial variables in patients with severe obesity. Clinical and psychosocial variables were measured in 38 adult patients with severe obesity (body mass index (BMI): 43.5 ± 7.2 kg/m2 ) consecutively readmitted to rehabilitative residential treatment (T1) for severe obesity after a cycle of weight loss (16.7 ±7.7 kg) and regain (15.1 ±11.3 kg), and compared with those recorded at a prior admission (T0). No significant differences were found between T0 and T1 values for weight, BMI, waist circumference, total body fat percentage, fat-free mass percentage, respiratory quotient, measured or predicted resting energy expenditure, metabolic adaptation, cardiovascular risk factors or psychosocial variables. However, younger patients (r = -0.38, P = 0.023) and those with higher historical weight (r = 0.43, P = 0.010) tended to regain more weight. The absence of negative physical and psychological effects of weight cycling indicates that the risk of weight regain should not be a barrier to encouraging weight loss efforts in patients with severe obesity.

Correlates of self-rated attachment in patients with cancer and their caregivers: a systematic review and meta-analysis.

This study aimed to evaluate the association between an anxious/avoidant attachment style and psychosocial variables in patients with cancer and their caregivers. PsycINFO, PubMed, Google Scholar, and SCOPUS were searched for empirical studies published in peer-reviewed journals between 1994 and 2015, and unpublished data from one cohort were added. Meta-analyses synthesized results from studies investigating the correlates of attachment styles, measured with validated scales, among patients with cancer or their caregivers. Thirteen studies (k = 13) were included in the quantitative synthesis (including unpublished data from one cohort). Anxious attachment was associated with depression (r = 0.29, CI 0.19-0.38, I(2) = 76%), anxiety (r = 0.34, CI 0.13-0.52, I(2) = 69%), and social support (r = -0.39, CI -0.55-0.21, I(2) = 87%). Avoidant attachment was associated with depressive symptoms (r = 0.20, CI 0.15-0.25, I(2) = 16%), anxiety (r = 0.13, CI 0.01-0.24, I(2) = 4%), and social support (r = -0.28, CI -0.42-0.14, I(2) = 75%). Patients with cancer and their caregivers showing high levels of insecure attachment are at risk of experiencing higher levels of depressive symptoms, anxiety, and poor social support. Findings suggest that clinicians' awareness of attachment styles may serve as important clinical insight to improve treatment outcomes. Large-scale studies and longitudinal studies are required to investigate distinct longitudinal pathways in cancer-related distress across different attachment styles Copyright © 2016 John Wiley & Sons, Ltd.

Comparative efficacy of three active treatment modules on psychosocial variables in patients with long-term mechanical low-back pain: a randomized-controlled trial.

BackgroundPsychosocial factors precipitate and perpetuate the risk of developing long-term Low-Back Pain (LBP) with resultant disability. However, management of psychosocial aspects of LBP still remains a major challenge. This study investigated the effect of static or dynamic back extensors endurance exercise on psychosocial variables of Fear-Avoidance Behaviour (FAB), Pain Self-Efficacy Belief (PSEB) and Back Pain Consequences Belief (BPCB) in patients with LBP.MethodsA randomized-controlled trial of 67 patients assigned into McKenzie Protocol (MP) group (n = 25), MP and Static Endurance Exercise Group (MPSEEG; n = 22); and MP and Dynamic Endurance Exercise Group (MPDEEG; n = 20) was carried out. Treatment was applied thrice weekly for eight weeks.ResultsThe groups were comparable in general and baseline psychosocial parameters (p > 0.05). The different regimens had significant effects on all outcome parameters across baseline, 4th and 8th week (p < 0.05). The regimens were comparable in mean change scores on BPCB and FAB at the 4th and 8th week respectively (p > 0.05). MPDBEEG had higher mean change in PSEB at the 4th and 8th week respectively.ConclusionsMcKenzie Protocol alone, or in combination with static or dynamic back extensors endurance exercise has comparable effect on FAB, PSEB and BPCB in patients with LBP. The addition of dynamic endurance exercise to the MP led to significantly higher positive effects on PSEB.Electronic supplementary materialThe online version of this article (doi:10.1186/s40945-015-0010-0) contains supplementary material, which is available to authorized users.

The role of headache chronicity among predictors contributing to quality of life in patients with migraine: a hospital-based study.

BackgroundHeadache chronicity has been known to elicit deleterious effects on quality of life (QOL). We evaluated the contribution of headache chronicity to QOL in relation to clinical, psychiatric, and psychosocial variables in patients with migraine.MethodsSubjects were recruited from a headache clinic and completed self-report questionnaires including the Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Migraine-Specific Quality of Life (MSQoL). We obtained predictors of MSQoL by multiple regression analyses. A path analysis model was constructed to analyze interrelationships between the variables.ResultsAmong 251 eligible patients, 183 (72.9%) had episodic migraine (EM) and 68 (27.1%) had chronic migraine (CM). Patients with CM had more serious clinical, psychiatric, and poor QOL than did patients with EM. The strongest predictor of the MSQoL score in all patients with migraine was the BDI score (β = -0.373, p < 0.001), followed by the MIDAS score (β = -0.223, p < 0.001), female gender (β = -0.192, p < 0.001), attack duration (β = -0.159, p = 0.001), and headache chronicity (β = -0.130, p = 0.012). Headache chronicity had a direct effect on the MSQoL score and exerted an indirect effect on the MSQoL score through the MIDAS and the BDI scores.ConclusionsChronic migraine appears to impair QOL directly as well as indirectly by provoking disability and depression.

Relationship between socio-demographic, clinical and psychosocial variables in patients with Type 2 Diabetes

The aim ofthis study is to analyze the relationship between socio-demographic, clinicaland psychosocial variables in patients with Type 2 Diabetes and to establishcomparative patterns between genders with this disorder. Patientsfrom a primary care center were assessed through a researcher design form andthrough the Hospital Anxiety and Depression Scale, the Satisfaction with SocialSupport Scale and the Pittsburgh Sleep Quality Index. A total of90 patients with Type 2 Diabetes were enrolled in this study, with a mean ageof 56.67±6.41 years. The HADS depression presented a score of 3.77±2.98 and6.7% of the sample revealed depression symptoms. The HADS anxiety presentedscores of 7.27±5.07 and 36.6% of the subjects had anxiety symptoms. Regardingsocial support, the results were positive and similar between genders. When itcomes to sleep, the sample presented a PSQI of 8.68±2.87, with 73.3% ofpatients revealing poor sleep quality and 24.4% showing a sleep disorder. Whencomparing genders, females had higher scores of anxiety and depression andworse sleep quality. Inconclusion, we can state that anxiety symptoms are very prevalent in patientswith Type 2 Diabetes and women are more vulnerable to anxiety, depression symptomsand poor sleep quality.

Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery

BackgroundMorbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain. MethodsThe study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P < .05 as statistically significant. ResultsThe variables of self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery. ConclusionThe study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study.

Measuring Psychosocial Variables in Patients With (Sub) Acute Low Back Pain Complaints, at Risk for Chronicity

A validation study of the Acute Low Back Pain Screening Questionnaire Dutch Language Version (ALBPSQ-DLV). To determine internal consistency, construct and convergent validity of the ALBPSQ-DLV in a population of patients with (sub) acute low back pain (LBP) referred to primary care physical therapy in The Netherlands. Viewing LBP as a multifactorial biopsychosocial syndrome enhances the need for validating instruments for screening psychosocial variables in patients with LBP. The ALBPSQ has been specifically constructed as a self-administered screening instrument, based on variables that have been suggested as a risk factor in the literature. A total of 69 patients with (sub) acute LBP were recruited. Internal consistency of the ALBPSQ-DLV was determined by calculating Cronbach alpha. Construct validity was determined by applying exploratory factor analysis. Convergent validity was assessed by calculating Pearson's correlation coefficients between domains of ALBPSQ-DLV and Dutch language versions of the Fear Avoidance Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Pain Coping Inventory, Quebec Back Pain Disability Scale, and the Visual Analogue Scale of pain intensity. Internal consistency of the ALBPSQ-DLV was 0.81. Values of the various subscales ranged between 0.48 and 0.88. Convergent validity was confirmed by moderate to good correlation coefficients (P = 0.01) between the scores on the subscales and the constructs of pain, disability, fear-avoidance beliefs, kinesiophobia, and coping (r = 0.38-0.64). Exploratory factor analysis, suppressing absolute values less than 0.40, revealed components which were in agreement with the various domains of the original ALBPSQ. The internal consistency and both construct and convergent validity of the ALBPSQ-DLV are well established in a Dutch population of 69 patients with (sub) acute nonspecific LBP referred to primary care physical therapy.

Narcissistic rage: The Achilles&amp;rsquo; heel of the patient with chronic physical illness

Based on the psychoanalytic reading of Homer's Iliad whose principal theme is "Achilles' rage" (the semi-mortal hero invulnerable in all of his body except for his heel, hence "Achilles' heel" has come to mean a person's principal weakness), we aimed to assess whether "narcissistic rage" has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ "omnipotence" and HDHQ "extraverted hostility". Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a "normal" mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an "Achilles' Heel" for patients with long-term physical illness. These findings may have important clinical implications.

Psychosocial characteristics of adults who experience difficulties with retching

Objectives The current study aimed to reach a greater understanding of psychosocial variables in patients who gag, and is a recognised gap within current literature. Obtaining a profile of patients who gag could provide valuable information in relation to future treatment planning and management of this type of difficulty. Methods All new patients aged ≥18 years, identified as having a difficulty with retching, and who attended the Anxiety Management Clinic, Department of Restorative Dentistry, Birmingham Dental Hospital, were invited to complete a brief questionnaire with questions related to general demographic data; difficulties with retching; and an oral health status measurement. This study has reported on 48 patients who attended the dental anxiety management clinic at Birmingham Dental Hospital and who presented with retching difficulties. One patient did not wish to take part in the study, leaving a final sample size of 47. The sample comprised 57% male ( n = 27) and 43% female ( n = 20) patients. Results Retching was more commonly seen in the 40–49-year age group. Onset was frequently related to an earlier dental experience and over half the sample studied had experienced previous psychological difficulties. A fear of choking or suffocation was frequently expressed, supporting a cognitive model in terms of assessment and treatment. Conclusion A number of themes were identified which would be worthy of further exploration. For example, the impact of previous or existing physical health problems such as respiratory complaints, family history of retching, and prevalence of other psychological difficulties. Through participation in this study, patients were able to reach a greater awareness of this commonly encountered difficulty within dentistry.

Health Related Quality of Life in Patients Awaiting Heart Transplantation

Quality of life is an important outcome measure in patients with end-stage heart failure waiting for heart transplantation. The purpose of this study was to investigate the relationship between aspects of quality of life and physiological and psychosocial variables in patients with end-stage heart failure. A total of 123 patients participated in the study. The functional status was assessed with New York Heart Association (NYHA) functional classification, a 6-minute walk test (6 MWT) and peak oxygen uptake (pVO(2)). Health related quality of life (HRQOL) was measured with Medical Outcomes Study, 36-item Short Form Survey (SF-36), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were used to assess psychological symptoms. A significant relationship was found between HRQOL (SF-36 and MLHFQ) and functional status (NYHA, 6 MWT and pVO(2)) (p < 0.05). Psychological symptoms (BDI) were associated with HRQOL (p < 0.05). In addition to clinical derangements, functional limitation and psychological distress can lead to limitations in activities of daily life through impairment of quality of life. It would be helpful to evaluate psychological symptoms and quality of life in patients with end-stage heart failure besides routine clinical evaluations.

Patient Education in Inflammatory Bowel Disease does not Influence Patients Knowledge and Long-Term Psychosocial Well-Being

Patient education is accepted in many disciplines as a valid component of disease management in chronic diseases. The aim of this prospective study was to analyze the effects of an education program in patients with inflammatory bowel disease. 145 patients with inflammatory bowel disease were prospectively included: 73 were educated in four sessions, 72 were educated after the one year evaluation period (control group). The following topics were presented: pathogenesis, diagnostic procedures, course of disease, medical and surgical treatment, nutrition, social problems and support, stress management, and coping with the disease. The repeated measurement two-way analysis of variances showed no effects of the patient education program on disease-related knowledge, depression and quality of life. This patient education program was not able to increase disease-related knowledge or psychosocial variables in patients with IBD. However, most of the patients were very satisfied with the education program, since as judged by their own assessment it helped them to act responsibly for themselves and their disease.

Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs

Psychosocial factors are known to affect recovery from acute low back pain. The factors with the greatest influence and the optimal methods of measurement and interpretation have not been established. The purpose of this study was to examine baseline psychosocial variables and their ability to predict prolonged work restrictions. The subjects were 78 people with work-related low back pain who were participating in a clinical trial (mean age=37.4 years, SD=10.4, range=18-58; mean duration of pain=5.5 days, SD=4.6, range=0-19). A baseline examination including measures of impairment, disability, and psychosocial variables was performed. All subjects had physical therapy interventions. Work status was assessed after 4 weeks. Sensitivity, specificity, and likelihood ratios were calculated for the prediction of work status by the use of psychosocial variables. Receiver operator characteristic curves and logistic regression were used to identify the variables that were most predictive of work status. Twenty-two subjects (29%) had persistent work restrictions. The work subscale of the Fear-Avoidance Beliefs Questionnaire was the strongest predictor of work status (negative likelihood ratio of 0.08 for scores less than 30, positive likelihood ratio of 3.33 for scores greater than 34). Fear-avoidance beliefs about work was the psychosocial factor that could best be used to predict return to work in patients with acute work-related low back pain. Examination of fear-avoidance beliefs may serve as a useful screening tool for identifying patients who are at risk for prolonged work restrictions.

Psychosocial variables in relation to various risk factors in patients with stable angina pectoris

To evaluate relationships between psychosocial variables and common risk factors such as age, concomitant diseases (hypertension, diabetes mellitus, myocardial infarction, heart failure) and smoking habits in patients with stable angina pectoris. University Hospital. Participants in the Angina Prognosis Study in Stockholm (APSIS), which comprised 809 patients (248 females) <70 years of age, with chronic stable angina pectoris, of whom 767 (236 females) participated in the present report. Patients with angina pectoris occurring only at rest constituted one group, patients with angina pectoris on effort with or without angina at rest were stratified according to signs of marked ischaemia on exercise and/or clinical signs of heart failure. Psychosomatic symptoms, job strain, Type-A behaviour, sleep disturbances and overall life satisfaction were evaluated by a structured interview, which also included questions regarding how the patients usually felt, and health related problems, according to a standardized check-list. Age correlated with several psychosomatic symptoms and tendency to worry. When adjusted for age and sex, patients with previous myocardial infarction and heart failure described more psychosomatic symptoms, but worried less about the future than patients without these diseases. In the group with angina pectoris at rest only there were fewer smokers than amongst other groups, regardless of risk stratification. Smoking habits and concomitant diseases influence psychosocial variables in patients with stable angina pectoris. The severity of angina pectoris does not seem to relate to life satisfaction and attitudes towards the future.

Sexual function in patients with advanced heart failure

To determine the effect of low ejection fraction on sexual function and the relation between alterations in sexual function and pertinent clinical, demographic, and psychosocial variables in patients with advanced heart failure. This study was descriptive and correlational in design. The setting was an outpatient clinic of a university-affiliated hospital. Sixty-two male (82%) and female (18%) patients with advanced heart failure (New York Heart Association [NYHA] class III or IV) were studied. Exercise tolerance and symptom severity were assessed by the 6-minute walk and NYHA classification. Ejection fraction was measured by echocardiography. Alterations in the patients' emotional, social, and sexual function were assessed with the self-report version of the Psychosocial Adjustment to Illness Scale. Approximately three quarters of the patients reported a marked decrease in sexual interest and in the frequency of sexual relations caused by illness, with one quarter having ceased all sexual activity. Half the patients described having experienced marked reductions, after heart failure developed, in the pleasure or satisfaction they normally experienced from sex. Few patients had arguments with their spouses about sex or reported significant marital problems as a result of their illness. A significant relation was documented between patients' sexual function and the results of the 6-minute walk (r = 0.32, p < 0.005), as well as between sexual function and NYHA functional class (r = 0.21, p < 0.05). Sexual function was also related to the patient's social environment (r = 0.59, p < 0.001), psychologic distress (r = 0.38, p < 0.001), and domestic environment (r = 0.29, p < 0.05). No significant differences in sexual function were noted when patients were compared on the basis of differences in ejection fraction, medications, gender, or age. Advanced heart failure results in marked changes in libido and in the ability to perform sexually. These changes do not affect the marital relationship negatively, at least in the view of the patient. As patients' symptoms of heart failure become increasingly more severe, physicians and nurses need to counsel patients and their spouses about the changes they may experience in their sexual relationships. Attention needs to focus on ways to cope with the decreasing physical status that accompanies advanced heart failure to minimize negative changes in sexual functioning.