Daily Affect and Female Sexual Function

Introduction The specific affective experiences related to changes in various aspects of female sexual function have received little attention as most prior studies have focused instead on the role of clinical mood and anxiety disorders and their influence on sexual dysfunction. Aim We sought to understand the transaction between daily affect and female sexual function in effort to provide a more nuanced understanding of the interplay between affective and sexual experiences. Methods The present study used a 2‐week daily diary approach to examine same‐day and temporal relations between positive and negative affect states and sexual function in young women. Main Outcome Measures We examined the unique relations between positive (i.e., joviality, serenity, self‐assurance) and negative (i.e., fear, sadness, hostility) affects and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) while controlling for higher order sexual distress, depression, and anxiety, as well as age effects and daily menstruation. Results Analyses revealed different aspects of both positive and negative affects to be independently related to sexual response indices. Specifically, results indicated that joviality was related to same‐day sexual desire and predicted increased desire the following day. This latter relation was partially mediated by sexual activity. Further, greater sexual desire predicted next‐day calmness, which was partially mediated by sexual activity. Notably, fear was related to same‐day subjective arousal, lubrication, orgasmic function, and vaginal pain, whereas poorer orgasmic function predicted greater next‐day sadness. Conclusions These findings describe the manner in which changes in affect correspond to variations in female sexual function, thus highlighting the inextricability of mental and sexual health. Further, these findings may offer insight into the progression of normative levels of affect and sexual function as they develop into comorbid depression, anxiety, and sexual dysfunction. Kalmbach DA and Pillai V. Daily affect and female sexual function. J Sex Med 2014;11:2938–2954.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109810/1/jsm12712.pd

How Changes in Depression and Anxiety Symptoms Correspond to Variations in Female Sexual Response in a Nonclinical Sample of Young Women: A Daily Diary Study

Introduction A large body of literature supports the co‐occurrence of depression, anxiety, and sexual dysfunction. However, the manner in which affective symptoms map onto specific female sexual response indices is not well understood. Aims The present study aimed to examine changes in depression and anxiety symptoms and their correspondence to fluctuations in desire, subjective arousal, genital response, orgasmic function, and vaginal pain. Methods The study used a 2‐week daily diary approach to examine same‐day and temporal relations between affective symptoms and sexual function. Main Outcome Measures The unique relations between shared and disorder‐specific symptoms of depression and anxiety (i.e., general distress, anhedonia, and anxious arousal) and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) were examined, controlling for baseline levels of sexual distress, depression, and anxiety, as well as age effects and menstruation. Results Analyses revealed that changes in depression and anxiety severity corresponded to same‐day variations in sexual response. Specifically, anhedonia (depression‐specific symptom) was related to poorer same‐day sexual desire, whereas greater anxious arousal (anxiety‐specific symptom) was independently related to simultaneous increases in subjective sexual arousal, vaginal lubrication, and sexual pain. Increases in general distress (i.e., shared symptoms) were associated with greater same‐day difficulties achieving orgasm. Notably, only one temporal relation was found; it indicated that higher levels of anhedonia predicted a next‐day decrease in sexual desire. Conclusions It is proposed that the simultaneous changes in affective symptoms and sexual function may indicate that they are products of shared underlying mechanisms. That is, in response to stress, the processes manifesting as feelings of weak positive affect and amotivation are the very same processes responsible for diminished capacity for sexual desire. In contrast, the physiological hyperarousal associated with anxiety also gives rise to sexual arousal difficulties and vaginal pain. Kalmbach DA, Kingsberg SA, and Ciesla JA. How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: A daily diary study. J Sex Med 2014;11:2915–2927.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109992/1/jsm12692.pd

A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination

STUDY OBJECTIVES: Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. METHODS: Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. RESULTS: Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23-43% of the effect of insomnia on depression. Insomnia mediated 12%-18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. CONCLUSION: Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night

Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study

Nearly half of US adults endorse insomnia symptoms. Sleep problems increase risk for depression during stress, but the mechanisms are unclear. During high stress, individuals having difficulty falling or staying asleep may be vulnerable to cognitive intrusions after stressful events, given that the inability to sleep creates a period of unstructured and socially isolated time in bed. We investigated the unique and combined effects of insomnia symptoms and stress-induced cognitive intrusions on risk for incident depression. 1126 non-depressed US adults with no history of DSM-5 insomnia disorder completed 3 annual web-based surveys on sleep, stress, and depression. We examined whether nocturnal insomnia symptoms and stress-induced cognitive intrusions predicted depression 1y and 2y later. Finally, we compared depression-risk across four groups: non-perseverators with good sleep, non-perseverators with insomnia symptoms, perseverators with good sleep, and perseverators with insomnia symptoms. Insomnia symptoms (β = .10-.13, p \u3c .001) and cognitive intrusions (β = .19-.20, p \u3c .001) predicted depression severity 1y and 2y later. Depression incidence across 2 years was 6.2%. Perseverators with insomnia had the highest rates of depression (13.0%), whereas good sleeping non-perseverators had the lowest rates (3.3%, Relative Risk = 3.94). Perseverators with sleep latency \u3e30 m reported greater depression than good sleeping perseverators (t = 2.09, p \u3c .04). Cognitive intrusions following stress creates a depressogenic mindset, and nocturnal wakefulness may augment the effects of cognitive arousal on depression development. Poor sleepers may be especially vulnerable to cognitive intrusions when having difficulty initiating sleep. As treatable behaviors, nighttime wakefulness and cognitive arousal may be targeted to reduce risk for depression in poor sleepers

The Impact of Sleep on Female Sexual Response and Behavior: A Pilot Study

IntroductionThe etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross‐sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined.AimWe sought to examine the influence of nightly sleep duration, sleep quality, and sleep onset latency on daily female sexual response and activity.MethodsThis study used a longitudinal design to study 171 women free of antidepressants and with reliable Internet access who were recruited from a university setting in the United States. Participants first completed baseline measures in a laboratory, and then completed web‐delivered surveys at their habitual wake time for 14 consecutive days.Main Outcome MeasuresAll outcome measures were modified for daily recall. Participants completed the Profile of Female Sexual Function's desire, subjective arousal, and orgasmic functioning scales and the Female Sexual Function Index's genital arousal scale, and indicated whether they engaged in partnered sexual activity or self‐stimulation in response to dichotomous items.ResultsAnalyses revealed that longer sleep duration was related to greater next‐day sexual desire (b = 0.32, P = 0.02), and that a 1‐hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity (odds ratio = 1.14, P < 0.05). In contrast, sleeping longer predicted poorer next‐day genital arousal (b = −0.19, P < 0.01). However, results showed that women with longer average sleep duration reported better genital arousal than women with shorter average sleep length (b = 0.54, P = 0.03).ConclusionsObtaining sufficient sleep is important to the promotion of healthy sexual desire and genital response, as well as the likelihood of engaging in partnered sexual activity. These relationships were independent of daytime affect and fatigue. Future directions may investigate sleep disorders as risk factors for sexual dysfunction. Kalmbach DA, Arnedt JT, Pillai V, and Ciesla JA. The impact of sleep on female sexual response and behavior: A pilot study. J Sex Med 2015;12:1221–1232.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111751/1/jsm12858.pd

Ground-State Spaces of Frustration-Free Hamiltonians

We study the ground-state space properties for frustration-free Hamiltonians. We introduce a concept of `reduced spaces' to characterize local structures of ground-state spaces. For a many-body system, we characterize mathematical structures for the set $\Theta_k$ of all the $k$-particle reduced spaces, which with a binary operation called join forms a semilattice that can be interpreted as an abstract convex structure. The smallest nonzero elements in $\Theta_k$, called atoms, are analogs of extreme points. We study the properties of atoms in $\Theta_k$ and discuss its relationship with ground states of $k$-local frustration-free Hamiltonians. For spin-1/2 systems, we show that all the atoms in $\Theta_2$ are unique ground states of some 2-local frustration-free Hamiltonians. Moreover, we show that the elements in $\Theta_k$ may not be the join of atoms, indicating a richer structure for $\Theta_k$ beyond the convex structure. Our study of $\Theta_k$ deepens the understanding of ground-state space properties for frustration-free Hamiltonians, from a new angle of reduced spaces.Comment: 23 pages, no figur

Type-Decomposition of a Pseudo-Effect Algebra

The theory of direct decomposition of a centrally orthocomplete effect algebra into direct summands of various types utilizes the notion of a type-determining (TD) set. A pseudo-effect algebra (PEA) is a (possibly) noncommutative version of an effect algebra. In this article we develop the basic theory of centrally orthocomplete PEAs, generalize the notion of a TD set to PEAs, and show that TD sets induce decompositions of centrally orthocomplete PEAs into direct summands.Comment: 18 page

Sleep to Reduce Incident Depression Effectively (STRIDE): study protocol for a randomized controlled trial comparing stepped-care cognitive-behavioral therapy for insomnia versus sleep education control to prevent major depression

BACKGROUND: Prevention of major depressive disorder (MDD) is a public health priority. Strategies targeting individuals at elevated risk for MDD may guide effective preventive care. Insomnia is a reliable precursor to depression, preceding half of all incident and relapse cases. Thus, insomnia may serve as a useful entry point for preventing MDD. Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia, but widespread implementation is limited by a shortage of trained specialists. Innovative stepped-care approaches rooted in primary care can increase access to CBT-I and reduce rates of MDD. METHODS/DESIGN: We propose a large-scale stepped-care clinical trial in the primary care setting that utilizes a sequential, multiple assignment, randomized trial (SMART) design to determine the effectiveness of dCBT-I alone and in combination with clinician-led CBT-I for insomnia and the prevention of MDD incidence and relapse. Specifically, our care model uses digital CBT-I (dCBT-I) as a first-line intervention to increase care access and reduce the need for specialist resources. Our proposal also adds clinician-led CBT-I for patients who do not remit with first-line intervention and need a more personalized approach from specialty care. We will evaluate negative repetitive thinking as a potential treatment mechanism by which dCBT-I and CBT-I benefit insomnia and depression outcomes. DISCUSSION: This project will test a highly scalable model of sleep care in a large primary care system to determine the potential for wide dissemination and implementation to address the high volume of population need for safe and effective insomnia treatment and associated prevention of depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT03322774. Registered on October 26, 2017