| Summary: | <p><strong>Systematic Literature Review</strong></p>
<p><strong>Background:</strong> There has been a significant rise in cosmetic surgery (CS) over the last two decades, including female genital cosmetic surgery (FGCS). There is ethical complexity in distinguishing FGCS and Female Genital Mutilation (FGM), an illegal practice in many countries, including the UK. This novel review aims to explore psychological factors associated with FGCS including body dysmorphic disorder (BDD). Screening for BDD is recommended in CS clinics1 as it is considered a contraindication for CS.</p>
<p><strong>Objective:</strong> The aim of this systematic review is to synthesise studies reporting psychological factors associated with FGCS in adult women.</p>
<p><strong>Method:</strong> A search of six databases (PsycINFO, MEDLINE, PubMed, Scopus, Cochrane and EMBASE) was conducted in addition to hand-searching reference lists in November and December 2022 and updated in February 2024. Eligible studies were published in English at any time in any country, employ any quantitative design and have adult cisgender female participants seeking or undergoing FGCS. Studies were assessed for quality and risk of bias using the QualSyst2 checklist.</p>
<p><strong>Results:</strong> The search strategy identified 21 studies that met inclusion criteria conducted in nine countries. There were 1,507 participants across all studies, including control participants. The most common psychological motivator was genital appearance dissatisfaction (GAD). Psychological outcomes included variable changes in GAD, self-esteem, body image and BDD symptoms, and some studies were at high risk of bias.</p>
<p><strong>Conclusion:</strong> The research has not yet identified clear and consistent outcomes of FGCS on women’s psychological health and body image. Significant ethical concerns remain regarding the definitions of FGCS and FGM. Limitations of the reviewed papers, as well as clinical and methodological implications, are discussed.</p>
<p><strong>Funding:</strong> This study was not funded.</p>
<p><strong>Registration:</strong> The protocol was registered on PROSPERO (CRD42022349763).</p></br>
<p><strong>Service Improvement Project</strong></p>
<p><strong>Background:</strong> Annually, Talking Therapies (TT) services treat over half a million people experiencing depression and anxiety. Around 40% of people with depression and anxiety experience a long-term physical health condition (LTC) including chronic pain (CP). Approximately 70% of people with a LTC will experience anxiety and/or depression (NHS England and NHS Improvement, 2018). Recovery rates for people with CP are consistently significantly lower than for those without CP. In Berkshire TT (BTT) in 2021, the recovery rate for people with CP was 36%.</p>
<p><strong>Aims:</strong> This study aimed to explore factors that contributed to the lower recovery rates and to make recommendations for improving recovery rates.</p>
<p><strong>Methods:</strong> The mixed methods study investigated whether demographic and clinical variables predicted recovery group. Twelve semi-structured interviews with discharged BTT patients explored their experiences and recovery status. Interviews were recorded, transcribed and analysed using thematic analysis.</p>
<p><strong>Results:</strong> The quantitative analysis indicated that initial depression and anxiety scores predicted recovery group. Additional predictive variables included age at referral, treatment duration, number of treatment episodes and risk. The qualitative analysis yielded three superordinate themes: (1) pain is misunderstood, (2) the therapist is influential on patients’ experiences of BTT and their recovery, and (3) the service offered impacts experience and recovery.</p>
<p><strong>Conclusion:</strong> Recovery appears to be influenced by various factors, including initial depression and anxiety scores, age, and experiences of therapists and the service. Recommendations include staff training, including pain in assessments and linking with local pain services.</p></br>
<p><strong>Theory-Driven Research Project</strong></p>
<p>Chronic pain (CP) is defined as pain that lasts for more than three months. Fibromyalgia (FMS) is a chronic pain condition characterised by widespread pain, fatigue and cognitive difficulties (CDs). Both CP and FMS can have a far-reaching impact, although symptoms are highly variable between individuals. Research suggests that cognitive-behavioural factors such as mental defeat, health anxiety, catastrophising and negative beliefs can distinguish people with CP from those without, but this has not been compared in two distinct pain presentations: CP and FMS.</p>
<p>A total of 109 participants across three groups (32 fibromyalgia, 25 chronic pain recruited in clinical settings) and 52 community controls completed an online questionnaire evaluating mental defeat, health anxiety, catastrophising (pain, fatigue and CDs) and negative beliefs (fatigue and CDs).</p>
<p>Participants with FMS scored significantly higher on health anxiety, pain catastrophising), fatigue catastrophising and CD catastrophising and had more negative beliefs about CDs than participants with CP and controls. There was no significant difference in mental defeat across the groups. There were no significant differences in any variables between CP and control groups. Functional impairment was associated with pain severity and pain self-efficacy. Pain interference was associated with pain self-efficacy, pain severity and pain catastrophising. Fatigue was not predicted by any variable.</p>
<p>People with FMS experience significantly greater health anxiety, catastrophising and had more negative beliefs than people with CP and without pain conditions. Implications for clinical practice include considering screening for these variables in pain clinics. Further research is required.</p>
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