Executive function and risky sexual behavior in individuals
with traumatic brain injury
Jhon Alexander Moreno, M.Sc. & Michelle McKerral, Ph.D.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) ─ Centre de réadaptation Lucie-Bruneau
Department of Psychology, Université de Montréal
Montréal (Québec) Canada
e-mail: [email protected]
Table 1. Total sample (N=89)
INTRODUCTION
Executive functions encompass a variety of higher-order abilities such
as judgment, planning, decision-making, response monitoring, insight,
and self-regulation. After a traumatic brain injury (TBI), 45% of
individuals with TBI can present difficulties in executive functioning that
can persist as long as 10 years post-injury.
Healthy controls
Variable
Mean (SD)
Mean (SD)
37.6 (10.7)
37.9 (9.7)
Education (Years)
13.0 (3.0)
12.8 (3.3)
Annual income (CAD)
31975.6
(18909.9)
39007.5
(19239.6)
Glasgow Coma Scale
-
12.5 (3.6)
Years post- injury
-
3.3 (4.3)
Note: There were no significant differences between the
groups in all of the sociodemographic variables.
Cause of the injury
OBJECTIVES
Violence
5%
METHODS
Sportsrelated
14%
Loss of consciousness
Healthy controls (N = 47)
Injury severity
Mild TBI
67%
Unknown
7%
Men
51%
Moderate
TBI
7%
No
43%
Yes
50%
Women
49%
Unknown
7%
Severe TBI
19%
Measures
Work status
Not
working
45%
1.  Dysexecutive questionnaire (DEX).
2.  The Sexual Risk Survey (SRS).
Work status
Full-time
38%
Missing
2%
Not
working
45%
Full-time
55%
Design
Correlational, exploratory, cross-sectional study.
Procedure
Part-time
17%
Participants were mailed two separate envelopes:
Part-time
15%
Relationship status
1. A consent form.
2. A package containing the questionnaires.
Relationship status
Single
45%
Single
62%
Married
11%
Each of the envelopes contained a prepaid envelope so that
the participant could return each document independently.
Widow
2%
Married
9%
Commonlaw
24%
Divorced
5%
Divorced
4%
Separated
8%
Commonlaw
30%
3
20
2
1
0
0
TBI
Healthy controls
TBI
Individuals with TBI reported significantly more dysexecutive
problems, but both groups showed similar levels of risky
sexual behavior.
There was a moderate positive correlation between risky
sexual behavior and executive function (r = .36, p < .05), with
more frequent and severe dysexecutive problems associated
with higher levels of risky sexual behavior. See also Table 2.
Risky sexual behavior was associated with number of hours
of loss of consciousness (r = .48, p < .05), but not with injury
severity (GCS score) or time since injury (p’s > .05).
1
2
3
4
5
6
7
8
Falls
10%
Work
accident
14%
p > .05
Table 2. Correlation matrix
Other
7%
To explore the relationship between risky sexual behavior and
executive function in individuals with TBI.
Women
55%
p < .01
Vehicle
accident
43%
Missing
7%
Sexual Risk Survey
4
30
Healthy controls
Thus, the relationship between risky sexual behavior and executive
function needs to be studied in individuals with TBI.
Men
45%
TBI
5
10
Executive functions are important to put in practice healthy behaviors.
Judging a situation as risky or safe can be challenging for some
individuals with TBI, and they may be involved in risky behaviors (e.g.,
smoking, risky driving, drug/alcohol use, among others).
TBI (N = 42)
DEX Questionnaire
40
Age (Years)
Risky sexual behavior can have negative consequences in terms of
sexual health. For instance, risky sexual behavior includes poor
protective behaviors (e.g., condom use), unintended pregnancies and
s e x u a l l y t r a n s m i t t e d d i s e a s e s ( S T D ’s ) , s u c h a s h u m a n
immunodeficiency virus infection and acquired immune deficiency
syndrome (HIV/AIDS).
RESULTS
ACKNOWLEDGMENTS
Special thanks to all individuals who accepted to participate in
this study.
Variable
SRT-UP
RSA
ISA
IE-RSB
RASA
DEXBEH
DEXCOG
DEXEMO
1
.26
.69**
.70**
.11
.45**
.46**
.38*
2
3
.23
.12
.60**
.01
-.02
-.12
.73**
.01
.38*
.32*
.29
4
5
6
7
.03
.26 -.17
.37* -.06 .72** .32* -.20 .52** .53**
Note: *p < .05; **p < .01. Abbreviations: SRT-UP, sexual risk taking with
uncommitted partners; RSA, risky sex acts; ISA, impulsive sexual acts; IERSB, intent to engage in risky sexual behaviors; RASA, risky anal sexual
acts; DEXBEH, Behavior subscale of the DEX; DEXCOG, Cognition
subscale of the DEX; DEXEMO, Emotion subscale of the DEX.
CONCLUSIONS
•  To our knowledge, this study is the first to examine the
relationships between risky sexual behavior and the presence
of reported dysexecutive problems post-TBI.
•  Our findings imply that TBI individuals with dysexecutive
problems could present a co-occurrence of risky sexual
behavior.
•  Given the high frequency of executive problems post-TBI and
their repercussion in everyday living, the association between
executive function and risky sexual behavior suggest that
special attention should be given to individuals with TBI
showing difficulties in executive functions in terms of
evaluation and interventions that could have a favorable
impact on the prevention and remediation of risky behaviors
in the sexuality domain.
•  Education about risky sexual behavior needs to be included in
rehabilitation, independently of injury severity or time since
injury.
•  Since individuals with TBI with more dysexecutive
symptomatology show higher risky sexual behavior, cognitive
rehabilitation of executive functions could also help to
promote healthy behaviors.