Introduction Among men with diabetes, little attention has been given to premature ejaculation (PE), reduced libido, and their associations with erectile dysfunction (ED), despite the presence of physical and psychologic factors that could predispose to all three. Aim To estimate the prevalence and inter-associations of ED, PE, and reduced libido among diabetic men and to describe the associated clinical, socioeconomic, and lifestyle parameters. Methods Cross-sectional observational study of 253 men with type 2 diabetes randomly selected from a clinic in Colombo, Sri Lanka. Main Outcome Measures Erectile function was assessed using the five-item version of the International Index of Erectile Function scale. The presence of PE, reduced libido, sociodemographic, and lifestyle data was obtained using an interviewer-administered questionnaire. Clinical data were obtained from relevant physical examination, patient records, and laboratory tests, which included glycosylated hemoglobin, serum cholesterol, serum creatinine, and electrocardiogram. Results One hundred and eighty-five (73.1%) of the individuals had some degree of ED, while 84 (33.2%) had severe to complete ED. After excluding men with complete ED, the prevalence of PE was 68 (40.2%). The overall prevalence of reduced libido was 64 (25%). In the multivariate analysis, the strongest associations with ED were PE (odds ratio [OR] = 4.41, 95% confidence interval [CI] = 2.08–9.39) and reduced libido (OR = 4.38, CI = 1.39–13.82) followed by lower income (OR = 2.16, CI = 1.32–3.52), advancing age (OR = 2.06, CI = 1.44–2.95), and duration of diabetes (OR = 1.48, CI = 1.09–2.01). In addition, ED was univariately associated with lower educational level (P = 0.05), the presence of hypertension (P = 0.005), and no alcohol intake (P = 0.001). The only significant association of PE was the severity grade of ED. Associations of reduced libido in the multivariate analysis were ED (OR=1.61, CI = 1.23–2.70), advancing age (OR = 1.7, CI = 1.4–2.2), and absence of masturbation (OR = 3.3, CI = 1.2–8.8). Conclusions ED was strongly associated with PE and reduced libido. Diabetic patients presenting with one of these three conditions should be screened for the other two.

BackgroundExposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women’s experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war.MethodWe conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis.ResultsParticipants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women’s fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports.ImplicationsThese findings revealed the need for more research about IPV in post-war contexts. Women’s experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women’s experiences of IPV- and community responses to it—is needed to develop more comprehensive solutions that are relevant to the local context.

Aim As the population ages, mental health issues among the elderly are becoming a major concern worldwide, including in Sri Lanka. With rapid globalization, the coping and adapting skills of elderly individuals are tested, potentially revealing predisposition to psychological disturbances. Previous studies have indicated a higher risk of depression among the elderly. The current study attempts to quantify the prevalence and associated factors of depression in a highly urbanized setting within Sri Lanka. Methods A community‐based, cross‐sectional analytical study was carried out in the urban areas of Colombo District. The subjects were young elders (60–74 years) who permanently reside in the area. Depression was assessed by the item Geriatric Depression Scale Sinhalese version (cut‐off score ≥8) among 1283 subjects. Logistic regression analysis was used to assess the association of depression with sociodemographic and health‐related variables. Results The prevalence of depression in the sample was 13.9% (mild depression: 11.2%; moderate to severe depression: 2.7%). Among the sociodemographic predictors, female sex (odds ratio (OR) = 10.60), being 60–64 years old (OR = 1.61), being unmarried, separated, divorced, or widowed (OR = 3.73), income ≤20 000 Sri Lankan rupees (OR = 2.27), and perceived financial burden (OR = 3.15) were significantly associated with clinically significant depression. Among the health‐related variables, smoking (OR = 2.18), alcohol use (OR = 7.58), presence of chronic disease (OR = 1.51), limitation in performing one or more instrumental activities of daily living (OR = 1.73), unsatisfactory partner relationship (OR = 2.94), perceived inadequate social support (OR = 2.47), experiencing abuse (OR = 3.90), and experiencing major life events (OR = 2.11) were significantly related with depression. Conclusion Depression is an important issue among the elderly living in an urbanized environment in Sri Lanka.

Erectile dysfunction was a strong predictor of poor generic and disease-specific quality of life among other sexual and clinical variables in men with diabetes.

Sri Lanka has the one of highest rates of suicide. Important factors associated with suicide were determined via the psychological autopsy approach (which had not been carried out previously in Sri Lanka). Over a 3-month period, in a catchment area, 31 suicides among Sinhalese were identified and 27 were investigated. Males were more likely to commit suicide and alcohol abuse and domestic violence were reported as contributory factors. We found it possible to use psychological autopsy methods to obtain information which can inform planned prevention measures.