Sexual risk-taking & mental health issues in adolescent females – an urgent call to action

Dianne Morrison-Beedy, PhD, RN, FNAP, FAANP, FAAN and Bernadette Melnyk, PhD, APRN-CNP, FNAP, FAANP, FAAN, issue an urgent call to action when it comes to combatting sexual risk-taking and mental health issues in adolescent females

Sexual risk-taking morbidities and mental health disorders are major public health epidemics adversely affecting the overall health and well-being of adolescent girls. Adolescence and the emerging adult years is a developmental period characterised by increased experimentation, risk-taking and evolving sexuality. It also is the time when mental health disorders often emerge, particularly anxiety and depression.

Sexual risk taking

Adverse consequences of sexual risk-taking behaviours, which often disproportionably impact females in this age group, include unplanned pregnancy, sexually transmitted infections (STIs) and HIV. Alarmingly, although teens account for only one-fourth of sexually active persons, they represent one-half of all STI diagnoses each year (Centers for Disease Control and Prevention, 2019). Teen pregnancies are still a major health issue that comes with a steep price tag costing billions of dollars every year. They are also a leading reason for girls leaving school often leading to un- or under-employment. Although great strides have been made with treatments helping move AIDS to a more chronic, versus acute, disease entity, worldwide young females still predominate heterosexually-acquired cases of HIV with women of colour being disproportionately impacted (Seth et al., 2011).

Mental health issues

To compound this issue, mental health disorders (for example, depression and anxiety) are on an alarming rise in this age group and are predictive of unhealthy behaviours, including sexual risk-taking (World Health Organization, 2020). Mental health issues are over-whelming this age group and by mid-adolescence, girls are twice as likely to be diagnosed with a mood disorder when compared to boys of the same age (Huang, Nigatu, Smail-Crevier, Zhang, & Wang, 2018).

Depression affects 20% of female adolescents, twice the male prevalence, and is the primary risk factor for suicide – the second leading cause of death in 10-34-year-olds (Centers for Disease Control and Prevention, 2021). Despite the high prevalence of mental health disorders in adolescents, less than one in four receive treatment due to the lack of mental health providers, inadequate screening practices, and stigma associated with these disorders (Fitzpatrick, Darcy, & Vierhile, 2017). Disparities are overwhelming with the burden of untreated mental health disability being heaviest among minority populations (Bailey, Mokonogho, & Kumar, 2019).

Research has demonstrated that certain conditions, such as depression, anxiety and stress are predictive of risky sexual behaviours, including having unprotected sex, multiple partners and using protection inconsistently (Hagedorn & Olfert, 2018; Norris et al., 2019). In adolescents with significant emotional distress at baseline, the frequency of participation in risky sexual behaviours, including unprotected and non-monogamous sex, were highly elevated compared to those without such distress (Hops et al., 2011). Following their longitudinal study identifying correlations between mental health and risky sex in black adolescents, Foley et al. (2019) recommended interventions should focus on mood and self-efficacy to enhance safer sex practices.

Health promotion and prevention

Unfortunately, healthcare systems across the globe are still focused on sick and crisis care instead of health promotion and prevention. Sexual risk-taking and mental health problems are two major public health epidemics that lack prevention and evidence-based intervention approaches that address these issues as intertwined, not separate, and unrelated issues. Despite studies that have examined interventions that address multiple risk behaviours, most multicomponent interventions target substance use; none have been identified that target both mental health and sexual risk outcomes in teens.

Given the high prevalence of mental health disorders in this age group, it seems plausible that addressing both depressive and anxiety symptoms are critical to ensure maximum efficacy of evidence-based sexual risk reduction interventions for adolescent girls. Much work is needed to combine current evidence-based interventions targeting single risk behaviours into more integrated programs that can address inter-related health challenges in teens. Only then, will we improve population health outcomes for this vulnerable group of adolescents and emerging adults.

References

1. Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: Current perspectives. Neuropsychiatric Disease and Treatment, 15, 603-609. doi:10.2147/NDT.S128584.
2. Centers for Disease Control and Prevention. (2017). HIV surveillance report 2016. Retrieved from https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
3. Centers for Disease Control and Prevention. (2019). Sexually transmitted disease surveillance 2018. Atlanta: U.S. Department of Health and Human Services. Retrieved from https://www.cdc.gov/std/stats18/STDSurveillance2018-full-report.pdf
4. Fitzpatrick, K. K., Darcy, A., & Vierhile, M. (2017). Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (woebot): A randomized controlled trial. JMIR Mental Health, 4(2), e19.
5. Foley, J. D., Vanable, P. A., Brown, L. K., Carey, M. P., DiClemente, R. J., Romer, D., & Valois, R. F. (2019). Depressive symptoms as a longitudinal predictor of sexual risk behaviors among African American adolescents. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 38(11), 1001-1009. doi:10.1037/hea0000780 [doi].
6. Hagedorn, R. L., & Olfert, M. D. (2018). Food insecurity and behavioral characteristics for academic success in young adults attending an Appalachian University. Nutrients, 10(3), 361. doi: 10.3390/nu10030361. doi:10.3390/nu10030361 [doi].
7. Hops, H., Ozechowski, T. J., Waldron, H. B., Davis, B., Turner, C. W., Brody, J. L., & Barrera, M. (2011). Adolescent health-risk sexual behaviors: Effects of a drug abuse intervention. AIDS and Behavior, 15(8), 1664-1676. doi:10.1007/s10461-011-0019-7 [doi].
8. Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., & Wang, J. (2018). Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 107, 1-10.
9. Norris, A. L., Rich, C., Krieger, N., Guthrie, K. M., Kaplan, C., Carey, K. B., & Carey, M. P. (2019). Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic. BMC Women’s Health, 19(1), 15. doi:10.1186/s12905-019-0709-2.
10. Seth, P., Patel, S. N., Sales, J. M., DiClemente, R. J., Wingood, G. M., & Rose, E. S. (2011). The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents. Psychology, Health & Medicine, 16(3), 346-356.
11. World Health Organization. (2020). Adolescent mental health fact sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health