Depression, suicidal ideation, and risky sexual behavior among U.S. adolescents

Abstract

<bold>Background<bold> Depressive disorders affect 11% of the U.S. adolescent population, and suicide is the second leading cause of death among adolescents. The prevalence of sexually transmitted infections (STI) among U.S. adolescents ranges from 14-43.9%, and while rates of adolescent pregnancy have declined in the U.S. in the last decade, the U.S. rates are still high relative to other developed countries. There are currently no studies that examine the association between depression, suicidality, and risky sexual behavior (RSB) among adolescents. Using national data from the CDC's 2009 and 2011 Youth Risk Behavior Surveys (YRBS), our objectives were to: determine if adolescents who are depressed and suicidal are more likely to engage in risky sexual behavior than those without depression and those with depression without suicidal behaviors. <bold> Methods </bold> Participants in this cross-sectional study were adolescent YRBS respondents in grades 9-12 who were sexually active (N=12,311). Depression was measured through a single question, (“During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?”). Depression with suicidality was measured as a positive response to the question regarding depression, plus a positive response to one or more of the three questions about suicidality (“During the past 12 months, did you ever seriously [consider/plan/attempt] suicide?”), and analyzed as a trichotomous variable. RSB was assessed using binary variables for each behavior: condom nonuse, birth control nonuse, drug/alcohol use at last sexual intercourse, or having had 4+ sexual partners. An additional dichotomous variable was created to examine the odds of engaging in any RSB. Logistic regression was conducted to determine the association between depression, suicidality, and RSB, and results were stratified by gender. Participants who were not sexually active (N=16,994) or missing information on depression/suicidality status or RSB (N=2,409) were excluded from analysis. <bold>Results</bold> Depressive symptoms were reported by 44.0% of sexually active girls and 25.5% of sexually active boys, and suicidal ideation was reported by 27.1% of girls and 18.0% of boys. Sixty-two percent of sexually active boys and girls engaged in at least one risky sexual behavior. Boys who were depressed and suicidal were 1.63 (95% CI: 1.22-2.18) times more likely to engage in risky behavior as those who were depressed only. They were 2.35 (95% CI: 1.81-3.05) times more likely to have not used a condom the last time they had sex, 2.39 (95% CI: 1.81-3.16) times more likely not to have used birth control, and 2.02 (95% CI: 1.36-2.49) times more likely to have used alcohol or drugs the last time they had sex, compared to boys who were depressed only. Girls who were depressed and suicidal were 1.49 (95% CI: 1.20-1.84) times more likely to engage in risky behavior as those who were depressed only. They were 1.39 (95% CI: 1.15-1.70) times more likely to have not used a condom the last time they had sex, 1.44 (95% CI: 1.17-1.76) times more likely not to have used birth control, and 1.42 (95% CI: 1.13-1.75) times more likely to have had 4+ sexual partners, compared to girls who were depressed only. Eighty-one percent of boys who reported binge-drinking reported engaging in at least one RSB, compared to 56.6% of boys who were not binge-drinkers, and 76.8% of girls who reported binge-drinking reported engaging in at least one RSB, compared to 57.0% of girls who were not binge-drinkers. <bold>Conclusion</bold> Adolescents who are depressed and suicidal are at increased odds for engaging in RSB. Although causality cannot be established, involvement in any RSB is cause for concern and should be part of the clinical assessment of depression and suicidality among adolescent boys and girls.