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Depressed Teens at Higher Risk for Pregnancy, STDs

They're more likely to forego condoms or contraceptives, study finds

THURSDAY, July 6, 2006 (HealthDay News) -- Depression can help prompt sexually active teens to engage in risky sexual behavior such as not using condoms or contraceptives, a new survey shows.

The study raises concerns about the sexual habits of millions of American adolescents, as an estimated 15 percent to 20 percent of teenagers in the United States are believed to experience major depression at some point in their pre-college years, according to the study's authors.

Depressed, sexually active teens "have a greater likelihood of engaging in behaviors that increase their risk of HIV, other sexually transmitted infections, and unintended pregnancy," concluded study lead author Jocelyn Lehrer, a senior research associate with the Bixby Center for Reproductive Health Research and Policy at the University of California, San Francisco.

Her team published its findings in the July issue of Pediatrics.

The UCSF group gathered data from in-person interviews conducted with middle- or high-school students across the United States during 1995 and 1996. The 1995 interview was focused on depression, while the follow-up interview a year later tracked each student's sexual behaviors over the preceding year.

All of those interviewed said they had experienced sexual intercourse prior to the first interview, and none were married by the time the follow-up interview took place.

In all, 1,921 boys and 2,231 girls were included in the current analysis, most of whom were non-Hispanic whites.

According to the researchers, more than 9 percent of the boys and nearly 16 percent of the girls displayed symptoms reflecting a "high" level of depression during their initial interview.

Lehrer and her colleagues also found that the more depressed the teens were at the start of the year, the more likely they were to engage in risky sexual behaviors later on. This observation held true for both boys and girls.

Boys who rated higher on a clinical scale of depression were more likely to say they had not used a condom or birth control the last time they had sex. As well, the more depressed the boy, the more likely he was to have consumed alcohol or drugs the last time he had sex.

Girls with higher depression scores were also more likely to say that they had not used a condom or birth control the last time they had sex. These girls were also more likely to indicate that they had had three or more sexual partners in the past year.

In absolute terms, "highly" depressed boys and girls were over 70 percent and 50 percent more likely to have engaged in at least one risky sexual behavior over the prior year, respectively, when compared with the least-depressed boys and girls.

Lehrer cited many factors that could account for the observed association.

"Youth who are both emotionally distressed and socially isolated may be more likely to seek or be successfully pressured into sexual activity, in the name of some kind of shared intimacy, or to maintain relationships that they value," she said.

"Youth who are depressed may also be less confident in their ability to engage in self-protective behaviors, such as refusing pressure to have sex, discussing condom use with their partner, using condoms, and refusing substance use," Lehrer said.

Depression can also lead a teen to want to harm him or herself by taking sexual risks, she added.

Lehrer urged parents and health-care providers to be on the lookout for teen depression, to provide young people with emotional support when needed, and to counsel them against engaging in risky sexual behaviors.

Professor Freya Sonenstein, director of the Center for Adolescent Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said the authors focused solely on sexually active teens -- thereby side-stepping the notion that teen sex of any kind might be considered risky by some.

But the "big story" here is not so much adolescent sexual risk-taking, she said, as it is the high prevalence of mental health woes among American teens.

"There is still a fair amount of stigma around mental health services," Sonenstein said, "and what this study points out is that mental health is part of the complex of risky behaviors and characteristics that kids have. And so, if kids are depressed, they are less likely to protect themselves sexually."

More information

For more on teens and depression, check out the Helpguide: Mental Health Issues.

SOURCES: Jocelyn Lehrer, senior research associate, Bixby Center for Reproductive Health Research and Policy, University of California at San Francisco; Freya Sonenstein, Ph.D., professor and director, Center for Adolescent Health, Johns Hopkins Bloomberg School of Public Health, Baltimore; July 2006 Pediatrics
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