Love hurts (in more ways than one): specificity of psychological symptoms as predictors and consequences of romantic activity among early adolescent girls

Developmental pathway for first onset of depressive disorders in females: from adolescence to emerging adulthood

BACKGROUND

Although risk markers for depressive disorders (DD) are dynamic, especially during adolescence, few studies have examined how change in risk levels during adolescence predict DD onset during transition to adulthood. We compared two competing hypotheses of the dynamic effects of risk. The risk escalation hypothesis posits that worsening of risk predicts DD onset beyond risk level. The chronic risk hypothesis posits that persistently elevated risk level, rather than risk change, predicts DD onset.

METHODS

Our sample included 393 girls (baseline age 13.5-15.5 years) from the adolescent development of emotions and personality traits project. Participants underwent five diagnostic interviews and assessments of risk markers for DD at 9-month intervals and were re-interviewed at a 6-year follow-up. We focused on 17 well-established risk markers. For each risk marker, we examined the prospective effects of risk level and change on first DD onset at wave six, estimated by growth curve modeling using data from the first five waves.

RESULTS

For 13 of the 17 depression risk markers, elevated levels of risk during adolescence, but not change in risk, predicted first DD onset during transition to adulthood, supporting the chronic risk hypothesis. Minimal evidence was found for the risk escalation hypothesis.

CONCLUSIONS

Participants who had a first DD onset during transition to adulthood have exhibited elevated levels of risk throughout adolescence. Researchers and practitioners should administer multiple assessments and focus on persistently elevated levels of risk to identify individuals who are most likely to develop DD and to provide targeted DD prevention.

Patterns of life stress and the development of ruminative brooding in adolescence: A person-centered approach

Research links life stressors, including acute, chronic, and early life stress, to the development of ruminative brooding. However, singular forms of life stress rarely occur in isolation, as adolescents typically encounter stressors that vary on important dimensions (e.g., types, timings, quantities) across development. The current study employs latent profile analysis (LPA) to identify natural clusters of life stress that, over time, may be differently associated with ruminative brooding. Evaluations of episodic, chronic, and early life stress were conducted with community-recruited mid-adolescents (N = 241, Mage = 15.90 years, 53% female) and their parents using the UCLA Life Stress Interview and lifetime adversity portions of the Youth Life Stress Interview. Analyses identified four distinct patterns: low stress, high peer stress, moderate home / family stress, and multifaceted / high school stress. Adolescents in the high peer stress and moderate home / family stress profiles were at highest risk for developing a brooding style over time. Despite high overall levels of stress, teens in the multifaceted / high school stress profile were at not at elevated risk for developing a brooding style. Findings demonstrate the utility of person-centered approaches to identify patterns of stress exposure that heighten risk for brooding over time.

Associations among relationship status, gender, and sexual attraction in Australian adolescents' eating pathology

OBJECTIVE

Engaging in romantic relationships in adolescence may inadvertently increase participation in appearance culture and the risk for eating pathology. Little research has considered this effect, particularly as it relates to adolescents' gender identity and sexual attraction. Therefore, this study examined the associations among relationship status, gender, and sexual attraction in adolescents' eating pathology.

METHODS

Data from the first wave of the EveryBODY study, a large sample of Australian adolescents aged 11-19 years (n = 3262, M_age  = 15.00, 53.80% girls), were used. Participants reported their relationship status and eating pathology (fasting, purging, binge eating, driven exercise, steroid use, and shape/weight concerns) using an online survey.

RESULTS

Logistic regressions adjusting for age and BMI percentile revealed that romantic relationships were associated with higher adjusted odds (AORs) for reporting clinical frequency/severity threshold of fasting, purging, steroid use, and shape and weight concerns (AORs: 1.34-3.68). Relative to boys, girls had higher adjusted odds of reporting clinical frequency/severity threshold of all eating disorder features (AORs: 1.47-7.40), except for steroid use for muscle gain. Adolescents who reported same-sex attraction, were unsure of their sexual attraction, or did not endorse any sexual attraction had greater adjusted odds of reporting clinical frequency/severity threshold of fasting, purging, and shape and weight concerns (AORs: 1.35-1.83) than those with only other-sex sexual attraction. Interactions among relationship status, gender, and sexual attraction were nonsignificant.

CONCLUSIONS

Romantic experience emerged as a novel correlate for adolescents' eating pathology. Future research should uncover the contextual factors within relationships that may contribute to this association.

PUBLIC SIGNIFICANCE

The initiation of romantic relationships is normative during adolescence. However, adolescents' romantic desirability is often determined by their physical appearance, increasing the risk for eating pathology. Among a large sample of Australian adolescents, romantic involvement was associated with greater likelihood of clinical threshold eating pathology for adolescent boys and girls, regardless of sexual attraction. It is urgent to identify the factors within romantic relationships that are associated with eating pathology.

Reducing Health Effects on Deceit in Heterosexual Sexual-Affective Relationships: The Impact of the Preventive Socialization Program (PSP)

Background: Health research has provided robust evidence of the negative effects caused by facing deceit in sexual-affective relationships. In this regard, several analyses have been conducted addressing psychological, family therapies, and educational interventions to improve marital problems. On the other hand, many investigations have addressed how the preventive socialization program (PSP), framed on the analysis of a dominant coercive discourse that is connected with the promotion of specific traditional masculine models, impacts on young people’s relationships free of violence. However, the link between deceit, health, and the PSP has not yet been analyzed. To cover this gap, a qualitative study has been performed with a methodology framed on the communicative approach. We enrolled heterosexual women and men aged 25 to 42 years old who have been in contact with the PSP and have experienced or know of any cases of deceit. Two different analytical categories emerged from the analysis, which distinguishes between exclusionary and transformative dimensions. Findings show that the majority of people involved in PSP were able to understand the reasons for deceit as well as to take decisions in their further sexual-affective relationships. Therefore, this study corroborates that access to scientific evidence in the framework of PSP is positively impacting interviewees’ health status.

Distinguishing Transdiagnostic versus Disorder-Specific Pathways between Ruminative Brooding and Internalizing Psychopathology in Adolescents: A Latent Variable Modeling Approach

Rumination is correlated with diverse types of internalizing problems, but the extent to which it relates to a higher-order internalizing spectrum versus disorder-specific pathology is unclear. Using a quantitative model of the internalizing dimension, we compared the strength of transdiagnostic versus diagnosis-specific pathways from brooding-the most depressogenic component of rumination-to major depressive disorder (MDD) in adolescents. Community-recruited mid-adolescents (N = 241, M_age = 15.90 years, 53% female) completed semi-structured interviews of anxiety and depressive conditions and a self-report brooding measure. Confirmatory factor analysis revealed good fit for a one-factor model of internalizing conditions. Results revealed a large, significant factor correlation between brooding and the internalizing factor (r = 0.55), with some evidence for a more modest specific link between brooding and the unique component of the MDD diagnosis (r = 0.17; approximately one-third as large as the transdiagnostic pathway). These cross-sectional associations were generally consistent across two assessment waves separated by 19 months. We concluded that brooding is better conceptualized as a common characteristic of all internalizing problems in adolescence, rather than a specific feature of MDD. Preregistered hypotheses, data analysis code, and correlation matrices for this study are posted at https://osf.io/dax7u/ .

Exploring the associations between middle adolescent romantic activity and positive youth development

INTRODUCTION

Although prior research has demonstrated romantic involvement can negatively impact adolescent well-being, it may also provide a context for developing characteristics of positive youth development (PYD). The present study explored the associations between adolescent romantic involvement and PYD. Study aim-1 determined if participation in different romantic activities was associated with PYD. Study aim-2 specifically focused on adolescents in romantic relationships, testing if relationship quality was associated with PYD.

METHODS

The study was a secondary analysis of cross-sectional data from the age-15 assessment of the NICHD Study of Early Child Care and Youth Development. Study aim-1 used data from 826 15-year-olds (50% female) who reported their romantic socializing, dating, and relationship involvement. Study aim-2 used data from 190 15-year-olds (52% female) in romantic relationships who reported positive and negative interactions in their relationships. For both study aims, PYD was assessed as psychosocial maturity, peer competence, and school bonding.

RESULTS

Based on hierarchical regression models, romantic socializing was positively associated with psychosocial maturity, peer competence, and school bonding; dating was positively associated with peer competence and school bonding; and relationship involvement was negatively associated with psychosocial maturity and school bonding. In terms of relationship quality, only one significant association emerged such that positive interactions were positively associated with peer competence.

CONCLUSIONS

Overall, results supported the expectation that romantic involvement is associated with PYD during middle adolescence. However, the potential benefits of romantic involvement may be limited to the on-time romantic activities of romantic socializing and dating.

Emotions relating to romantic love-further disruptors of adolescent sleep

OBJECTIVE

Early-stage romantic involvement may resemble hypomania in its manifestation on behavioral, physiological, and psychological levels. Previous research suggests that self-reported sleep duration may diminish as a result of falling in love during adolescence. We investigated how feelings of infatuation are related to subjective and objective measures of sleep duration, quality, and timing.

METHODS

1374 adolescents (66% girls; mean age: 16.9, SD=0.6 years) selected from the population register responded to online questionnaires regarding romantic love, mental well-being, and sleep behavior. A subsample (n=309) underwent a week-long actigraphy measurement (GENEActiv Original). We compared the sleep duration, quality, and timing of those who reported being in the early stages of love to those who were not.

RESULTS

11% of all participants reported being in the early stages of romantic love. Those girls and boys who were in love had higher scores of depression and anxiety than others. Girls who were in love reported poorer sleep quality, later sleep timing, and shorter sleep duration both on weekdays (mean difference: 32 minutes, p≤0.001) and at weekends (15 minutes, p=0.037) than those who were not in love. Actigraphy measurements were similar (sleep duration mean difference: 27 minutes, p=0.04).

CONCLUSIONS

We conclude that romantic love is one further cause for short or poor quality sleep in girls and may relate to symptoms of depression and anxiety in both sexes. However, feelings of infatuation contain important developmental lessons.

Prevalence of Romantic Experiences and Competencies Among 14 to 17 Year Olds: Implications for the Primary Care Setting

Using data from 600 adolescents (14-17 years old) from the 2015 National Survey of Sexual Health and Behavior, we examined the prevalence and demographic correlates of adolescents' romantic activities (ie, group dating, dyadic dating, and relationship involvement) and their confidence in avoiding unwanted romantic experiences. Overall, 55.8% of adolescents had engaged in at least one romantic activity. More adolescents reported having gone on dyadic (42.1%) and group (37.3%) dates than had been involved in romantic relationships (32.9%). Age and gender were the most consistent correlates of each romantic activity. Each type of romantic activity becomes more common as adolescents mature. Female adolescents were less likely to report romantic activities. Approximately 25.7% of adolescents were not confident that they could turn down unwanted dates, and 34.3% were not confident that they could end a relationship they no longer wanted to be in. Clinicians can draw on our results when discussing romantic development with their adolescent patients.

Longitudinal Associations of the Attainment of Developmental Tasks With Psychological Symptoms in Adolescence: A Meta-Analysis

The present meta-analysis integrates results from 310 longitudinal studies on associations of the attainment of 10 developmental tasks with psychological symptoms (e.g., internalizing or externalizing symptoms, anxiety, and depression). Higher initial success with getting access to a peer group, building friendships, preparing for a future career, body acceptance, as well as developing a personal identity, a value system, and socially responsible behavior predicted lower levels of symptoms at follow-up and stronger declines of symptoms over time when controlling for initial symptom levels. Furthermore, higher initial symptom levels predicted lower attainment of these tasks at follow-up as well as lower progress in task attainment. In contrast, more initial romantic/sexual involvement predicted an increase in symptoms over time, while higher initial symptoms were related to an increase in romantic/sexual involvement. Associations with autonomy varied between different forms of autonomy, while acquisition of a gender role was not related with psychological symptoms.

Serotonergic multilocus genetic variation moderates the association between major interpersonal stress and adolescent depressive symptoms: Replication and candidate environment specification

Serotonin-linked genetic risk and stressful life event (SLE) interaction research has been criticized for using single genetic variants with inconsistent replicability. A recent study showed that a multilocus genetic profile score (MGPS) capturing additive risk from five serotonin-linked polymorphisms moderated the association between major interpersonal SLEs and depression, but no subsequent replication attempts have been reported. Moreover, major interpersonal SLEs have been suggested as "candidate environments" for this MGPS, but it has never been demonstrated that gene-environment interactions (G × Es) for major interpersonal SLEs are significantly stronger than for other contexts. Adolescents (N = 241) completed contextual-threat life stress interviews and clinical interviews assessing depressive symptoms, and provided DNA. MGPS intensified the major interpersonal stress-depression association; the interaction accounted for 4% of depressive symptom variance. Genetic moderation was statistically unique to major interpersonal stress versus other environments. Extending previous findings, results support an MGPS approach and underscore the cruciality of the G × E candidate environment.

Childhood adversity moderates the influence of proximal episodic stress on the cortisol awakening response and depressive symptoms in adolescents

Childhood adversity (CA) is known to predict sensitization to proximal stressors. Researchers have suggested that disruptions in hypothalamus-pituitary-adrenal axis functioning may be a biological mechanism. If so, CA may predict altered associations between proximal life stress and markers of cortisol secretion. We examined whether CA moderates associations between recent episodic stress and (a) the cortisol awakening response (CAR), and (b) depressive symptoms, in 241 adolescents aged 14-17 years (cortisol n = 196). Salivary cortisol was sampled at 0, 30, and 60 min postawakening for 2 days. The CAR was calculated as the area under the curve with respect to increase and waking cortisol. CA and episodic stress were assessed using contextual-threat-method-coded objective interviews. CA significantly interacted with episodic stress to predict both the CAR and depression. Among those with low CA, episodic stress predicted increased CAR but did not predict depression. For adolescents with high CA, episodic stress predicted lower CAR and higher depression. These interactions were found only for independent (uncontrollable, fateful) events, and not for dependent (self-generated) stress. Increased allostatic load resulting from CA exposure may interfere with adolescents' ability to optimally regulate their CAR in relation to recent stress, contributing to increased depression risk.

Long-Term Risks and Possible Benefits Associated with Late Adolescent Romantic Relationship Quality

Adolescent romantic relationships have the potential to affect psychological functioning well into adulthood. This study assessed adolescent romantic relationship qualities as long-term predictors of psychological functioning utilizing a longitudinal multi-method, multi-informant study of 80 participants (59% female; 54% Caucasian, 35% African American, 11% mixed or other race) assessed at age 17 along with their romantic partners and at ages 25-27. Controlling for gender, family income, and baseline mental health, partner-reported hostile conflict at age 17 predicted relative increases in internalizing behaviors from age 17 to 27. In contrast, observed teen support with their partner during a help-seeking task at age 17 predicted relative decreases in externalizing behaviors over time. The results are interpreted as suggesting qualities that may help determine whether adolescent romances have positive vs. negative long-term psychological health implications.

Consequences of Casual Sex Relationships and Experiences on Adolescents' Psychological Well-Being: A Prospective Study

Casual sexual relationships and experiences (CSREs) are still considered to be detrimental to the psychological well-being of youth even though findings remain inconclusive. Most studies have focused on emerging adulthood. Using a prospective design based on a representative sample of high school students in the province of Québec, we measured sexually active adolescents' (N = 2,304) psychological well-being six months after engaging in these relationships while controlling for prior well-being. We analyzed two forms of CSREs, friends with benefits (FWB) and one-night stand (ONS) relationships, as well as levels of sexual intimacy. The results show that CSREs had a small impact (small effect sizes) on subsequent psychological well-being, especially among girls; FWB relationships involving penetrative contact increased girls' psychological distress and both their alcohol and drug consumption. ONSs including sexual touching increased girls' psychological distress and their drug use. None of the CSREs influenced boys' psychological well-being. The findings underscored the importance of using caution when arguing that CSREs are detrimental or harmless to the psychological well-being of adolescents. The results also highlight the importance of taking into account gender and forms of CSREs in prevention and health interventions.

Psychosocial functioning in adolescents with and without borderline personality disorder

OBJECTIVE

Little is known about the psychosocial functioning of adolescents with borderline personality disorder (BPD). The main objective of this paper is to compare the psychosocial functioning of a group of adolescents with BPD to a group of psychiatrically healthy adolescents.

METHODS

The present cross-sectional study included 104 adolescent inpatients with BPD, compared with 60 age-matched psychiatrically healthy comparison subjects. All participants were rigorously diagnosed using three semi-structured interviews: the Structured Clinical Interview for DSM-IV Childhood Diagnoses, the Revised Diagnostic Interview for Borderlines and the Childhood Interview for DSM-IV Borderline Personality. All subjects were also interviewed using the adolescent version of the Background Information Schedule to assess multiple facets of psychosocial functioning.

RESULTS

Adolescents with BPD rated their relationships with their parents as significantly less positive, were more likely to date, but spent more time alone than their healthy counterparts. In addition, adolescents with BPD reported significantly more problems at work and school (i.e. lower frequency of having a good work or school history, higher frequency of being suspended or expelled from school) and significantly lower rates of participation in extra-curricular activities than their healthy counterparts.

CONCLUSIONS

Taken together, the results of this study suggest that adolescents with BPD are more impaired in both the social and vocational areas of functioning than psychiatrically healthy comparison subjects. They might also suggest that an overlooked area of strength concerns their relationships with peers. Copyright © 2017 John Wiley & Sons, Ltd.

Developmental Trajectories of Borderline Personality Disorder Symptoms and Psychosocial Functioning in Adolescence

In recent years, major gains toward understanding the emergence of borderline personality disorder (BPD) pathology, which is typically first noted during adolescence, have been made. Simultaneously, a profound shift has occurred in the adult personality pathology literature, in which empirical evidence rebuts the idea that personality disorders (PDs) are intractable disorders that do not develop or otherwise change over time, and therefore cannot be treated. The present study addresses a gap in our understanding of within-person change in BPD symptoms across adolescence and contributes to the limited literature on outcomes associated with adolescent BPD. Using an at-risk community sample of girls (N = 2,450), the authors used bivariate latent growth curve models to analyze the codevelopment of BPD symptoms with eight domains of psychosocial functioning (e.g., academic achievement, social skills, sexual behavior) across ages 14-17. Findings revealed moderate to strong effect sizes for the associations between BPD symptoms and every domain of psychosocial functioning, suggesting that the development of BPD was coupled with poorer outcomes across development. Controlling for depression and conduct disorder features revealed unique associations between BPD and self-perception, social skills, and sexual behavior. These results highlight the increased need for extending advancements in the adult PD literature to research on PDs in adolescence, and for greater recognition of adolescent BPD in clinical settings.

Young Love: Romantic Concerns and Associated Mental Health Issues among Adolescent Help-Seekers

Over 50% of young people have dated by age 15. While romantic relationship concerns are a major reason for adolescent help-seeking from counselling services, we have a limited understanding of what types of relationship issues are most strongly related to mental health issues and suicide risk. This paper used records of 4019 counselling sessions with adolescents (10–18 years) seeking help from a national youth counselling service for a romantic relationship concern to: (i) explore what types and stage (pre, during, post) of romantic concerns adolescents seek help for; (ii) how they are associated with mental health problems, self-harm and suicide risk; and (iii) whether these associations differ by age and gender. In line with developmental-contextual theory, results suggest that concerns about the initiation of relationships are common in early adolescence, while concerns about maintaining and repairing relationships increase with age. Relationship breakups were the most common concern for both male and female adolescents and for all age groups (early, mid, late adolescence). Data relating to a range of mental health issues were available for approximately half of the sample. Post-relationship concerns (including breakups) were also more likely than pre- or during-relationship concerns to be associated with concurrent mental health issues (36.8%), self-harm (22.6%) and suicide (9.9%). Results draw on a staged developmental theory of adolescent romantic relationships to provide a comprehensive assessment of relationship stressors, highlighting post-relationship as a particularly vulnerable time for all stages of adolescence. These findings contribute to the development of targeted intervention and support programs.

Quality Counts: Developmental Shifts in Associations Between Romantic Relationship Qualities and Psychosocial Adjustment

The present study assessed a developmental task theory of romantic relationships by examining associations between romantic relationship qualities and adjustment across 9 years using a community-based sample of 100 male and 100 female participants (Mage Wave 1 = 15.83) in a Western U.S. city. Using multilevel modeling, the study examined the moderating effect of age on links between romantic relationship qualities and adjustment. Consistent with developmental task theory, high romantic quality was more negatively associated with internalizing symptoms and dating satisfaction during young adulthood than adolescence. Romantic relationship qualities were also associated with externalizing symptoms and substance use, but the degree of association was consistent across ages. The findings underscore the significance of romantic relationship qualities across development.

Genetic moderation of the association between adolescent romantic involvement and depression: Contributions of serotonin transporter gene polymorphism, chronic stress, and family discord

Studies support a link between adolescent romantic involvement and depression. Adolescent romantic relationships may increase depression risk by introducing chronic stress, and genetic vulnerability to stress reactivity/emotion dysregulation may moderate these associations. We tested genetic moderation of longitudinal associations between adolescent romantic involvement and later depressive symptoms by a polymorphism in the serotonin transporter linked polymorphic region gene (5-HTTLPR) and examined contributory roles of chronic stress and family discord. Three hundred eighty-one youth participated at ages 15 and 20. The results indicated that 5-HTTLPR moderated the association between age 15 romantic involvement and age 20 depressive symptoms, with strongest effects for short homozygotes. Conditional process analysis revealed that chronic stress functioned as a moderated mediator of this association, fully accounting for the romantic involvement-depression link among short/short genotypes. Also, romantic involvement predicted later depressive symptoms most strongly among short-allele carriers with high family discord. The results have important implications for understanding the romantic involvement-depression link and the behavioral and emotional correlates of the 5-HTTLPR genotype.

"Tell me, how bright your hypomania is, and I tell you, if you are happily in love!"--among young adults in love, bright side hypomania is related to reduced depression and anxiety, and better sleep quality

BACKGROUND

Studies on adolescents and adults show that romantic love (RL) is associated with favorable emotional states. However, data on these associations are scarce for adults. The aim of the present study was, therefore, to explore the associations between RL, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep in a sample of adults.

METHOD

A total of 844 participants currently in love (M = 24.79 years, 75.8% females) took part in the study. They completed a series of questionnaires related to RL, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep.

RESULTS

An increased state of RL was associated both with the bright and the dark side of hypomania (BRHYP and DAHYP). Relative to participants with BRHYP, participants with DAHYP reported stronger symptoms of depression and state anxiety, and poor sleep quality.

CONCLUSIONS

The pattern of results adds to our knowledge that in adults RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults in love, bright versus dark side of hypomania was associated with a different quality of psychological functioning and sleep. We conclude that experiencing RL might be a critical life event associated with symptoms of depression and anxiety, and poor sleep.

"I love you more than I can stand!" - romantic love, symptoms of depression and anxiety, and sleep complaints are related among young adults

BACKGROUND

Falling in love is a universal human behavior. Studies indicate that both adolescents and adults experience romantic love (RL) and emotional states of joy and happiness. However, there is evidence that among adolescents RL is also associated with symptoms of depression and anxiety, but no data on these associations are available for adults. The aim of the present study was therefore to explore the associations between RL, symptoms of depression, anxiety, hypomania, and sleep among a sample of Iranian adults.

METHODS

One hundred adults (mean age: 26 years; 53% males) took part in the study. They completed a series of questionnaires related to RL, symptoms of depression, anxiety, hypomania, and sleep.

RESULTS

An increased state of RL was associated with the bright side of hypomania, stronger symptoms of depression and state anxiety, and better sleep quality. There was no relation to sleep duration.

CONCLUSIONS

Unlike psychobiological studies assessing highly selected samples of adults happily in love, the present pattern of results shows that in adults, RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults, falling in love might be a critical life event also associated with uncertainty and unpleasant feelings.

Bidirectional linkages between psychological symptoms and sexual activities among African American adolescent girls in psychiatric care

The current study examines longitudinal associations between light and heavy sexual experiences and psychiatric symptoms in African American adolescent girls receiving mental health care. Research supports bidirectional associations between adolescent romantic and sexual behaviors and depression and other mental health problems, but this finding has not been examined among African American youth or in clinical samples. African American girls in psychiatric treatment suffer disparities in HIV/AIDS vulnerability, and understanding the context of girls' risk-taking (and how psychological symptoms contribute) may aid prevention efforts. Two-hundred-sixty-five African American girls seeking psychiatric care were assessed for mental health symptoms and light and heavy sexual behaviors. Participants completed a 6-month follow-up. Baseline light sexual activity predicted increased internalizing and externalizing symptoms and substance use at follow-up. Internalizing and externalizing symptoms predicted increased heavy sexual behaviors over time, including HIV-risk behaviors. Results support the association between romantic involvement and depression. Psychological symptoms may play a key role in the emergence of risky sexual behaviors among African American adolescent girls in psychiatric care and should be considered in prevention program development.