Adolescent Sexual Behavior Patterns, Mental Health, and Early Life Adversities in a British Birth Cohort

Lifestyles and Sexual Behaviour Among School-Going Adolescents: A Mediational Role of Mental Health

Sexual behaviour and mental health among adolescents are major public health issues. This study examines how lifestyles affect sexual behaviour among school-going adolescents in Malaysia, and the potential mediational role of mental health. It is the first to our knowledge to explore the mediating effect of mental health on sexual behaviour with a focus on a fast-growing developing country. Data were obtained from the National Health and Morbidity Survey 2017 (n = 27,497). Structural equation modelling was utilized to examine depression and anxiety as mediators of the relationships between sexual behaviour and smoking, alcohol drinking and illicit drug use, controlling for sociodemographic factors. Results showed that adolescents who smoked, consumed alcohol, used illicit drugs, and had depression and anxiety were more likely to engage in sexual behaviour than others. Depression and anxiety partially mediated the relationships between sexual behaviour and smoking, and illicit drug use. The association between alcohol drinking and sexual behaviour was fully mediated by depression and anxiety. In conclusion, lifestyles may affect sexual behaviour through mediation of mental health. Therefore, policymakers should take mental health factors into consideration when designing adolescent sexual behaviour preventative interventions.

Health Disparities by Sexual Orientation: Implications of Genetic and Environmental Explanations

Xu and colleagues add to the growing research literature on the role of potential familial (i.e., genetic and shared environment) causes in sexual orientation and in the relation between sexual orientation and poor mental health, in which lesbian, gay, bisexual, and other sexual minority individuals have poorer mental health than heterosexual individuals. I address several implications of the findings by Xu et al. and others. First, the nuance or complexity of genetics is considered, given the implications of genetics for health via a single gene, epistasis, or epigenetics. Second, I highlight the magnitude of the genetic relation between sexual orientation and psychopathology, suggesting some, but not all, sexual minority individuals may differ from heterosexual individuals on psychiatric vulnerability. In turn, this suggests that research should identify for whom or under what circumstances the relation holds. Third, I underscore the need for a within-subjects design, in which attention turns to differences among sexual minority individuals. Fourth, the need to reevaluate Minority Stress Theory, the predominant theory accounting for health disparities by sexual orientation, is addressed because of the implications of genetics for health. Fifth, I acknowledge the concern attached to genetic research for potentially compounding the stigmatization already experienced by sexual minority individuals. Nevertheless, this research is occurring and will likely increase in volume. It will inform understanding of sexual minority individuals.

How are young people's mental health related to their sexual health and substance use? A systematic review of UK literature

OBJECTIVES

The transition from childhood to adulthood is complex and presents challenges to young people's mental health. Mental health impacts and is impacted by a range of contextual and personal factors. Adolescence and young adulthood also coincide with increased experimentation with sex, sexuality and substance use. Addressing the mental health, sexual health and substance-use challenges experienced by young people therefore necessitates an understanding of how these elements relate to one another. By collecting and analysing existing literature, this review aims to identify associations between young people's mental health and sexual health, their mental health and substance use and any resulting gaps-in-knowledge.

CONTENT

Seven electronic databases were searched between March and May 2021 and updated in May 2022 with terms collated under the categories of "young people", "mental health", "sexual health" and "substance use". English-language articles, presenting data from the UK & Ireland, on young people aged 16-24 years inclusive were screened and subjected to a selection process in accordance with PRISMA guidelines (preregistered on PROSPERO, ref. number CRD42021245096). The quality of the resulting articles were assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were tabulated through a data extraction process.

SUMMARY

27 articles were included in the review. Various mental health indices such as depression, anxiety, self-harm, psychotic-like experiences, hypomanic symptoms and binge-purge type eating disorders were found to be associated with higher use of substances such as alcohol, cannabis, ecstasy and generalised drug use. Additionally, mental health indices such as depression, anxiety and self-harm were found to be associated with sex before age 16 and/or unprotected sex at age 16, positive Chlamydia infection and higher levels of sexual activity at a younger age. Overall, cross-sectional associations were stronger than the longitudinal associations presented in the articles.

OUTLOOK

This review into the specific relations between young people's mental health, sexual health and substance use has revealed the complex and bi-directional nature of these associations, with some conditions and substances having been more extensively investigated (e.g., alcohol and depression/anxiety) as opposed to the relations between young people's sexual health and mental health which is lacking in the UK and Irish context. The findings can help inform mental health related policies and service provisions targeted at young people in the UK and Ireland. Areas for future work are suggested.