High-risk sexual behaviour in young people with mental health disorders

Interest in Contraceptive Information and Initiation Among Adolescents Hospitalized With Psychiatric Disorders

PURPOSE

Adolescents with psychiatric disorders face increased risks for unintended pregnancy. This study examines adolescents hospitalized with psychiatric disorders' interest in contraceptive information and initiation and associated factors.

METHODS

We enrolled 451 adolescents assigned female at birth, ages 14-17, hospitalized with psychiatric disorders at a Midwestern quaternary children's hospital from November 19, 2021, to March 22, 2023. Participants completed a questionnaire that assessed interest in contraceptive information and contraceptive initiation and explanatory factors. Survey data were linked to data from health records. We examined factors associated with interest in contraceptive information and initiation during hospitalization using logistic and multinomial logistic regression.

RESULTS

Participants' mean age was 16.1 (95% CI: 14.1-18.1). Over half (51.3%) of participants were interested in contraceptive information during hospitalization and 21.4% were interested in contraceptive initiation. The strongest predictors for interest in information about contraceptives and contraceptive initiation were not knowing where to get contraceptives (adjusted odds ratio (aOR) 2.96; 95% CI 1.6-5.5 and aOR 2.85; 95% CI 1.43-5.68, respectively), difficulty getting to contraceptive access (aOR 3.33: 95% CI 1.49-7.4 and aOR 4.72; 95% CI 2.03-10.95, respectively), and ever having sex (aOR 2.91; 95% CI 1.86-4.57 and aOR 2.12; 95% CI 1.22-3.68 respectively).

DISCUSSION

Interest in contraceptive information and initiation is high among adolescents hospitalized with psychiatric disorders. Sexually active adolescents and adolescents with access barriers were more likely to indicate interest in contraceptive care. Hospitalizations represent opportunities for important reproductive health services for adolescents with psychiatric disorders.

Causal associations between sexually transmitted infections, depression, and self-harm: a mendelian randomization and cross-sectional study

BACKGROUND

The causal relationships between sexually transmitted infections, depression, and self-harm remain unclear.

METHODS

We executed various Mendelian Randomization (MR) analyses. At the same time, a cross-sectional analysis from NHANES was used for verification and an enrichment analysis was also utilized to explore the potential common gene functions.

RESULTS

We found that STIs may have a potential causal effect on depression (P = 0.002) and self-harm (P = 0.003). Conversely, self-harm has been identified as a risk factor for the acquisition of STIs (P = 0.006), while there is no evidence to support an effect of depression on STIs. Furthermore, mediation MR indicated that monocyte absolute count played a mediating role in the association between STIs and depression, accounting for 7.7%. And then, the weighted regression analysis of the cross-sectional analysis demonstrated a significant association between one of the common STIs, HPV, and depression. Gene enrichment analysis suggested that the PI3K-Akt signalling pathway and the infectious virus signalling pathway may represent a common underlying pathogenesis.

CONCLUSION

STIs may increase the risk of depression and self-harm, while self-harm might also represent a risk factor for STIs, which could provide insights and a foundation for the control of STIs and mental health monitoring in clinical practice.

Depression, Contraception, and Ambivalence Concerning Fertility

Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (N = 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

Aims

To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations.

Methods

We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023.

Results

33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders.

Conclusion

The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries.

Systematic Review Registration

https://osf.io/8mz7a.

The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project

BACKGROUND

Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia.

METHODS

We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention.

RESULTS

Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified.

CONCLUSIONS

Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.

Novel Application of Dot Survey Methodology at a Youth Health Clinic: A Pilot Study

PURPOSE

We tested a novel dot survey methodology at our clinic that provides sexual health services to youth ages 13 to 24. We conducted two interactive dot surveys to assess their feasibility and acceptability while gaining insight into patients' attitudes about mental health.

METHODS

We adapted a dot survey approach to assess youths' familiarity with mental health and attitudes toward related services. We also assessed their attitudes toward participating in this survey method. All patients with scheduled appointments were eligible to participate. Participants used dot stickers to indicate their responses on survey posters displayed in the waiting room.

RESULTS

Three hundred patients participated between June and September 2021 (150 participants/survey). About 95% of participants liked seeing others' responses to the dot surveys, and over 70% reported that the surveys made them think more about mental health. Over 90% would participate in future dot surveys at the clinic. Survey items with the most consensus among participants included that 74.5% "really agree" youth face barriers to accessing mental health services (n = 141, mean = 4.61, standard deviation = 0.79) and 87.1% "really agree" primary care providers should ask youth about their mental health (n = 139, mean = 4.81, standard deviation = 0.59).

DISCUSSION

The dot surveys were effective at assessing patients' attitudes about mental health and feasible to conduct in our waiting room. Results confirmed that this survey method was well received among patients. Dot surveys can be adapted by other clinical settings to engage youth regarding their health-related attitudes.

Sexual Dysfunctions and Problematic Sexuality in Personality Disorders and Pathological Personality Traits: A Systematic Review

PURPOSE OF REVIEW

This aim of the present systematic literature review is to critically analyze problematic sexuality and sexual dysfunctions in personality disorders (PDs) and pathological personality traits.

RECENT FINDINGS

An initial pool of 123 studies was found, out of which 17 met the selection criteria and were therefore included. Traumatic experiences as childhood sexual abuse and adverse childhood experiences characterize the relationship between sexual behavior and PDs. From this point of view, sexual compulsivity and sexual risk behaviors, typical of BPD and ASPD, respectively, are among the pathognomonic aspects of PDs and of pathological personality traits. A maladaptive personality functioning may manifest through a problematic sexuality and a sexual impairment. In this regard, traumatic life experiences may structure personality together with sexual functioning. Therefore, it would be useful to consider the relationship between trauma, sexuality, and personality in research and in the clinical setting.

High-risk sexual behaviours in young people experiencing a first episode of psychosis

AIM

The sexual health of adults with schizophrenia is poorer than the general population; however, less is known about young people experiencing a first episode of psychosis (FEP). The aim of this study was to explore the high-risk sexual behaviours and sexual well-being indicators of a cohort of young people with FEP.

METHODS

Data collected from young people (15-24 years) with FEP attending the EPPIC service in Melbourne and participating in a physical health intervention were analysed. Baseline trial data collected on sexual health and high-risk behaviours, psychiatric symptomology, functioning, and substance use are presented by gender. Associations between symptomology and functioning with sexual behaviour are explored.

RESULTS

A total of 69 young people were included in this study; mean age was 19.6 years (SD±2.8), 53.6% were male, 59.6% identified as heterosexual, and 21.7% were currently in a relationship. Within the cohort, 78.3% had ever been sexually active. Of these, 44.2% consistently used a condom at last sex act and 35.7% used barrier contraception consistently, 22.5% had previously been pregnant, and 18.6% had tested positive for an STI. Finally, young people were more likely to have been sexually active if they were currently using substances.

CONCLUSIONS

These findings suggest that high rates of high-risk sexual behaviour remain an issue for young people experiencing a first episode of psychosis. Promoting sexual well-being and communication skills between sexual partners should be targeted to ensure that high-risk sexual health outcomes are mitigated as early as possible.

Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

BACKGROUND AND HYPOTHESIS

The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders.

STUDY DESIGN

We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14-24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality.

STUDY RESULTS

Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention.

CONCLUSION

Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women's health, sexual violence, gender, and sexuality in young people with psychosis.

What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients

OBJECTIVE

Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity.

METHOD

A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored.

RESULTS

One hundred and seven young people (18-25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients.

CONCLUSIONS

High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.

Evaluating schizotypy and alcohol usage as predictors of increased engagement in risky sexual behaviors in an undergraduate sample

The window of risk for developing a schizophrenia-spectrum disorder overlaps with young adulthood, a time of increased independence and self-sufficiency. Research suggests that this period is also associated with increased substance use and risky sexual encounters. The current study aimed to examine rates of alcohol usage and risky sexual behaviors in those demonstrating higher rates of schizotypy (i.e., risk indicator for schizophrenia). Data was collected at a midsized university in the Northeastern United States during the 2019-2020 and 2020-2021 academic years. A total of 385 undergraduate students enrolled in introductory psychology classes completed the study either in-person or online. The study consisted of questionnaires related to alcohol usage, rates of sexual risk behaviors, and schizotypal traits. Due to COVID-19 restrictions and the time period covered by the sexual risk measure (i.e., the last six months), the authors deemed it necessary to omit certain participants, leaving 179 participants in our main analyses. Participants who reported higher levels of alcohol usage and positive schizotypy demonstrated increased engagement in specific sexual risk behaviors, while higher levels of negative schizotypy may have acted as a protective factor against engagement in sexual risk. Descriptive data for participants collected during the pandemic period was provided for comparison and for the interest of future researchers looking at the pandemic period (n = 180). The current findings provide a snapshot (baseline rate) of sexual behavior and alcohol usage in a nonclinical sample with varying risk for psychosis that extends previous research involving clinical samples.

Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions

Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.

Addressing physical health in mental illness: the urgent need to translate evidence-based interventions into routine clinical practice

People affected by severe mental health disorders have a greatly reduced life expectancy compared to their non-affected peers. Cardiovascular disease is the main contributor to this early mortality, caused by higher rates of smoking, physical inactivity, unhealthy diet, sleep disturbance, excessive alcohol use or substance abuse and medication side effects. Therefore, we need to take a preventative approach and translate effective interventions for physical health into routine clinical practice. These interventions should be delivered across all stages of mental health disorders and could also have the added benefit of leading to improvements in mental health. Furthermore, we need to advocate to ensure that people affected by severe mental health disorders receive the appropriate medical assessments and treatments when indicated. This themed issue highlights that physical health is now an urgent priority for funding and development in mental health services. The widespread implementation of evidence-based interventions into routine clinical practice is an essential need for consideration by clinicians and policymakers.

Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

Aim

Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK.

Methods

Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months.

Results

Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence.

Conclusions

The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.

Physical health assistance in early recovery of psychosis: Study protocol for a randomized controlled trial

AIM

Young people with psychotic disorders have poorer physical health compared to their healthy peers, a state compounded by the metabolic side-effects of antipsychotic medications. To address this, Orygen Youth Health has introduced physical health services including exercise physiologists and dieticians. These services are typically coordinated by the case manager and doctor. It is not yet known whether a treating team member dedicated to physical health will improve engagement, adherence and outcomes with these services. Hence, the protocol is presented here for a trial to evaluate the effect of including a physical health nurse in the care of young people with first-episode psychosis.

METHODS

This will be a single-blind randomized controlled trial that includes 15- to 24-year-olds with first-episode psychosis who have just commenced (within 30 days) antipsychotic medication. The primary outcome will be the event of clinically significant weight gain (≥7% body weight). Participants will be assigned either a physical health nurse in their treating team (in addition to the case manager and doctor) for a 12-week period, or treatment as usual (case manager and doctor). Research assessments will be conducted at baseline, 12 and 26 weeks. Activity trackers worn by participants for the study's duration will measure sleep and physical activity.

CONCLUSION

The present study will determine whether a physical health nurse will facilitate participants in attending and engaging in physical health interventions and whether this will be associated with physical health improvements or the prevention of worsening physical health.

Role of optimism in adolescent mental health: a protocol for a systematic review

INTRODUCTION

Adolescence is a critical period of human development, where adaptive or maladaptive experiences can happen. These experiences are associated with psychological, social, biological and health factors. Previous empirical evidence suggests that mental health is associated with individual assets and positive states, whose presence may become a factor of protection and resistance to mental disorders. Among these, optimism could play a fundamental role in sustaining physical and mental well-being and in dealing with threats potentially harmful to health. Given the rise of research on optimism and its importance in the various health outcomes, it is necessary to initiate processes of compilation and synthesis of this evidence to facilitate the understanding of the importance of this variable on the mental health of adolescents.

METHODS AND ANALYSIS

The included studies will be experimental, observational, cross-sectional and longitudinal focussed on the role of optimism on mental health in adolescents, regardless of whether they belong to clinical or non-clinical populations. This systematic review protocol will be carried out following the Cochrane Manual for systematic reviews and will follow the statement on systematic reviews and meta-analysis of PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Searches will run from October 2019 to March 2020, and will be carried out from the following electronic databases: APA PsycNet, BVS (Biblioteca Virtual em Saúde), Web of Science, PubMed Central and Scopus. Two reviewers will obtain the eligible articles, published from January 2009 onward, to assess the quality of each study and extract the data. For the presentation of the results, a narrative and quantitative synthesis will be carried out that groups the data found.

ETHICS AND DISSEMINATION

The approval of an ethics committee is not required for a systematic review protocol. The results will be presented at congresses in social sciences and psychology and will be published in a peer-reviewed social or health science journal.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42019142616.

The relationship between early risk-taking behavior and mental health problems among a nationally representative sample of Australian youth

BACKGROUND

Earlier engagement in risk-taking behaviors has been associated with more severe mental health problems across development. However, sex differences in risk-outcome relationships remain underexplored and mental health outcomes spanning both ends of the internalizing and externalizing spectra are rarely considered within the same sample. The present study examined associations between age at initiation of alcohol use, illicit drug use, and sexual intercourse, and symptoms of internalizing, externalizing, depression and self-harm, for males and females.

METHODS

The present study analyzed self-report survey data from a nationally representative sample of Australian adolescents (N=2,950). Logistic regression models were conducted separately for males and females to test the association of early (age 15 or younger) and concurrent (age 16-17) initiation of alcohol use, illicit drug use and sexual behavior with symptoms of internalizing, externalizing, depression and self-harm at age 16-17.

RESULTS

Risk-taking behaviors were associated with all mental health outcomes. Generally, earlier initiation of risk-taking behaviors demonstrated stronger associations with mental health outcomes than concurrent initiation. Associations between risk-taking behaviors and mental health outcomes varied by participant sex and mental health outcome.

LIMITATIONS

Mechanisms underlying the relationship between risk-taking behaviors and mental health problems were not tested and the sample had not yet reached early adulthood.

CONCLUSIONS

Risk-taking behaviors, particularly when initiated early, share links with multiple mental health problems in adolescence. Public health strategies to delay the onset of risk-taking behaviors may therefore incur multiple benefits as might an integrated approach to mental health prevention programs for youth.