Caught in a bad romance: adolescent romantic relationships and mental health

The role of romantic relationships for sexual minority young adults' depressive symptoms: Does relationship type matter?

Sexual minority young adults consistently report higher rates of depression than heterosexual young adults. Drawing on the National Longitudinal Study of Adolescent to Adult Health, this study examines if types of romantic relationships provide mental health benefits for lesbian, gay, and bisexual young adults. Further, analyses distinguish between same- and different-sex unions to help determine which relationship types offer the most mental health benefits. The results show that marriage is linked to fewer depressive symptoms for gay and lesbian young adults, compared to being unpartnered or in a dating relationship. Further, same-sex unions are associated with fewer depressive symptoms, but not different-sex unions. Yet, bisexual respondents' depressive symptoms are not associated with romantic relationships, regardless of relationship type. The results suggest that it is important to address the stigma surrounding sexual minority status and same-sex relationships to improve the burden of depressive symptoms on sexual minority young adults.

Adolescents' Love Lives: Heterogeneity in Relationship Status Trajectories and Links with Affect

Romantic experiences are more fluid and heterogeneous during middle adolescence than at any other life stage, but current understanding of this heterogeneity and flux is limited because of imprecise measurement. A sample of 531 adolescents (55% female; 28% non-Hispanic White; 32% Black; 27% Hispanic; 14% Other) recruited from an ongoing birth cohort study (Mean age = 16.7 years, SD = 0.358), was administered bi-weekly diaries over 52 weeks to prospectively record transitions in and out of romantic and sexual relationships and to assess links with positive affect (frequency of happiness) and negative affect (frequency of sadness). Relationship statuses considered included not only dating, but also liminal and asymmetrical statuses such as talking/flirting and crushes. Latent profile analyses revealed six relationship status trajectories, or love life profiles, based on the number of intra-year partners and on the extent of involvement in each of the relationship statuses. Approximately half of teens either were in stable dating relationships or uninvolved romantically during the year; however, half experienced variable levels of flux in their love lives. Relationship instability, not romantic involvement per se, was associated with higher levels of sadness and lower levels of happiness. Snapshots of teen romantic involvement based on one or two points in time obscure the extent of relationship heterogeneity and flux and how relationship status trajectories are associated with positive and negative affect.

Adolescent Partnership Quality and Emotional Health: Insights from an Intensive Longitudinal Study

Prior research has documented an association between adolescents' romantic experiences and poor emotional health. However, lack of intensive longitudinal measurement and an emphasis on negative affect have limited understanding about the extent to which adolescent relationship quality influences the emotional health of adolescents in partnerships, including the potential benefits of high-quality partnerships. Previous research has also been limited in its ability to account for factors that select adolescents into lower or higher quality partnerships. Using biweekly intensive longitudinal data from the mDiary Study of Adolescent Relationships linked to six waves of birth cohort data from the Fragile Families and Child Wellbeing Study, this paper uses multilevel mixed-effects models to address three questions: (1) How are changes in partnership quality (defined as validation, frequency of disagreements, and global quality) associated with changes in both positive and negative affect; (2) Do observed associations persist net of factors that potentially select adolescents into lower or higher quality partnerships (e.g., childhood family experiences); and (3) Do associations between partnership quality and affect differ by gender? Results show that higher quality partnerships are associated with both decreases in negative affect and increases in positive affect. There were no significant gender differences on average. The study's findings highlight the importance of partnership quality as a key source of temporal variation in adolescents' emotional states.

Effects of Friendship among Same-Sex Attracted Youth on Sexual Minority Identity Development in Young Adulthood

Using data from Waves 1 and 3 of the National Longitudinal Study of Adolescent to Adult Health, this study investigated the interactive impact of adolescent friendship network characteristics and same-sex attraction (SSA) on the development of sexual minority (SM) identity in young adulthood. Results indicate that SSA youth who identified a best friend that also identified them as their best friend were 5.3 times more likely to identify as a SM compared to those who did not experience reciprocity. For each additional classmate who listed them as a friend, SSA youth were 1.2 times more likely to identify as a SM. Increased centrality in friendship network increased the likelihood that SSA youth would identify as a SM by 1.8 times. Sex-stratified results reveal that particular network characteristics impact boys and girls differently. These findings point to the importance of further investigating relationships between friendship characteristics and identity formation among adolescents.

Adolescents' Partner Search in the Digital Age: Correlates and Characteristics of Relationships Initiated Online

Digital technology and social media platforms have transformed the ways adolescents communicate and cultivate romantic relationships, but few studies consider whether relationships initiated online are less salutary than those formed in person. A sample of 531 adolescents (Mean age = 16.7 years, SD = 0.358; 55% female) was recruited from an ongoing birth cohort study and administered bi-weekly diaries over a year to evaluate the circumstances associated with adolescents' romantic relationship formation and relationship quality. Two-thirds of respondents initiated one or more romantic relationships during the study, of which 15% were initiated online. Girls who did not fit in well at school and who had difficulty making friends were more likely to initiate romantic relationships online than their more sociable peers who fit in well at school; for boys, however, access to mobile devices increased the odds that romantic relationships were initiated online. The diaries captured considerable flux in the evolution of romantic relationships, but there was limited evidence that relationships initiated online involved greater risks, with the notable exception of greater age asymmetry.

Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships

We developed measures of relational beliefs and expectations among single young gay and bisexual men (YGBM). Data come from an online cross-sectional study YGBM, which ran from July 2012 until January 2013. There were 50 items on relational beliefs and 25 items on relational expectations. We used random split samples and a priori analysis to group items together and applied principal axis factoring with varimax orthogonal rotation. We had a total N = 1582 in our analytical sample and identified six constructs of relational expectations (restrictions, negative break up, masculine and gender norms, optimism, cheating, immediacy) and two constructs of relational beliefs (sex beliefs, equality). Our findings highlight specific relational cognitions among YGBM and offer insight into the beliefs and expectations that may inform their relationships. Findings may be useful for health professionals to help YGBM reflect and understand the health implications of their beliefs and expectations about same-sex relationships to promote healthy decision-making as they seek future partners.

Mental health difficulties, coping mechanisms and support systems among school-going adolescents in Ghana: A mixed-methods study

BACKGROUND

Although adolescents are highly vulnerable to mental health challenges, they receive little attention, especially in developing countries. We investigated the mental health difficulties (MHDs) faced by adolescent students in four senior high schools in Ghana, their coping strategies and support systems.

METHODS

In this convergent mixed-methods study, quantitative data was obtained using validated strengths and difficulties questionnaire to assess the mental health of 405 adolescents. Qualitative data was collected through in-depth interview with 18 teachers and seven focused group discussions with 35 students. Adjusted odds ratios (OR) for MHDs were estimated through ordinal logistic regression in Stata 14.2. Qualitative data was analyzed inductively and deductively using ATLAS.ti 7.1.

RESULTS

Over half (58.5%) experienced peer (20.5%), emotional (16.3%), conduct (13.3%) and hyperactivity (3.0%) problems, whereas 5.4% exhibited prosocial behaviours. MHDs were associated with females (OR = 2.27, 95% CI: 1.47-3.50), bullying (OR = 1.72, CI: 1.07-2.75), domestic violence (OR = 1.87, CI: 1.10-3.17), substance abuse (OR = 8.14, CI: 1.41-46.8), academic pressure (OR = 2.40, CI: 1.30-4.42) and self-perceived poor school performance (OR = 7.36 CI: 2.83-19.16). Qualitatively, we identified financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence as the main themes attributed to MHDs. Coping strategies included isolation, substance use and spiritual help. The main school-based support system was the guidance and counselling unit, but there were complaints of it been ineffective due to trust and confidentially issues, and non-engagement of qualified counsellors.

CONCLUSIONS

As many triggers of MHDs emanate in schools, we need mental health-friendly school environments where trained psychotherapists head counselling centres. We propose incorporating mental health education into school curricula and generating surveillance data on adolescent's mental health.

The Long Arm of Social Integration: Gender, Adolescent Social Networks, and Adult Depressive Symptom Trajectories

Peer connections in adolescence shape mental health in ways that differ by gender. However, it is unclear whether this association has an enduring impact on life course mental health. Using growth models with survey data from the National Longitudinal Study of Adolescent to Adult Health (Add Health Waves I-IV, N = 13,821, 51% white, 49% male), we examine how two dimensions of social integration during adolescence-popularity and sociality-predict depressive symptom trajectories from adolescence to adulthood (ages 12-32) by gender. We find that for both men and women, low sociality predicts higher depressive levels through adolescence into adulthood. For women, higher popularity predicts greater depressive symptoms in adolescence, followed by a steeper decline to lower levels in early adulthood. Overall, this study suggests that social integration among peers in adolescence has long-term consequences for mental health that vary by gender.

Youth's Socio-Sexual Competences With Romantic and Casual Sexual Partners

We investigated youth's self-reported socio-sexual competences (esteem, assertiveness, control, communication) within their most recent sexual partnerships, and explored disparities in these competences between romantic versus casual sexual partnerships, including age and gender differences therein. Data were used from 6,098 Dutch adolescents and young adults (12.1-26.1 years), who participated in a national study on sexual health. Results indicated that being in love and sexual activity frequency were significant confounders for the associations between sexual partnership typology and youth's socio-sexual competence levels. After controlling for confounding relationship characteristics and sociodemographics, no differences were found between sexual partnership types in youth's sexual esteem, assertiveness, and control. However, romantic sexual partnerships were characterized by more frequent sexual communication than casual sexual partnerships. This pattern was gender-consistent, but for young adults, this difference in sexual communication across sexual partnership types was larger than for adolescents. Our findings emphasize that considering the relationship context (e.g., romantic, casual) for the development, utilization, and evaluation of young people's socio-sexual competences - particularly sexual communication - is a vital task for parents, educators, clinicians, and researchers. Individual (person-centered) versus relational (dyad-centered) differences in youth's socio-sexual competences require further exploration, as does the link between socio-sexual competences and sexual health and satisfaction.

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.

Well-Being and Romantic Relationships: A Systematic Review in Adolescence and Emerging Adulthood

Adolescence and emerging adulthood are both stages in which romantic relationships play a key role in development and can be a source of both well-being and negative outcomes. However, the limited number of studies prior to adulthood, along with the multiplicity of variables involved in the romantic context and the considerable ambiguity surrounding the construct of well-being, make it difficult to reach conclusions about the relationship between the two phenomena. This systematic review synthesizes the results produced into this topic over the last three decades. A total of 112 studies were included, following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. On the one hand, these works revealed the terminological heterogeneity in research on well-being and the way the absence of symptoms of illness are commonly used to measure it, while on the other hand, they also showed that romantic relationships can be an important source of well-being for both adolescents and emerging adults. The findings underline the importance of providing a better definition of well-being, as well as to attribute greater value to the significance of romantic relationships. Devoting greater empirical, educational, and community efforts to romantic development in the stages leading up to adulthood are considered necessary actions in promoting the well-being of young people.

The "concept-reality mismatch" in the globalization era as a psychosocial stressor contributing to the occurrence of mental disorders

AIMS

The "concept-reality mismatch" in the globalization era is a novel conceptualization of psychosocial stress due to difficulties in experiencing five of the most important positive emotions for psychological well-being. These emotions are love, trust, faith, pleasure and self-esteem.

METHODS

a narrative overview of the literature using the terms "positive emotions," "positive psychology," "globalization" and "self-discrepancy" has been done. Selected articles are those considered to support the basic ideas mentioned in this hypothesis.

RESULTS

Differences in how adolescents and young adults experience positive emotions in real life in relation to their conceptual background exist. Authentic love described in books and movies might become perceived as more difficult to find. Trust, in the era of long distance relationships, is being built based on different criteria than those adolescents and young adults are taught to apply. Faith is challenged by the facility of accessing scientific data and by the lack of parental positive influence towards religiosity. Pleasure is being claimed as a right to cope with stress even artificially. Self-esteem is becoming more and more restricted to wealth, beauty and fame as promoted by modern communication technologies.

CONCLUSIONS

The "concept-reality mismatch" may be considered as an essential and preventable psychosocial stressor contributing to the development of mental and substance use disorders in the modern world. Studies evaluating this hypothesis and elaborating on its management strategies are needed in the near future.

Avoidant romantic attachment in adolescence: Gender, excessive internet use and romantic relationship engagement effects

Romantic development is a distinctive characteristic of puberty. However, a significant proportion of adolescents present with avoidant romantic attachment (ARA) tendencies, which have significant impact on their general adaptation. ARA variations have been suggested in relation to age, gender, engagement with a romantic partner and Excessive Internet Use (EIU) behaviours. In this longitudinal, two-wave study of a normative sample of 515 Greek adolescents at 16 and 18 years, ARA was assessed with the relevant subscale of the Experiences in Close Relationships-Revised and EIU with the Internet Addiction Test. A three-level hierarchical linear model found ARA tendencies to decrease between 16 and 18 while engagement in a romantic relationship and EIU were associated with lower and higher ARA tendencies respectively. Gender did not differentiate ARA severity either at the age of 16 or its changes over time. Results highlight the need of adopting a longitudinal-contextualized approach and provide implications for prevention and intervention initiatives in relation to the romantic development of adolescents.

Intimate partner relationship stress and suicidality in a psychiatrically hospitalized military sample

OBJECTIVE

Suicide among United States service members is a significant public health concern. Intimate partner relationship stress may contribute to suicide risk, as a failed or failing relationship is the most commonly documented stressor preceding military suicide attempts and deaths. However, little is known about the manner by which relationship stressors are associated with the experience of military suicidality.

METHODS

A sample of 190 psychiatrically hospitalized military personnel and adult dependents enrolled in an ongoing randomized controlled trial evaluating the efficacy of an inpatient cognitive behavioral treatment for suicidality were included in this study. Analyses examined depression, hopelessness, and suicidality among participants with (n = 105) and without (n = 85) self-reported romantic relationship stress.

RESULTS

Over half (55%) of the sample reported current romantic relationship stress. Compared to participants without current romantic relationship stress, results indicated that individuals reporting current romantic relationship stress were more hopeless (AOR = 1.07 (95% CI: 1.01-1.12), p = 0.020), more likely to endorse multiple suicide attempts (AOR = 1.96 (95% CI: 1.01-3.79), p = 0.046), had higher overall suicide risk (AOR = 2.49, (95% CI: 1.03-6.06), p = 0.044), and were more likely to report that the reason for their suicidality was at least in part to get a reaction from others.

CONCLUSIONS

Findings suggest romantic relationship stress is associated with greater suicide risk, and have clinical implications for suicide prevention and intervention. Future research may examine mechanisms and pathways between romantic relationship stress, suicidality, and prevention and intervention strategies.

Congruity and Divergence in Perceptions of Adolescent Romantic Experience Between Chinese Parents and Adolescents

This qualitative research article explored the convergences and divergences of perceptions of adolescent romantic experience between a group of adolescents and parents in China. One-to-one, in-depth interviews were conducted with 38 adolescents (aged 15-18 years; 26 girls, 12 boys) and 27 parents (aged 40-52 years; 16 mothers, 11 fathers) from the urban areas of a northern Chinese city. Data analysis was conducted using thematic analysis and interpreted using a socio-ecological approach. Four major themes were identified: opportunities and risks, acceptable versus unacceptable sexual intimacy, generational difference, and girls’ vulnerability and “self-respect.” In these themes, congruity and divergence of perceptions were found between the groups of adolescents and parents. These perceptions were largely influenced by traditional cultural beliefs of education, sexuality, gender, and family as well as the current socio-cultural context of modernization and globalization in China. The findings provide implications regarding how to support both adolescents and parents in managing adolescent romantic experience for adolescent health-promoting romantic and sexual behaviors.

Sexual intercourse, romantic relationship inauthenticity, and adolescent mental health

Numerous studies indicate sexual intercourse, especially when it occurs early in adolescence, increases youths' risk of mental health problems. However, no research has examined whether the association between sexual intercourse and mental health varies by romantic relationship inauthenticity, or the level of incongruence between thoughts/feelings and actions within romantic relationships. Using data from a subset of romantically-involved Add Health respondents, we measured sexual involvement in romantic relationships and applied sequence analysis to reports of ideal and actual romantic relationship to measure inauthenticity within adolescent romances. Regressions of depression symptoms indicate that the magnitude of the positive associations between sexual intercourse and girls' mental health is most pronounced in relationships characterized by high levels of relationship inauthenticity and that there is no association between sexual intercourse and girls' depression at low levels of relationship inauthenticity. Having sexual intercourse is positively associated with depression symptoms among boys, but relationship inauthenticity does not alter this association. We discuss the implications of these findings for research on adolescent sexuality and programs aimed at enhancing youth sexuality development.

Are You Still Bringing Me Down?: Romantic Involvement and Depressive Symptoms from Adolescence to Young Adulthood

Romantic involvement and mental health are dynamically linked, but this interplay can vary across the life course in ways that speak to the social and psychological underpinnings of healthy development. To explore this variation, this study examined how romantic involvement was associated with trajectories of depressive symptomatology across the transition between adolescence and young adulthood. Growth mixture modeling of data from the National Longitudinal Study of Adolescent to Adult Health identified trajectories of depressive symptomatology as teens grew into their late 20s and early 30s ( N = 8,712). Multinomial logistic techniques regressed these trajectories on adolescent and young adult romantic experiences. Adolescent dating was associated with increased depressive symptoms early on, particularly for girls, but this risk faded over time. For both boys and girls, trajectories of decreasing symptoms were associated with young adult unions but also the coupling of adolescent dating with young adult singlehood.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies

OBJECTIVE

To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults.

METHOD

We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775).

RESULTS

From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07).

CONCLUSION

Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.

You can't always get what you want: Network determinants of relationship inactualization in adolescence

Despite widespread interest in the link between social and sexual networks, little research has focused on how social networks influence the progression of intimate relationships (e.g., from holding hands to sexual intercourse). I argue that social networks not only affect individuals' opportunities to meet romantic partners, but also shape the ideal and actual progressions of intimate acts within their relationships. Using data from the National Longitudinal Survey of Adolescent to Adult Health (Add Health), I conduct an optimal matching analysis of adolescents' purported ideal versus actual relationship sequences, which are comprised of romantic and sexual events. Low discrepancy scores indicate that intimate acts in one's recent relationship were sequenced much as one had desired. Results demonstrate that how students are situated within their schools' broader friendship networks affects their experiences with intimacy: high rank prestige individuals are better able to achieve their ideal relationships, as are individuals with densely knit friendship networks. Additionally, increased gender salience among boys within the socio-centric friendship network is associated with increased discord between desired and actual relationship progressions, but this relationship is mediated by the rareness of the individual's ideal relationship trajectory.

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.

The impact of intimate partner relationships on suicidal thoughts and behaviours: A systematic review

BACKGROUND

A systematic review was conducted to identify the impact of intimate partner relationships on suicidality. The aim of the review was to identify factors within intimate partner relationships that influence suicidal ideation, attempts and completion.

METHOD

Fifty-one articles were identified through Scopus, PubMed and PsycINFO databases. Due to the high heterogeneity of the included studies, a narrative data synthesis was conducted.

RESULTS

The research drew attention to specific contingents of the population, for example examining suicide risk in individuals under the age of 35 or lesbian, gay, bisexual and transgender (LGBT) individuals who are experiencing relationship discord, and in males who have recently separated.

LIMITATIONS

Interpretation of these findings is constrained by methodological limitations prevalent in much of the literature. Limitations of the existing literature and corresponding directions for future research are discussed.

CONCLUSIONS

Relationship separation and poor quality relationships are likely to be important risk factors for suicidal thoughts and behaviours and are frequent triggers for a suicide attempt. This review highlights intimate partner relationships as a significant component in a suicide risk assessment, regardless of the clinical setting. Consequently, clinicians should be aware that individuals reporting relationship problems are likely to be at increased risk of suicidal thoughts and behaviours.

[Effects of Sexual Intercourse on Suicidal Behaviors among Adolescents in South Korea]

PURPOSE

For the current article an examination was done as to whether engaging in sexual intercourse before or during adolescence has a negative impact on the suicidal behaviors of suicide ideation, suicide attempt, and suicide lethality and whether the impact varies according to the context of sexual intercourse and/or gender.

METHODS

Adolescents who experienced casual sex and romantic sex were compared to adolescents who retained their virginity. Data was from samples drawn from the three waves (2010~2012) of the Korea Youth Risk Behavior Web-Based Survey. Logistic models were used to adjust for a wide array of confounding variables.

RESULTS

Any type of sexual intercourse increases risk of all suicidal behaviors. Sexual intercourse in a romantic relationship exhibits enhanced risk of suicidal behaviors compared to casual sex. Adjusting for experience of sexual violence, however, decreases risk of romantic sex substantially, turning some estimates statistically insignificant. In addition, risks for suicide lethality are greater for girls than boys.

CONCLUSION

Romantic sex put adolescents at higher risk for suicidal behaviors than casual sex owing to prevalent sexual violence in the relationships. Girls suffer more substantively adverse outcomes than boys. These results suggest that adolescents will benefit from comprehensive education on sexuality and sexual behaviors regarding how to form and maintain a romantic relationship that is characterized by personal integrity and mutual respect. It is also important to help victims of sexual violence recover from traumatic events by providing emotional support and effective counseling.