Depression, risky sex behavior linked in African-American youth

September 05, 2006

Providence, RI - A new study from the Bradley Hasbro Children's Research Center and Brown Medical School reveals that African American teens with symptoms of depression are more than four times likely to engage in risky sexual behavior (i.e. not wear condoms).

This is one of the first studies that looks at African American teens of both genders and from more than one geographic location. It concludes that depressive symptoms (feeling lonely, feeling blue, feelings of worthlessness etc.) can indicate future sexual risk.

The findings appear in the current online edition of the Journal of Adolescent Health.

"This means that clinicians should assess symptoms of depression in African American patients as an indicator of future sexual risk, and HIV intervention programs should be designed as to address depression, especially in this population," says lead author, Larry K. Brown, MD, a child psychiatrist with the Bradley Hasbro Children's Research Center and Brown Medical School.

Four hundred and fifteen African American adolescents and young adults (15-21 years of age) from Atlanta and Providence, who had had unprotected sex within the past ninety days, participated in this study.

They were asked about the number times they'd had unsafe sex in the past ninety days, and about their particular attitudes concerning condom use (e.g. are they pleasurable/unpleasurable). Participants were also asked to answer questions on their psychological distress. They rated, on a scale of zero to four, whether or not they were lonely, feeling blue, feeling no interest in things, feeling hopeless about the future and feeling worthless.

The odds that African American adolescents who reported depressive symptoms at baseline would report inconsistent condom use at six-month follow-up was approximately four times greater than that of their peers who did not report depressive symptoms, the study reports.

Additionally, out of the four hundred and fifteen adolescents, sixty-seven percent were inconsistent condom users (used condoms less than seventy-five percent of the time). Those reporting lower annual household incomes reported a lower proportion of condom use at follow-up, and lower income was related to living in the study site in the Northern United States (Rhode Island).

"Unsurprisingly, in terms of psychosocial context, those adolescents living with a partner and reporting less pleasurable expectations about condoms reported a lower proportion of condom use at the six-month follow-up," says Brown.

The authors conclude that psychosocial context is therefore relevant to all adolescents' sexual risk and should be incorporated into adolescent HIV risk assessments and prevention interventions. Assessing depressive symptoms and intervening early can help prevent more severe emotional disorders from developing, but also help prevent the spread of HIV and other sexually transmitted infections (STIs) among adolescents.

Over 3 million new cases of STIs occur among teenagers each year in the United States, with people under the age of 25 accounting for half of all new human immunodeficiency virus (HIV) infections. African Americans are at particular risk. In 2003 African Americans represented approximately twelve percent of the U.S. population, but, according to the Centers for Disease Control and Prevention (CDC), made up fifty percent of HIV/AIDS cases diagnosed. Such prevalence reflects the high rates of HIV risk behaviors among African American teenagers.

In addition, the authors note that recent survey data suggest that African American high school students are more likely than their Hispanic or Caucasian counterparts to have had sexual intercourse (67% vs. 51% vs. 42%, respectively) and more likely to have had four or more lifetime sex partners (29% vs. 16% vs. 11%, respectively).

"We also found that older adolescents and females were less likely to use condoms consistently and certain contextual factors, such as less pleasurable expectations about condom use, and living with a partner also heightened the risk of HIV," says Brown.

As a result, the authors say that clinicians should assess for depression symptoms in African American adolescent patients as an indicator of future sexual risk.

"Prevention interventions that address depressed mood could have a significant impact on later HIV/STI sexual risk behaviors. Further research is needed to understand the effect of depressive symptoms on sexual risk among adolescents of other race/ethnicities and to examine the potential cultural forces that affect this relationship," they note.

Inquiring about particular partner's attitudes and the adolescents' perception of the fit and feel of condoms can help clinicians accurately assess for adolescent HIV risk without adding much burden to clinical screening interviews.
This study is part of a large multi-site HIV study that involves participants from Florida, Georgia and Rhode Island (although these particular results were from Rhode Island and Georgia only).

Founded in 1931, Bradley Hospital ( was the nation's first psychiatric hospital operating exclusively for children. Today, it remains a premier medical institution devoted to the research and treatment of childhood psychiatric illnesses. Bradley Hospital, located in Providence, RI, is a teaching hospital for Brown Medical School and ranks in the top third of private hospitals receiving funding from the National Institutes of Health. Its research arm, the Bradley Hasbro Children's Research Center (BHCRC), brings together leading researchers in such topics as: autism, colic, childhood sleep patterns, HIV prevention, infant development, obesity, eating disorders, depression, obsessive-compulsive disorder (OCD) and juvenile firesetting. Bradley Hospital is a member of the Lifespan health system.


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