Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 189-200 (doi:10.1542/10.1542/peds.2005-1320)
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Depressive Symptoms as a Longitudinal Predictor of Sexual Risk Behaviors Among US Middle and High School Students

Jocelyn A. Lehrer, ScDa, Lydia A. Shrier, MD, MPHb, Steven Gortmaker, PhDc and Stephen Buka, ScDc

a Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, California
b Division of Adolescent Medicine, Harvard Medical School, Children’s Hospital Boston, Boston, Massachusetts
c Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts

OBJECTIVE. The purpose of this study was to examine whether depressive symptoms are predictive of subsequent sexual risk behavior in a national probability sample of US middle and high school students.

METHODS. Sexually active, unmarried, middle and high school students (n = 4152) participated in home interviews in waves I and II of the National Longitudinal Study of Adolescent Health, at an ~1-year interval. Associations between baseline depressive symptoms and sexual risk behaviors over the course of the following year were examined separately for boys and girls, adjusting for demographic variables, religiosity, same-sex attraction/behavior, sexual intercourse before age 10, and baseline sexual risk behavior.

RESULTS. In adjusted models, boys and girls with high depressive symptom levels at baseline were significantly more likely than those with low symptom levels to report ≥1 of the examined sexual risk behaviors over the course of the 1-year follow-up period. For boys, high depressive symptom levels were specifically predictive of condom nonuse at last sex, birth control nonuse at last sex, and substance use at last sex; these results were similar to those of parallel analyses with a continuous depression measure. For girls, moderate depressive symptoms were associated with substance use at last sex, and no significant associations were found between high depressive symptom levels and individual sexual risk behaviors. Parallel analyses with the continuous depression measure found significant associations for condom nonuse at last sex, birth control nonuse at last sex, ≥3 sexual partners, and any sexual risk behavior.

CONCLUSION. In this study, depressive symptoms predicted sexual risk behavior in a national sample of male and female middle and high school students over a 1-year period.

Key Words: adolescents • depressive symptoms • depression • sexual behavior • unsafe sex • HIV

Abbreviations: SRB—sexual risk behavior(s) • STI—sexually transmitted infection(s) • CES-D—Center for Epidemiologic Studies-Depression Scale • CI—confidence interval • A-CASI—audio-computer-assisted self-interview

Accepted Jan 3, 2006.


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