Nation’s First Collaborative School of Public Health Relationship between multiple sexual partners and depression in adolescent females? Authors: Tyree Oredein, MPH & Cristine D. Delnevo, PhD, MPH University of Medicine and Dentistry of New Jersey-School of Public Health (UMDNJ-SPH) Abstract Results cont’d Results cont’d Depression affects as many as 28% of youth in the United States, the majority being females. Previous studies have found a relationship between adolescent depression and age at first intercourse, history of sexual abuse, pregnancy, and STIs. However little research explicitly examined the relationship between multiple sexual partners and depression. This study used nationally representative data from the 2003 Youth Risk Behavior Survey to explore the relationship between the number of lifetime sexual partners and symptoms of depression among adolescent females. Results showed that there is a relationship between number of lifetime sexual partners and depressive symptoms. Reports of sadness, suicidal ideation, and suicide plans and attempts increased with the number of partners. While the association existed across all racial and ethnic groups, the relationship was less dramatic for non-Hispanic African-Americans even though they were more likely to be sexually active. It is possible that teenage girls presenting with depressive symptoms may be engaging in more sexual activity and thus putting themselves at increased risk for HIV/STIs and pregnancy. Conversely, young females that are engaging in sexual activities with multiple partners may be at increased risk for depression and/or suicide. African-American+ females had the most sexual partners (Table 1). 35.5% of all females reported feeling sad for at least two consecutive weeks so that they stopped doing their usual activities (Table 1). Hispanic females were significantly more likely to report feeling sad, report making a suicide plan, and attempting suicide than African-American+ and Caucasian+ females (Table 1). African-American+ females were significantly less likely to report suicidal ideation than non-African-American females (Table 1). For all symptoms, African-American+ females had lower odds compared to Caucasian+ females (Table 3). The adjusted odds for each of the four mental health indicators increased as the number of lifetime sexual partners increased, relative to those with no sexual partners (Table 3). The greatest odds for each of the four symptoms were for those with 3 or more lifetime partners (Table 3). 10th, 11th and 12th graders were significantly less likely to report depressive symptoms than 9th graders (Table 3). Table 2: Adjusted odds ratios (OR) for depressive symptoms and suicidal gestures according to number of sexual partners within each ethnicity while controlling for grade and age (*p<.05) Discussion On average African-American+ females had the highest number of sex partners when compared to non- African-Americans+. Hispanic females had the highest frequency of reporting depressive where African-American females had the lowest frequency. There is a relationship between symptoms of depression and number of sexual partners. As the number of lifetime sexual partners increases, the prevalence of sadness, suicide ideation, making a suicide plan, and attempting suicide also increases. This relationship between depressive symptoms and number of sexual partners occurred across all ethnic and racial categories, though the trend was less in African-American+ females. This could be due to underreporting of symptoms because presentation of mental health symptoms continues to remain taboo in the African-American+ community. The trend between sexual partners and depressive symptoms is most prominent in Hispanics. There may be an over-reporting of symptoms as the Hispanic culture is often viewed as very emotive and expressive. The relationship is difficult to untangle because overall, adolescent females with multiple sexual partners may later feel depressed because of their behaviors. The contrary could be true as well where young females who are suffering from depressive symptoms might self-medicate by engaging in sexual activities in an attempt to alleviate their mental anguish. Sad Ideation Plan Attempt OR 95% CI Caucasian+ 0 partners 1.00 1.00-1.00 1 partner 2.13* 1.68-2.70 2.62* 1.89-3.64 1.48-3.05 3.08* 1.75-5.41 2 partner 2.48* 1.83-3.34 2.39* 1.70-3.36 2.00* 1.31-3.06 2.17* 1.29-3.67 3+ partner 3.51* 2.78-4.45 3.98* 2.87-5.52 3.54* 2.4-4.74 5.17* 3.50-7.66 African-American+ 1.28 0.78-2.11 1.15 0.75-1.77 1.47 0.84-2.57 1.49 0.54-4.09 2.76* 1.46-5.22 2.71* 1.20-6.12 3.40* 1.57-7.40 5.54* 2.19-14.02 2.55* 1.78-3.65 3.56* 2.27-5.60 4.16* 2.43-7.11 6.31* 3.02-13.17 Hispanic 1.52 0.96-2.39 2.07* 1.28-3.34 1.44 0.79-2.61 2.32* 1.28-4.21 2.52-3.57 2.33* 1.16-4.69 1.82* 1.12-2.95 3.25* 1.69-6.25 2.67* 1.79-4.00 2.25-5.56 3.34* 2.18-5.14 6.10* 3.40-10.95 Other 1.27 0.42-3.80 0.19* 0.05-0.75 1.23 0.31-4.92 0.52-2.92 0.71 0.19-2.61 0.87 0.21-3.63 2.09 0.55-7.95 4.38* 1.95-9.85 2.35* 1.22-4.52 2.20* 1.08-4.47 6.38* 2.09-19.48 Introduction Depression is estimated to affect as many as 28% of adolescents. Females are 2 to 3 times more likely to suffer from depression than males. Adolescent depression has been linked to violence, smoking, substance use, eating behaviors, suicide risk, and sexual activities including lack of condom use, history of sexual abuse, STIs, pregnancy, and age at first intercourse. International studies found an association between depression and the number of sexual partners, but few studies in the U.S. have explored this relationship. This study examined the relationship between the number of sexual partners and depression in adolescent females. Methods This study used data from the 2003 Youth Risk Behavior Survey (YRBS) which gathers information on risk behaviors among high school students in the U.S. The number of female respondents in this sample were 7361. Five items from the YRBS were used to explore the relationship between the number of sexual partners and depressive symptoms: The first item inquired about the number of lifetime sexual partners. The four remaining items were used as proxies to measure symptoms of depression (in the last 12 months): feeling sad for two or more consecutive weeks so that they stopped doing some usual activities; considering attempting suicide (suicidal ideation); making a suicide plan; and suicide attempt. Females with at least one sexual partner reported more symptoms of depression than those with no sexual partners (Table 2). Females with 3 or more partners were significantly more likely to report depressive symptoms than those with fewer partners (Table 2). The trend existed across all racial and ethnic categories with African-American+ females having the lowest effect (Table 2). Limitations The YRBS uses a cross-sectional study design. The YRBS is not designed to diagnose depression. The YRBS does not inquire about current psychotropic medications individuals might be taking, nor does it consider other mental health disorders, such as bipolar disorder, schizophrenia, or borderline personality disorder. Suicidal ideation, plans, and attempts are not limited to depression, and can be indicative of other mental health conditions. The YRBS does not survey absent/truant youth who may be different than those who participated. Due to local policies, some schools omitted sensitive questions regarding sexual history. Table 3. Adjusted odds ratios (OR) for depressive symptoms and suicidal gestures according to race, grade level and number of sexual partners (*p<.05) Results Table 1: Prevalence of lifetime sexual partners, sadness, suicidal ideation, suicide plan, and suicide attempts within the past 12 months among U.S. high school females (YRBS, 2003) Sad Ideation Plan Attempt OR 95% CI Caucasian+ 1.00 1.00-1.00 African-American+ 0.70* 0.55-0.89 0.47* 0.36-0.62 0.59* 0.44-0.81 0.40-.086 Hispanic 1.64* 1.25-2.15 1.02 0.82-1.27 1.16 0.91-1.48 1.34 0.97-1.85 Other 1.39* 1.03-1.89 1.40 0.95-1.07 1.82* 1.05-3.14 1.72* 1.01-2.94 9th grade 10th grade 0.89 0.71-1.11 0.92 0.72-1.17 0.91 0.72-1.15 0.68* 0.50-0.93 11th grade 0.83 0.67-1.03 0.66* 0.48-0.90 0.62* 0.42-.092 0.44* 0.29-0.66 12th grade 0.50-0.70 0.58* 0.44-0.75 0.56* 0.43-0.73 0.29* 0.20-0.42 0 partners 1partner 1.84* 1.84-2.23- 2.20* 1.67-2.90 1.62* 1.22-2.15 2.58* 1.61-4.14 2 partner 2.44* 1.89-3.13 2.25* 1.66-3.05 1.94* 1.46-2.58 2.72* 1.89-3.92 3+partner 3.23* 2.68-3.89 3.36* 2.85-4.70 3.30* 2.57-4.24 5.50* 3.83-7.92 Total (%) CI Black+ White+ Hispanic Other Life Sex Partners None 54.7 2.6 39.5 4.1 57.1 3.2 53.6 3.6 65.0 7.7 1 person 18.8 1.4 18.2 18.9 2.0 22.2 2.2 11.7 4.4 2 people 9.0 1.1 14.8 2.3 8.5 1.2 7.9 1.5 6.4 2.7 3+ people 17.4 1.8 27.5 4.5 15.6 1.9 16.4 17.0 6.1 Sadness 35.5 2.5 30.8 3.1 33.3 3.8 44.9 4.0 39.9 5.9 Suicide Thoughts 21.2 14.7 23.4 28.1 6.6 Suicide Plan 12.4 18.6 4.9 20.7 3.7 28.2 7.1 Suicide Attempts 11.4 10.3 15.0 17.6 7.4 Implications Practitioners with adolescent female clients should screen girls engaging in sex with multiple partners for depression, as they may be at higher risk for depression and/or suicide. Mental health workers with adolescent female clients should address sexual health as they may be at increased risk for HIV, STDs, pregnancy and other physical, mental, and emotional consequences associated with multiple sexual partners. + = non-Hispanic Nation’s First Collaborative School of Public Health