Archives of Sexual Behavior

, Volume 42, Issue 5, pp 863–872 | Cite as

The Relationship Between Multiple Sex Partners and Anxiety, Depression, and Substance Dependence Disorders: A Cohort Study

  • Sandhya Ramrakha
  • Charlotte Paul
  • Melanie L. Bell
  • Nigel Dickson
  • Terrie E. Moffitt
  • Avshalom Caspi
Original Paper

Abstract

Changes in sexual behavior have resulted in longer periods of multiple serial or concurrent relationships. This study investigated the effects of multiple heterosexual partners on mental health, specifically, whether higher numbers of partners were linked to later anxiety, depression, and substance dependency. Data from the Dunedin Multidisciplinary Health and Development Study, a prospective, longitudinal study of a birth cohort born in 1972–1973 in Dunedin, New Zealand were used. The relationship between numbers of sex partners over three age periods (18–20, 21–25, and 26–32 years) and diagnoses of anxiety, depression, and substance dependence disorder at 21, 26, and 32 years were examined, using logistic regression. Interaction by gender was examined. Adjustment was made for prior mental health status. There was no significant association between number of sex partners and later anxiety and depression. Increasing numbers of sex partners were associated with increasing risk of substance dependence disorder at all three ages. The association was stronger for women and remained after adjusting for prior disorder. For women reporting 2.5 or more partners per year, compared to 0–1 partners, the adjusted odd ratios (and 95 % CIs) were 9.6 (4.4–20.9), 7.3 (2.5–21.3), and 17.5 (3.5–88.1) at 21, 26, and 32 years, respectively. Analyses using new cases of these disorders showed similar patterns. This study established a strong association between number of sex partners and later substance disorder, especially for women, which persisted beyond prior substance use and mental health problems more generally. The reasons for this association deserve investigation.

Keywords

Sex partners Sexual behavior Anxiety Depression Substance use 

References

  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (Third ed., rev.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  3. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.PubMedCrossRefGoogle Scholar
  4. Aral, S. O. (2006). Social and behavioral determinants of sexually transmitted disease: Scientific and technologic advances, demography, and the global political economy. Sexually Transmitted Diseases, 33, 698–702.PubMedCrossRefGoogle Scholar
  5. Arnett, J. J. (1992). Reckless behavior in adolescence: A developmental perspective. Developmental Review, 12, 339–373.CrossRefGoogle Scholar
  6. Bachanas, P. J., Morris, M. K., Lewis-Gess, J. K., Sarett-Cuasay, E. J., Flores, A. L., Sirl, K. S., & Sawyer, M. K. (2002). Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: Developmental differences during adolescence. Journal of Pediatric Psychology, 27, 373–384.Google Scholar
  7. Baskin-Sommers, A., & Sommers, I. (2006). The co-occurrence of substance use and high risk behaviors. Journal of Adolescent Health, 38, 609–611.PubMedCrossRefGoogle Scholar
  8. Blythe, M. J., Fortenberry, J. D., Temkit, M., Tu, W., & Orr, D. P. (2006). Incidence and correlates of unwanted sex in relationships of middle and late adolescence women. Archives of Pediatric Medicine, 160, 591–595.CrossRefGoogle Scholar
  9. Boden, J. M., Fergusson, D. M., & Horwood, L. J. (2010). Alcohol and STI risk: Evidence from a New Zealand longitudinal birth cohort. Drug and Alcohol Dependence, 113, 200–206.PubMedCrossRefGoogle Scholar
  10. Bohon, C., Garber, J., & Horowitz, J. L. (2007). Predicting school dropout and adolescent sexual behavior in offspring of depressed and non-depressed mothers. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 15–24.PubMedCrossRefGoogle Scholar
  11. Boyer, C. B., Shafer, M., Wibbelsman, C. J., Seeberg, D., Teitle, E., & Lowell, N. (2000). Associations of sociodemographic, psychosocial, and behavioral factors with sexual risk and sexually transmitted diseases in teen clinic patients. Journal of Adolescent Health, 27, 102–111.PubMedCrossRefGoogle Scholar
  12. Brook, J. S., Balka, E. B., & Whiteman, M. (1999). The risks for late adolescence of early adolescent marijuana use. American Journal of Public Health, 89, 1549–1554.PubMedCrossRefGoogle Scholar
  13. Brown, L. K., Tolou-Shams, M., Lescano, C., Houck, C., Zeidman, J., Pugatch, D., et al. (2006). Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults. Journal of Adolescent Health, 39, 444e1–444e8.Google Scholar
  14. Carroll, J. L., Volk, K. D., & Hyde, J. S. (1985). Differences between males and females in motives for engaging in sexual intercourse. Archives of Sexual Behavior, 14, 131–139.PubMedCrossRefGoogle Scholar
  15. Caspi, A., Begg, D., Dickson, N., Harrington, H., Langley, J., Moffit, T. E., & Silva, P. A. (1997). Personality differences predict health-risk behaviors in young adulthood: Evidence from a longitudinal study. Journal of Personality and Social Psychology, 73, 1052–1063.Google Scholar
  16. Cavazos-Rehg, P. A., Spitznagel, E. L., Bucholz, K. K., Norberg, K., Reich, W., Numberger, J., et al. (2007). The relationship between alcohol problems and dependence, conduct problems and diagnosis, and number of sex partners in a sample of young adults. Alcoholism, Clinical and Experimental Research, 31, 2046–2052.PubMedCrossRefGoogle Scholar
  17. Centers for Disease Control and Prevention. (2005). Trends in reportable sexually transmitted disease in the United States, 2004. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
  18. Cooper, M. L., Shapiro, C. M., & Powers, A. M. (1998). Motivations for sex and risky sexual behavior among adolescents and young adults: A functional perspective. Journal of Personality and Social Psychology, 75, 1528–1558.PubMedCrossRefGoogle Scholar
  19. Cornelius, J. R., Clark, D. B., Reynolds, M., Kirisci, L., & Tarter, R. (2007). Early age of first sexual intercourse predict development of SUD: A prospective longitudinal study. Addictive Behaviors, 32, 850–854.PubMedCrossRefGoogle Scholar
  20. Crawford, M., & Popp, D. (2003). Sexual double standards: A review and methodological critique of two decades of research. Journal of Sex Research, 40, 13–26.PubMedCrossRefGoogle Scholar
  21. Crepaz, N., & Marks, G. (2000). Are affective negative states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychology, 20, 291–299.CrossRefGoogle Scholar
  22. Crowe, L. C., & George, W. H. (1989). Alcohol and human sexuality: Review and integration. Psychological Bulletin, 105, 374–386.PubMedCrossRefGoogle Scholar
  23. Desiderato, L. L., & Crawford, H. J. (1995). Risky sexual behavior in college students: Relationships between number of sexual partners, disclosure of previous risky behavior, and alcohol use. Journal of Youth and Adolescence, 24, 55–68.CrossRefGoogle Scholar
  24. Dishion, T. J. (2000). Cross-setting consistency in early adolescent psychopathology: Deviant friendships and problem behavior sequelae. Journal of Personality, 68, 1109–1126.PubMedCrossRefGoogle Scholar
  25. Dogan, S. J., Stockdale, G. D., Widman, K. F., & Conger, R. D. (2010). Developmental relations and patterns of change between alcohol use and number of sexual partners from adolescence through adulthood. Developmental Psychology, 46, 1747–1759.PubMedCrossRefGoogle Scholar
  26. Donovan, J. E., & Jessor, R. (1985). Structure of problem behavior in adolescence and young adulthood. Journal of Consulting and Clinical Psychology, 53, 890–904.PubMedCrossRefGoogle Scholar
  27. Duncan, S. E., Strycker, L. A., & Duncan, T. E. (1999). Exploring associations in developmental trends of adolescent substance use and risky sexual behavior in a high-risk population. Journal of Behavioral Medicine, 22, 21–33.PubMedCrossRefGoogle Scholar
  28. Erbelding, E., Hummel, B., Hogan, T., & Zenlman, J. (2001). High rates of depressive symptoms in STD clinic patients. Sexually Transmitted Diseases, 28, 281–284.PubMedCrossRefGoogle Scholar
  29. Fergusson, D. M., & Lynskey, M. T. (1996). Alcohol misuse and adolescent sexual behaviors and risk taking. Pediatrics, 98, 91–96.PubMedGoogle Scholar
  30. Fromme, K., D’Amico, E. J., & Katz, E. C. (1999). Intoxicated sexual risk taking: An expectancy or cognitive impairment explanation? Journal of Studies on Alcohol, 60, 54–63.PubMedGoogle Scholar
  31. Grunseit, A. C., Richters, J., Crawford, J., Song, A., & Kippax, S. (2005). Stability and change in sexual practices among first-year Australian university students (1990–1999). Archives of Sexual Behavior, 34, 557–568.PubMedCrossRefGoogle Scholar
  32. Hallfors, D. D., Waller, M. W., Bauer, D., Ford, C. A., & Halpern, C. T. (2005). Which comes first in adolescence—sex and drugs or depression? American Journal of Preventive Medicine, 29, 163–170.PubMedCrossRefGoogle Scholar
  33. Humblet, O., Paul, C., & Dickson, N. (2003). Core group evolution over time: High-risk behavior in a birth cohort between sexual debut and age 26. Sexually Transmitted Diseases, 30, 818–824.PubMedCrossRefGoogle Scholar
  34. Hutton, H. E., Lyketsos, C. G., Zenilman, J. M., Thompson, R. E., & Erbelding, E. J. (2004). Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry, 161, 912–914.PubMedCrossRefGoogle Scholar
  35. Johnson, A. M., Wadsworth, J., Wellings, K., & Field, J. (1994). Sexual attitudes and lifestyle. Oxford: Blackwell.Google Scholar
  36. Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.PubMedCrossRefGoogle Scholar
  37. Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H. L., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder. Archives of General Psychiatry, 60, 709–717.PubMedCrossRefGoogle Scholar
  38. Långström, N., & Hanson, (2006). High rates of sexual behavior in the general population: Correlates and predictors. Archives of Sexual Behavior, 35, 37–52.PubMedCrossRefGoogle Scholar
  39. Lavan, H., & Johnson, J. G. (2002). The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence. Journal of Personality Disorders, 16, 73–94.PubMedCrossRefGoogle Scholar
  40. Mazzaferro, K. E., Murray, P. J., Ness, R. B., Bass, D. C., Tyus, N., & Cook, R. L. (2006). Depression, stress, and social support as predictors of high-risk sexual behaviors and STIs in young women. Journal of Adolescent Health, 39, 601–603.PubMedCrossRefGoogle Scholar
  41. McGue, M., & Iacono, W. G. (2005). The association of early adolescent problem behavior with adult psychopathology. American Journal of Psychiatry, 162, 1118–1124.PubMedCrossRefGoogle Scholar
  42. Meston, C. M., & Buss, D. M. (2007). Why humans have sex. Archives of Sexual Behavior, 36, 477–507.PubMedCrossRefGoogle Scholar
  43. Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A., & Poulton, R. (2007). Depression and generalized anxiety disorder. Archives of General Psychiatry, 64, 651–660.Google Scholar
  44. Mota, N. P., Cox, B. J., Katz, L. J., & Sareen, J. (2010). Relationship between mental disorders/suicidality and three sexual behaviours: Results from the National Comorbidity Survey Replication. Archives of Sexual Behavior, 39, 724–734.PubMedCrossRefGoogle Scholar
  45. Oliver, M. B., & Hyde, J. S. (1993). Gender differences in sexuality: A meta-analysis. Psychological Bulletin, 114, 29–51.PubMedCrossRefGoogle Scholar
  46. Page, R. M., Allen, O., Moore, L., & Hewitt, C. (1993). Co-occurrence of substance use and loneliness as a risk factor for adolescent hopelessness. Journal of School Health, 63, 104–108.PubMedCrossRefGoogle Scholar
  47. Ramrakha, S., Bell, M. L., Paul, C., Dickson, N., Moffitt, T. E., & Caspi, A. (2007). Childhood behavior problem linked to sexual risk taking in young adulthood: A birth cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1272–1279.PubMedCrossRefGoogle Scholar
  48. Ramrakha, S., Caspi, A., Dickson, N., Moffitt, T. E., & Paul, C. (2000). Psychiatric disorders and risky sexual behavior in young adulthood: Cross sectional study in birth cohort. British Medical Journal, 321, 263–266.PubMedCrossRefGoogle Scholar
  49. Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.PubMedCrossRefGoogle Scholar
  50. Sarigiani, P. A., Ryan, L., & Petersen, A. C. (1999). Prevention of high risk behaviors in adolescent women. Journal of Adolescent Health, 25, 109–119.PubMedCrossRefGoogle Scholar
  51. Shrier, L. A., Harris, S. K., & Beardslee, W. R. (2002). Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Archives of Pediatrics and Adolescent Medicine, 156, 599–606.PubMedCrossRefGoogle Scholar
  52. Sprecher, S., & Hatfield, E. (1996). Premarital sexual standards among U.S. college students: Comparisons with Russian and Japanese students. Archives of Sexual Behavior, 25, 261–287.PubMedCrossRefGoogle Scholar
  53. Spriggs, A. L., & Halpern, C. T. (2008). Sexual debut timing and depressive symptoms in emerging adulthood. Journal of Youth and Adolescence, 37, 1085–1096.PubMedCrossRefGoogle Scholar
  54. Stoner, S. A., George, W. H., Peters, L. M., & Norris, J. (2006). Liquid courage: Alcohol fosters risky sexual decision-making in individuals with sexual fears. AIDS and Behavior, 11, 227–237.CrossRefGoogle Scholar
  55. Taylor, J., Fulop, N., & Green, J. (1999). Drink, illicit drugs and unsafe sex in women. Addiction, 94, 1209–1218.PubMedCrossRefGoogle Scholar
  56. Tolman, D. (2002). Dilemmas of desire: Teenage girls talk about sexuality. Cambridge, MA: Harvard University Press.Google Scholar
  57. Valois, R. F., Oeltmann, J. E., Waller, J., & Hussey, J. R. (1999). Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents. Journal of Adolescent Health, 25, 328–335.PubMedCrossRefGoogle Scholar
  58. Weinhardt, L. S., & Carey, M. P. (2000). Does alcohol lead to sexual risk behavior? Findings from event-level research. Annual Review of Sex Research, 11, 125–157.PubMedGoogle Scholar
  59. Zenilman, J. M., Hook, E. W., Shepherd, M., Rompalo, A. M., & Celentano, D. D. (1994). Alcohol and other substance use in STD clinic patients: Relationships with STDs and prevalent HIV infection. Sexually Transmitted Diseases, 21, 220–225.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sandhya Ramrakha
    • 1
  • Charlotte Paul
    • 2
  • Melanie L. Bell
    • 2
    • 3
  • Nigel Dickson
    • 2
  • Terrie E. Moffitt
    • 4
    • 5
  • Avshalom Caspi
    • 4
    • 5
  1. 1.Dunedin Multidisciplinary Health and Development Research Unit, Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  2. 2.Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  3. 3.Psycho-Oncology Co-Operative Research Group, School of PsychologyUniversity of SydneySydneyAustralia
  4. 4.Departments of Psychology and Neuroscience and Psychiatry and Behavioral Sciences and Institute for Genome Sciences and PolicyDuke UniversityDurhamUSA
  5. 5.Social, Genetic, and Developmental Psychiatry Research Centre, Institute of PsychiatryKings CollegeLondonUK

Personalised recommendations