Journal of Child and Family Studies

, Volume 26, Issue 6, pp 1635–1645 | Cite as

Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors

  • Bridgette M. BrawnerEmail author
  • Loretta Sweet Jemmott
  • Gina Wingood
  • Janaiya Reason
  • Bridget Daly
  • Kiahana Brooks
  • Yzette Lanier
Original Paper


Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention models may not address psychological complexities among adolescents with mental illnesses. This study examined contextual factors related to HIV/STI risk among heterosexually active Black adolescents with mental illnesses to inform the development of targeted HIV/STI prevention strategies. Black adolescent males and females (aged 14–17) were recruited from outpatient mental health programs in Philadelphia, PA to complete a computer-assisted personalized interview on sociodemographics, sexual behaviors, and emotion regulation (N = 53). Two sample t-tests, Wilcoxon Rank Sum tests and regression modeling were used to examine differences in the study measures by gender and relationship status. Reports of sexual partner concurrency were high—both while already in a sexual relationship (67.3%) and multiple sexual partners in the same day (42.3%). Boys reported significantly more risk behaviors than girls. Sadness dysregulation predicted currently being in a relationship, older age at first oral sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters. Coping difficulties predicted a greater number of vaginal and oral sexual partners, and a lower age at first vaginal sex. Increasing depression severity was related to older age at first vaginal sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters in the past 3 months. This formative work suggests that coping mechanisms should be addressed in HIV/STI prevention research through the inclusion of activities targeted toward emotion regulation and decreasing sexual risk behaviors. Psycho-education and skills building may mitigate the psychopathology that contributes to HIV/STI risk in the target demographic.


Adolescents Depression Emotion regulation HIV prevention Sexual partner concurrency 



This research was funded by the Centers for Disease Control and Prevention (Minority AIDS Research Initiative) grant # U01PS003304 awarded to Dr. Brawner. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors would like to acknowledge Naixue Cui and Rose Lu for their assistance with the data analyses. They are also grateful to the study participants, and thank the Made Aware with Care (MAC) research team and youth community advisory board for their assistance with data collection.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interest.

Ethical approval

This research involved participation of human participants and was approved by the Institutional Review Boards (IRBs) at the University of Pennsylvania and the Philadelphia Department of Public Health.

Informed consent

Informed consent was obtained from all participants. In the state of Pennsylvania, youth aged 14 and older can consent to both HIV/STI testing and mental health treatment, thus parental permission was not required for participation and participants consented rather than assented to the study (Juvenille Law Center 2006).


  1. Adimora, A. A., Schoenbach, V. J., Taylor, E. M., Khan, M. R., Schwartz, R. J., & Miller, W. C. (2013). Sex ratio, poverty, and concurrent partnerships among men and women in the United States: A multilevel analysis. Annals of Epidemiology, 23(11), 716–719. doi: 10.1016/j.annepidem.2013.08.002.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Aggleton, P., & Campbell, C. (2000). Working with young people-towards an agenda for sexual health. Sexual and Relationship Therapy, 15(3), 283–296. doi: 10.1080/14681990050109863.CrossRefGoogle Scholar
  3. Blank, M. B., Hennessy, M., & Eisenberg, M. M. (2014). Increasing quality of life and reducing HIV burden: The PATH+ intervention. AIDS and Behavior, 18(4), 716–725. doi: 10.1007/s10461-013-0606-x.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Boily, M.-C., Alary, M., & Baggaley, R. (2012). Neglected issues and hypotheses regarding the impact of sexual concurrency on HIV and sexually transmitted infections. AIDS and Behavior, 16(2), 304–311. doi: 10.1007/s10461-011-9887-0.CrossRefPubMedGoogle Scholar
  5. Braje, S. E., Eddy, J. M., & Hall, G. C. N. (2015). A comparison of two models of risky sexual behavior during late adolescence. Archives of Sexual Behavior, 45(1), 73–83. doi: 10.1007/s10508-015-0523-3.CrossRefPubMedGoogle Scholar
  6. Brawner, B. M., Alexander, K. A., Fannin, E. F., Baker, J. L., & Davis, Z. M. (2016a). The role of sexual health professionals in developing a shared concept of risky sexual behavior as it relates to HIV transmission. Public Health Nursing, 33(2), 139–150. doi: 10.1111/phn.12216.CrossRefPubMedGoogle Scholar
  7. Brawner, B. M., Davis, Z. M., Fannin, E. F., & Alexander, K. A. (2012a). Clinical depression and condom use attitudes and beliefs among African American adolescent females. Journal of the Association of Nurses in AIDS Care, 23(3), 184–194. doi: 10.1016/j.jana.2011.03.005.CrossRefPubMedGoogle Scholar
  8. Brawner, B. M., Fannin, E. F., Reason, J. L., & Weissinger, G. (2016b). Addressing unmet sexual health needs among black adolescents with mental illnesses. Journal of Black Sexuality and Relationships, 2(3), 75–91. doi: 10.1353/bsr.2016.0007.CrossRefGoogle Scholar
  9. Brawner, B. M., Gomes, M. M., Jemmott, L. S., Deatrick, J. A., & Coleman, C. L. (2012b). Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: Unmasking the numbers. AIDS Care, 24(5), 618–625. doi: 10.1080/09540121.2011.630344.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Brown, L. K., DiClemente, R., Crosby, R., Fernandez, M. I., Pugatch, D., & Cohn, S., et al. (2008). Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms. Public Health Reports, 123(5), 601–607.PubMedPubMedCentralGoogle Scholar
  11. Brown, J. L., Sales, J. M., Swartzendruber, A. L., Eriksen, M. D., DiClemente, R. J., & Rose, E. S. (2014a). Added benefits: Reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention. Journal of Behavioral Medicine, 37(5), 912–920. doi: 10.1007/s10865-013-9551-4.CrossRefPubMedGoogle Scholar
  12. Brown, L. K., Hadley, W., Donenberg, G. R., DiClemente, R. J., Lescano, C., & Lang, D. M., et al. (2014b). Project STYLE: A multisite RCT for HIV prevention among youths in mental health treatment. Psychiatric Services, 65(3), 338–344. doi: 10.1176/ Scholar
  13. Brown, L. K., Hadley, W., Stewart, A., Lescano, C., Whiteley, L., Donenberg, G., & DiClemente, R. (2010). Psychiatric disorders and sexual risk among adolescents in mental health treatment. Journal of Consulting and Clinical Psychology, 78(4), 590–597. doi: 10.1037/a0019632.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Centers for Disease Control and Prevention (2014). Youth Risk Behavior Surveillance--United States, 2013 Retrieved February 9, 2016, from
  15. Centers for Disease Control and Prevention (CDC) (2013). HIV surveillance — Adolescents and young adults. National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention Retrieved February 9, 2016, from
  16. Cubbin, C., Brindis, C. D., Jain, S., Santelli, J., & Braveman, P. (2010). Neighborhood poverty, aspirations and expectations, and initiation of sex. Journal of Adolescent Health, 47(4), 399–406. doi: 10.1016/j.jadohealth.2010.02.010.CrossRefPubMedGoogle Scholar
  17. DiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Brown, L. K., & Rothbaum, B., et al. (2001). A prospective study of psychological distress and sexual risk behavior among black adolescent females. Pediatrics, 108(5), e85.CrossRefPubMedGoogle Scholar
  18. Donenberg, G. R., Emerson, E., Brown, L. K., Houck, C., & Mackesy-Amiti, M. E. (2012). Sexual experience among emotionally and behaviorally disordered students in therapeutic day schools: An ecological examination of adolescent risk. Journal of Pediatric Psychology, 37(8), 904–913. doi: 10.1093/jpepsy/jss056.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Ford, K., Sohn, W., & Lepkowski, J. (2002). American adolescents: Sexual mixing patterns, bridge partners, and concurrency. Sexually Transmitted Diseases, 29(1), 13–19.CrossRefPubMedGoogle Scholar
  20. Goyal, M. K., Dowshen, N., Mehta, A., Hayes, K., Lee, S., & Mistry, R. D. (2013). Pediatric primary care provider practices, knowledge, and attitudes of human immunodeficiency virus screening among adolescents. The Journal of Pediatrics, 163(6), 1711–1715. doi: 10.1016/j.jpeds.2013.08.023.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Grieb, S. D., Davey-Rothwell, M., & Latkin, C. (2012). Concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS and Behavior, 16(2), 323–333. doi: 10.1007/s10461-011-9954-6.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Hess, K. L., Gorbach, P. M., Manhart, L. E., Stoner, B. P., Martin, D. H., & Holmes, K. K. (2012). Risk behaviours by type of concurrency among young people in three STI clinics in the United States. Sexual Health, 9(3), 280–287. doi: 10.1071/SH11047.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Jackson, J. M., Seth, P., DiClemente, R. J., & Lin, A. (2015). Association of depressive symptoms and substance use with risky sexual behavior and sexually transmitted infections among African American female adolescents seeking sexual health care. American Journal of Public Health, 105(10), 2137–2142. doi: 10.2105/ajph.2014.302493.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Jørgensen, M. J., Maindal, H. T., Larsen, M. B., Christensen, K. S., Olesen, F., & Andersen, B. (2015). Chlamydia trachomatis infection in young adults—association with concurrent partnerships and short gap length between partners. Infectious Diseases, 47(12), 838–845. doi: 10.3109/23744235.2015.1071916.CrossRefPubMedGoogle Scholar
  25. Juvenille Law Center. (2006). Consent to treatment and confidentiality provisions affecting minors in Pennsylvania (2nd ed.). Philadelphia, PA: Juvenille Law Center. Google Scholar
  26. Kissinger, P., Rice, J., Farley, T., Trim, S., Jewitt, K., Margavio, V., & Martin, D. (1999). Application of computer-assisted interviews to sexual behavior research. American Journal of Epidemiology, 149, 950–954.CrossRefPubMedGoogle Scholar
  27. Kraft, J. M., Kulkarni, A., Hsia, J., Jamieson, D. J., & Warner, L. (2012). Sex education and adolescent sexual behavior: Do community characteristics matter? Contraception, 86(3), 276–280. doi: 10.1016/j.contraception.2012.01.004.CrossRefPubMedGoogle Scholar
  28. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lee, S., O’Riordan, M., & Lazebnik, R. (2009). Relationships among depressive symptoms, sexually transmitted infections, and pregnancy in African-American adolescent girls. Journal of Pediatric and Adolescent Gynecology, 22(1), 19–23. doi: 10.1016/j.jpag.2007.12.003.CrossRefPubMedGoogle Scholar
  30. Lehrer, J. A., Shrier, L. A., Gortmaker, S., & Buka, S. (2006). Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics, 118(1), 189–200. doi: 10.1542/peds.2005-1320.CrossRefPubMedGoogle Scholar
  31. Lilleston, P. S., Hebert, L. E., Jennings, J. M., Holtgrave, D. R., Ellen, J. M., & Sherman, S. G. (2015). Attitudes towards power in relationships and sexual concurrency within heterosexual youth partnerships in Baltimore, MD. AIDS and Behavior, 19(12), 2280–2290. doi: 10.1007/s10461-015-1105-z.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 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(4), 601–603. doi: 10.1016/j.jadohealth.2006.02.004.CrossRefPubMedGoogle Scholar
  33. Morrison-Beedy, D., Carey, M. P., Crean, H. F., & Jones, S. H. (2011). Risk behaviors among adolescent girls in an HIV prevention trial. Western Journal of Nursing Research, 33(5), 690–711.CrossRefPubMedGoogle Scholar
  34. Nelson, S. J., Manhart, L. E., Gorbach, P. M., Martin, D. H., Stoner, B. P., Aral, S. O., & Holmes, K. K. (2007). Measuring sex partner concurrency: It’s what’s missing that counts. Sexually Transmitted Diseases, 34(10), 801–807. doi: 10.1097/OLQ.0b013e318063c734.PubMedGoogle Scholar
  35. Paxton, K. C., & Robinson, W. L. (2008). Depressive symptoms, gender, and sexual risk behavior among African-American adolescents. Journal of Prevention & Intervention in the Community, 35(2), 49–62. doi: 10.1300/J005v35n02_05.CrossRefGoogle Scholar
  36. Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., & Brown, G., et al. (2008). ColumbiaPlease provide place of publication in Reference (Posner et al. 2008).-suicide severity rating scale (C-SSRS). New York: New York State Psychiatric Institute.Google Scholar
  37. Quinn, C., Happell, B., & Browne, G. (2011). Talking or avoiding? Mental health nurses’ views about discussing sexual health with consumers. International Journal of Mental Health Nursing, 20(1), 21–28. doi: 10.1111/j.1447-0349.2010.00705.x.CrossRefPubMedGoogle Scholar
  38. Raiford, J. L., Herbst, J. H., Carry, M., Browne, F. A., Doherty, I., & Wechsberg, W. M. (2014). Low prospects and high risk: Structural determinants of health associated with sexual risk among young African American women residing in resource-poor communities in the South. American Journal of Community Psychology, 54(3-4), 243–250. doi: 10.1007/s10464-014-9668-9.CrossRefPubMedGoogle Scholar
  39. Reece, M., Herbenick, D., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. The Journal of Sexual Medicine, 7(S5), 266–276. doi: 10.1111/j.1743-6109.2010.02017.x.CrossRefPubMedGoogle Scholar
  40. Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., & Russo, J. E., et al. (2010). Evaluation of the patient health questionnaire-9 item for detecting major depression among adolescents. Pediatrics, 126(6), 1117–1123. doi: 10.1542/peds.2010-0852.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Sales, J. M., Lang, D. L., Hardin, J. W., DiClemente, R. J., & Wingood, G. M. (2010a). Efficacy of an HIV prevention program among African American female adolescents reporting high depressive symptomatology. Journal of Women’s Health, 19(2), 219–227. doi: 0.1089/jwh.2008.1326.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Sales, J. M., Latham, T. P., Diclemente, R. J., & Rose, E. (2010b). Differences between dual-method and non-dual-method protection use in a sample of young African American women residing in the Southeastern United States. Archives of Pediatriacs and Adolescent Medicine, 164(12), 1125–1131. doi: 10.1001/archpediatrics.2010.230.Google Scholar
  43. SAS Institute Inc. (2012). Base SAS® 9.3 Procedures Guide. Cary, NC: SAS Institute Inc.Google Scholar
  44. Seth, P., Patel, S. N., Sales, J. M., DiClemente, R. J., Wingood, G. M., & Rose, E. S. (2011). The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents. Psychology, Health, and Medicine, 16(3), 346–356. doi: 10.1080/13548506.2011.554562.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Seth, P., Raiji, P. T., DiClemente, R. J., Wingood, G. M., & Rose, E. (2009). Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents. Psychology, Health & Medicine, 14(3), 291–300. doi: 10.1080/13548500902730119.CrossRefGoogle Scholar
  46. Shrier, L. A., Walls, C., Lops, C., & Feldman, H. A. (2011). Correlates of incorrect condom use among depressed young women: An event-level analysis. Journal of pediatric and adolescent gynecology, 24(1), 10–14. doi: 10.1016/j.jpag.2010.04.002.CrossRefPubMedGoogle Scholar
  47. Slinkard, M. S., & Kazer, M. W. (2011). Older adults and HIV and STI screening: The patient perspective. Geriatric Nursing, 32(5), 341–349. doi: 10.1016/j.gerinurse.2011.05.002.CrossRefPubMedGoogle Scholar
  48. Spiegel, H. M., & Futterman, D. C. (2009). Adolescents and HIV: prevention and clinical care. Current HIV/AIDS Reports, 6(2), 100–107.CrossRefPubMedGoogle Scholar
  49. Substance Abuse and Mental Health Services Administration (SAMSHA) (2015). Results from the 2014 National Survey on Drug Use and Health: National Findings, from
  50. Swenson, R. R., Rizzo, C. J., Brown, L. K., Vanable, P. A., Carey, M. P., & Valois, R. F., et al. (2010). HIV knowledge and its contribution to sexual health behaviors of low-income African American adolescents. Journal of the National Medical Association, 102(12), 1173.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Tice, D. M., Bratslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation takes precedence over impulse control: If you feel bad, do it! Journal of Personality & Social Psychology, 80(1), 53–67.CrossRefGoogle Scholar
  52. Towner, S. L., Dolcini, M. M., & Harper, G. W. (2015). Romantic relationship dynamics of urban African American adolescents: Patterns of monogamy, commitment, and trust. Youth & Society, 47(3), 343–373. doi: 10.1177/0044118x12462591.CrossRefGoogle Scholar
  53. Zeman, J., Shipman, K., & Penza-Clyve, S. (2001). Development and initial validation of the Children’s Sadness Management Scale. Journal of Nonverbal Behavior, 25(3), 187–205.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaUSA
  2. 2.Health and Health EquityDrexel UniversityPhiladelphiaUSA
  3. 3.Columbia University Mailman School of Public HealthNew YorkUSA
  4. 4.Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaUSA
  5. 5.New York University School of NursingNew YorkUSA

Personalised recommendations