Skip to main content

Advertisement

SpringerLink
Log in

Psychological Distress, Substance Use, and HIV/STI Risk Behaviors Among Youth

  • Empirical Research
  • Published:
Journal of Youth and Adolescence Aims and scope Submit manuscript

Abstract

Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.

    Article  PubMed  Google Scholar 

  • Armstrong, T. D., & Costello, E. J. (2002). Community studies of adolescent substance use, abuse or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology, 70, 1224–1239.

    Article  PubMed  Google Scholar 

  • Bachanas, P., Morris, M., Lewis-Gess, J., Sarett-Cuasay, E. J., Flores, A. L., Sirl, K., et al. (2002a). Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: Developmental differences during adolescence. Journal of Pediatric Psychology, 27(4), 373–384.

    Article  PubMed  Google Scholar 

  • Bachanas, P., Morris, M., Lewis-Gess, J., Sarett-Cuasay, E. J., Sirl, K., Ries, J. K., et al. (2002b). Predictors of risky sexual behavior in African-American girls: Implications for prevention interventions. Journal of Pediatric Psychology, 27(6), 519–530.

    Article  PubMed  Google Scholar 

  • Bauermeister, J. A., Elkington, K. S., Brackis-Cott, E., Dolezal, C., & Mellins, C. (2009a). Sexual behavior and perceived peer norms: Comparing perinatally infected and affected youth. Journal of Youth and Adolescence, 38(8), 1110–1122.

    Article  PubMed  Google Scholar 

  • Bauermeister, J. A., Zimmerman, M., Barnett, T. E., & Caldwell, C. (2007). Working in high school and adaptation in the transition to young adulthood among African American youth. Journal of Youth and Adolescence, 36, 877–890.

    Article  Google Scholar 

  • Bauermeister, J. A., Zimmerman, M., Gee, G., Caldwell, C., & Xue, Y. (2009b). Work and sexual trajectories among African American youth. Journal of Sex Research, 46(4), 290–300.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Ryan, N., Williamson, D., Brent, D. A., Kaufman, J., Dahl, R. E., et al. (1996). Childhood and adolescent depression: A review of the past 10 years, part I. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1427–1439.

    Article  PubMed  Google Scholar 

  • Blankenship, K., Friedman, S., Dworkin, S., & Mantell, J. (2006). Structural interventions: Concepts, challenges and opportunities for research. Journal of Urban Health, 83(1), 59–72.

    Article  PubMed  Google Scholar 

  • Brook, D. W., Brook, J. S., Zhang, C., Cohen, P., & Whiteman, M. (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry, 59, 1039–1044.

    Article  PubMed  Google Scholar 

  • Brook, J. S., Cohen, P., & Brook, D. W. (1998). Longitudinal study of co-occurring psychiatric disorders and substance use. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 322–330.

    PubMed  Google Scholar 

  • Brooks-Gunn, J., & Paikoff, R. (1997). Sexuality and developmental transitions during adolescence. In J. Schulenberg, J. Maggs, & K. Hurrelmann (Eds.), Health risks and developmental transactions during adolescence (pp. 190–219). New York, NY: Cambridge University Press.

    Google Scholar 

  • Brown, L. K., Danovsky, M. B., Lourie, K. J., DiClemente, R. J., Ralph, J., & Ponton, L. E. (1997). Adolescents with psychiatric disorders and the risk of HIV. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1609–1617.

    Article  PubMed  Google Scholar 

  • 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(3), 444.e1–444.e8.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2008a). Sexually transmitted disease surveillance 2007. Retrieved July 20, 2009, from http://www.cdc.gov/std/stats07/toc.htm.

  • Centers for Disease Control and Prevention. (2008b). Youth risk surveillance—United States 2007. MMWR, 57(SS-4). Retrieved July 9, 2009, from http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf.

  • Centers for Disease Control and Prevention. (2008c). HIV/AIDS among youth. Retrieved August 26, 2009, from http://www.cdc.gov/hiv/resources/factsheets/youth.htm.

  • Chen, Y., Stiffman, A. R., Cheng, L., & Dore, P. (1997). Mental health, social environment and sexual risk behaviors of adolescent service users: A gender comparison. Journal of Child and Family Studies, 6(1), 9–25.

    Article  Google Scholar 

  • Collins, R. L., Ellickson, P. L., Orlando, M., & Klein, D. J. (2005). Isolating the nexus of substance use, violence and sexual risk for HIV infection among young adults in the United States. AIDS and Behavior, 9(1), 73–87.

    Article  PubMed  Google Scholar 

  • Cook, R. L., Comer, D. M., Wisenfeld, H. C., Chang, C., Tarter, R., Lave, J. R., et al. (2006). Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sexually Transmitted Diseases, 33(9), 565–570.

    Article  PubMed  Google Scholar 

  • Dausey, D. J., & Desai, R. A. (2003). Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse. The Journal of Nervous and Mental Disease, 191(1), 10–17.

    Article  PubMed  Google Scholar 

  • Dermen, K. H., Cooper, M. L., & Agocha, V. B. (1998). Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol, 59(1), 71–77.

    PubMed  Google Scholar 

  • Derogatis, L. R., & Spencer, P. M. (1982). The Brief Symptom Inventory (BSI): Administration and procedures. Manual-I. Baltimore, MD: Clinical Psychometric Research.

  • Deykin, E. Y., Levy, J. C., & Wells, V. (1987). Adolescent depression, alcohol and drug abuse. American Journal of Public Health, 77(2), 178–182.

    Article  PubMed  Google Scholar 

  • Doljanac, R. F., & Zimmerman, M. A. (1998). Psychosocial factors and high risk sexual behavior: Race differences among urban adolescents. Journal of Behavioral Medicine, 21, 451–467.

    Article  PubMed  Google Scholar 

  • Donenberg, G. R., Emerson, E., Bryant, F. B., Wilson, H., & Weber-Shifrin, E. (2001). Understanding AIDS-risk behavior among adolescents in psychiatric care: Links to psychopathology and peer relationships. Journal of the American Academy of Child Adolescent Psychiatry, 40(6), 642–653.

    Article  Google Scholar 

  • Donenberg, G. R., & Pao, M. (2005). Youths and HIV/AIDS: Psychiatry’s role in a changing epidemic. Journal of the American Academy of Child Adolescent Psychiatry, 44(8), 728–747.

    Article  Google Scholar 

  • Dworkin, S., Pinto, R. M., Hunter, J., Rapkin, B., & Remien, R. (2008). Keeping the spirit of community partnerships alive in the scale up of HIV/AIDS prevention: Critical reflections on the roll-out of DEBI (diffusion of effective behavioral interventions). American Journal of Community Psychology, 42(1–2), 51–59.

    Article  PubMed  Google Scholar 

  • Elkington, K. S., Bauermeister, J. A., Brackis-Cott, E., Dolezal, C., & Mellins, C. A. (2009). Substance use and sexual risk behaviors in perinatally human immunodeficiency virus-exposed youth: The role of caregivers, peers and HIV status. Journal of Adolescent Health, 45(2), 133–141.

    Article  PubMed  Google Scholar 

  • Elkington, K. S., Teplin, L. A., Mericle, A. A., Welty, L. J., Romero, E. G., & Abram, K. M. (2008). HIV/STI risk behaviors in delinquent youth with psychiatric disorders: A longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 901–911.

    Article  PubMed  Google Scholar 

  • Ellickson, P. L., McCaffrey, D. F., & Klein, D. J. (2009). Long-term effects of drug prevention of risky sexual behavior among young adults. Journal of Adolescent Health, 45, 111–117.

    Article  PubMed  Google Scholar 

  • Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419.

    Article  PubMed  Google Scholar 

  • Gordon, C. M., Carey, M. P., & Carey, K. B. (1997). Effects of a drinking event on behavioral skills and condom attitudes in men: Implications for HIV risk from a controlled experiment. Health Psychology, 16, 490–495.

    Article  PubMed  Google Scholar 

  • Graves, K. L., & Leigh, B. C. (1995). The relationship of substance use to sexual activity among young adults in the United States. Family Planning Perspectives, 27(1), 18–22.

    Article  PubMed  Google Scholar 

  • Greene, J. M., Ennett, S. T., & Ringwalt, C. L. (1999). Prevalence and correlates of survival sex among runaway and homeless youth. American Journal of Public Health, 89(9), 1406–1409.

    Article  PubMed  Google Scholar 

  • Guo, J., Chung, I. J., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R. D. (2002). Developmental relationships between adolescent substance use and risky sexual behavior in young adulthood. Journal of Adolescent Health, 31(4), 354–362.

    Article  PubMed  Google Scholar 

  • Hamilton, E. B., Asarnow, J. R., & Tompson, M. C. (1999). Family interaction styles of children with depressive disorders, schizophrenia-spectrum disorders, and normal controls. Family Process, 38(4), 463–476.

    Article  PubMed  Google Scholar 

  • Houck, C. D., Lescano, C. M., Brown, L. K., Tolou-Shams, M., Thompson, J., DiClemente, R., et al. (2006). “Islands of risk”: Subgroups of adolescents at risk for HIV. Journal of Pediatric Psychology, 31(6), 619–629.

    Article  PubMed  Google Scholar 

  • Kandel, D. B., Johnson, J. G., Bird, H. R., Canino, G., Goodman, S. H., Lahey, B. B., et al. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the methods for the epidemiology of child and adolescent mental disorders (MECA) study. Journal of Abnormal Child Psychiatry, 25(2), 121–132.

    Article  Google Scholar 

  • Kandel, D. B., Yamaguchi, K., & Chen, K. (1992). Stages of progression in drug involvement from adolescence to adulthood: Further evidence for the gateway theory. Journal of Studies on Alcohol, 53(5), 447–457.

    PubMed  Google Scholar 

  • Kelder, S. H., Murray, N. G., Orpinas, P., Prokhorov, A., McReynolds, L., Zhang, Q., et al. (2001). Depression and substance use in minority middle-school students. American Journal of Public Health, 91(5), 761–766.

    Article  PubMed  Google Scholar 

  • Kessler, R., Avenevoli, S., & Merikangas, K. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49(12), 1002–1014.

    Article  PubMed  Google Scholar 

  • Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56(10), 730–737.

    Article  PubMed  Google Scholar 

  • Krull, J. L., & MacKinnon, D. P. (1999). Multilevel mediation modeling in group-based intervention studies. Evaluation Review, 23(4), 418–444.

    Article  PubMed  Google Scholar 

  • LaBrie, J., Earlywine, M., Schiffman, J., Pedersen, E., & Marriot, C. (2005). Effects of alcohol, expectancies, and partner type on condom use in college males: Event-level analyses. Journal of Sex Research, 42, 259–266.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Lewinsohn, P. M., Gotlib, I. H., & Seeley, J. R. (1995). Adolescent psychopathology, IV: Specificity of psychosocial risk factors for depression and substance abuse in older adolescents. Journal of the American Academy of Child Adolescent Psychiatry, 34(9), 1221–1229.

    Article  Google Scholar 

  • Logan, T. K., Cole, J., & Leukefeld, C. (2002). Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin, 128(6), 851–885.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995a). A simulation study of mediated effect measures. Multivariate Behavioral Research, 30, 41–62.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995b). A simulation study of mediated effect measures: Erratum. Multivariate Behavioral Research, 30(3), ii.

  • Marston, C., & King, E. (2006). Factors that shape young people’s sexual behavior: A systematic review. Lancet, 368, 1581–1586.

    Article  PubMed  Google Scholar 

  • McFarlane, A. H., Bellissimo, A., & Norman, G. R. (1995). The role of family and peers in social efficacy: Links to depression in adolescence. American Journal of Orthopsychiatry, 63, 402–410.

    Article  Google Scholar 

  • McKinnon, K. (1996). Sexual and drug-use risk behavior. In F. Cournos & N. Bakalar (Eds.), AIDS and people with severe mental illness: A handbook for mental health professionals (pp. 17–46). New Haven, CT: Yale University Press.

    Google Scholar 

  • Mellins, C. A., Elkington, K. S., Bauermeister, J. A., Brackis-Cott, E., Dolezal, C., McKay, M., et al. (2009). Sexual and drug use behavior in perinatally-HIV-infected youth: Mental health and family influences. Journal of the American Academy of Child and Adolescent Psychiatry, 48(8), 810–819.

    Article  PubMed  Google Scholar 

  • Nakao, K., & Treas, J. (1994). Updating occupational prestige and socioeconomic scores: How the new measures measure up. Sociological Methodology, 24, 1–72.

    Article  Google Scholar 

  • O’Hare, T. (2005). Risky sex and drinking contexts in freshman first offenders. Addictive Behaviors, 30(3), 585–588.

    Article  PubMed  Google Scholar 

  • Oshri, A., Tubman, J. G., Wagner, E. F., Leon-Morris, S., & Snyders, J. (2008). Psychiatric symptom patterns, proximal risk factors, and sexual risk behaviors among youth in outpatient substance abuse treatment. American Journal of Orthopsychiatry, 78(4), 430–441.

    Article  PubMed  Google Scholar 

  • Ott, M., Millstein, S., & Halpern-Felsher, B. (2004). Positive motivations for sex among male and female teens. Paper presented at the Annual Meeting of the Society for Adolescent Medicine, St. Louis, MO.

  • Pine, D., Cohen, E., Cohen, P., & Brook, J. (1999). Adolescent depressive symptoms as predictors of adult depression: Moodiness or mood disorder? American Journal of Psychiatry, 156, 133–135.

    PubMed  Google Scholar 

  • Ramirez-Valles, J., Zimmerman, M. A., & Newcomb, M. D. (1998). Sexual risk behavior among youth: Modeling the influence of prosocial activities and socioeconomic factors. Journal of Health and Social Behavior, 39, 237–253.

    Article  PubMed  Google Scholar 

  • Ramrakha, S., Caspi, A., Dickson, N., Moffitt, T. E., & Paul, C. (2000). Psychiatric disorders and risky sexual behaviour in young adulthood: Cross sectional study in birth cohort. British Medical Journal, 321, 263–266.

    Article  PubMed  Google Scholar 

  • Raudenbush, S., & Bryk, A. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Rogers, J. L. (1996). Sexual transitions in adolescence. In J. A. Graber, J. Brooks-Gunn, & A. C. Peterson (Eds.), Transitions through adolescence: Interpersonal domains and context (pp. 85–110). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Rosenthal, D., Moore, S., & Flynn, I. (1991). Adolescent self-efficacy, self-esteem, and sexual risk-taking. Journal of Community and Applied Social Psychology, 1(2), 77–88.

    Article  Google Scholar 

  • Rubin, A. G., Gold, D. O., & Primack, B. A. (in press). Associations between depressive symptoms and sexual risk behavior in a diverse sample of female adolescents. Journal of Pediatric and Adolescent Gynocology.

  • Salazar, L. F., DiClemente, R. J., Wingood, G. M., Crosby, R. A., Harrington, K., Davies, S., et al. (2004). Self-concept and adolescents’ refusal of unprotected sex: A test of mediating mechanisms among African American girls. Prevention Science, 5(3), 137–149.

    Article  PubMed  Google Scholar 

  • Sanderson, C., & Cantor, N. (1995). Social dating goals in late adolescence: Implications for safer sexual activity. Journal of Personality and Social Psychology, 68, 1121–1134.

    Article  PubMed  Google Scholar 

  • Scientific Software International. (2009). Hierarchical linear models. Chicago, IL: SSI Inc.

    Google Scholar 

  • Seal, A., Minichiello, V., & Omodei, M. (1997). Young women’s sexual risk taking behaviour: Revisiting the influences of sexual self-efficacy and sexual self-esteem. International Journal of STD and AIDS, 8, 159–165.

    Article  PubMed  Google Scholar 

  • Shrier, L. A., Harris, S. K., Sternberg, M., & Beardslee, W. R. (2001). Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Preventative Medicine, 33(3), 179–189.

    Article  Google Scholar 

  • Shrier, L., Harris, S., & Beardslee, W. (2002). Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Archives of Pediatric and Adolescent Medicine, 156(6), 599–606.

    Google Scholar 

  • Smith, M. D. (2001). HIV risk in adolescents with severe mental illness: Literature review. Journal of Adolescent Health, 29, 320–329.

    Article  PubMed  Google Scholar 

  • Stiffman, A. R., Dore, P., Earls, F., & Cunningham, R. (1992). The influence of mental health problems on AIDS-related risk behaviors in young adults. Journal of Nervous and Mental Disease, 180(5), 314–320.

    Article  PubMed  Google Scholar 

  • Stoner, S. A., George, W. H., Peters, L. M., & Norris, J. (2007). Liquid courage: Alcohol fosters risky sexual decision-making in individuals with sexual fears. AIDS and Behavior, 11, 227–237.

    Article  PubMed  Google Scholar 

  • Tapert, S. F., Aarons, G. A., Sedlar, G. R., & Brown, S. A. (2001). Adolescent substance use and sexual risk-taking behavior. Journal of Adolescent Health, 28(3), 181–189.

    Article  PubMed  Google Scholar 

  • Teplin, L. A., Elkington, K. S., McClelland, G. M., Abram, K. M., Mericle, A. A., & Washburn, J. J. (2005). Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees. Psychiatric Services, 56, 823–828.

    Article  PubMed  Google Scholar 

  • Tolou-Shams, M., Brown, L. K., Houck, C., & Lescano, C. M. (2008). The association between depressive symptoms, substance use, and HIV risk among youth with an arrest history. Journal of Studies on Alcohol and Drugs, 69(1), 58–64.

    PubMed  Google Scholar 

  • Tolou-Shams, M., Paikoff, R. L., McKirnan, D. J., & Holmbeck, G. N. (2007). Mental health and HIV risk among African American adolescents: The role of parenting. Social Work in Mental Health, 5(1–2), 27–58.

    Article  Google Scholar 

  • Tubman, J., Windle, M., & Windle, R. (1996). The onset and cross-temporal patterning of sexual intercourse in middle adolescence: Prospective relations with behavioral and emotional problems. Child Development, 67(2), 327–343.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by two National Institute of Drug Abuse grants (5R01DA007484-11; “A longitudinal study of school dropout and substance use”, and 1R03AA017240-01; “Protective factors for alcohol use among urban adolescents”) awarded to Dr. Zimmerman. Dr. Elkington is supported by the Center Grant P30 MH43520 to the HIV Center for Clinical and Behavioral Studies, Anke A. Ehrhardt, PhD, Principal Investigator, from the National Institute of Mental Health. All authors have nothing to disclose.

Author information

Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive #15, New York, NY, 10032, USA

    Katherine S. Elkington

  2. Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    José A. Bauermeister & Marc A. Zimmerman

Authors
  1. Katherine S. Elkington
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José A. Bauermeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc A. Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine S. Elkington.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elkington, K.S., Bauermeister, J.A. & Zimmerman, M.A. Psychological Distress, Substance Use, and HIV/STI Risk Behaviors Among Youth. J Youth Adolescence 39, 514–527 (2010). https://doi.org/10.1007/s10964-010-9524-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10964-010-9524-7

Keywords

Search

Navigation