Associations of depression, self-esteem, and substance use with sexual risk among adolescents

Background. Adolescents are the population at highest risk for acquiring se xually transmitted diseases (STDs). Previous research has suggested that me ntal health problems, including depression and low self-esteem, may play an important role in the development and maintenance of sexual risk behaviors . Methods. National Longitudinal Study of Adolescent Health data from baselin e interviews of 7th-12th graders reporting sexual intercourse in the preced ing year were analyzed. Using logistic regression, associations of depressi ve symptoms, self-esteem, and substance use with condom nonuse at last sexu al intercourse and with ever having had an STD were explored separately for each gender. Results. Among boys (N = 3,192), depressive symptoms were associated with a n increased risk of condom nonuse at last sexual intercourse. The associati on between depressive symptoms and STD appeared to be mediated by alcohol a nd marijuana use. For girls (N = 3,391), depressive symptoms were associate d with a history of STD, but not with condom nonuse. Self-esteem was not si gnificant in any model that included depressive symptoms. Conclusions. Adolescents with depressive symptoms are at risk for not using a condom and for having an STD. Further research is needed to elucidate th e relationship among depression, substance use, and sexual risk to optimize STD prevention strategies for adolescents. (C) 2001 American Health Founda tion and Academic Press.