A prospective study of psychological distress and sexual risk behavior among black adolescent females

Objective. The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/ human immunodeficiency virus (STD/HIV)-associated sexual behaviors and atti tudes. Method. Sexually active black adolescent females (N = 522) completed, at ba seline and again 6 months later, a self-administered questionnaire that ass essed sexual health attitudes and emotional distress symptoms (using standa rdized measures, alpha =.84), a structured interview that assessed STD/HIV- associated sexual risk behaviors, and a urine screen for pregnancy. Results. In multivariate analyses, controlling for observed covariates, ado lescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), h ave had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partner s (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additiona lly, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have expe rienced dating violence (AOR = 2.4), feel less efficacious in negotiating c ondom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). Discussion. The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive s ymptoms among adolescent females can alert the clinician to the need to con duct a sexual health history, initiate STD/HIV-preventive counseling, and r efer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotion al distress may be at heightened risk for further unhealthy outcomes. STD/ HIV interventions should also consider psychological distress as one potent ial risk factor that may impact program efficacy.