Editorials

Adolescent mental health and risky sexual behaviour

Young people need health care that covers psychological, sexual, and social areas

Papers p 263

Risk taking among adolescents is of great concern to health professionals. Most of the morbidity among young people is related to behaviours that result in unintentional or intentional injuries, drug and alcohol misuse, tobacco use, sexual behaviour, diet, and physical inactivity.¹ Mental health problems in young people are common, with an overall prevalence of around 15%.²

Against this background, the observation in the paper by Ramrakha and colleagues (p 263) of the strong correlation between psychiatric disorders, substance misuse, and risky sexual behaviour in a birth cohort of 21 year olds is important.³ This finding has been observed previously,⁴ although in another study Bardone found risky sexual behaviour associated only with conduct disorders, and not with depression or anxiety, in a cohort of girls followed from ages 15 to 21.⁵ Many studies have reported associations between mental health and the risk of HIV infection.⁶

Ramrakha et al's work is part of the Dunedin study, a multidisciplinary, population based study of a birth cohort that uses a diverse range of measures, including those for diagnosing mental health disorders. The study has reported comorbid psychiatric conditions in children and adolescents and has explored aspects of adolescent risk taking and delinquency.⁷ Questions about mental health and behaviour were added initially at the assessment at age 11, and questions about sexual behaviour were added at the 18 year assessment. In this latter assessment 37% of the sample had one or more mental health disorders, while 58% of the men and 68% of the women reported having had sexual intercourse.

Risky sex may be an expression of anger
Ramrakha et al identified an increased probability of risky sex across a range of mental health diagnoses.³ Even the most prevalent, clinical depression, was associated with increased rates of risky sex, sexually transmitted diseases, and early sexual experience. With regard to sexual initiation, other questions arise, such as the role of sexual abuse (also a major precursor to mental health disorder). With the addition of histories of sexual abuse at the recently completed assessment at 26 years of age in the Dunedin study, important new information is likely to emerge.

Youths who drop out of school have complex needs
The public health and policy implications of this study relate to the identification of high risk groups and the need to understand the frequent clustering of risk among adolescents. Those with health risks often have multiple problems by the end of their high school education.¹⁰ Youths who drop out of school have special and complex needs, with extremely high rates of sexual behaviour, mental health problems, and drug misuse.¹¹ The causal relations and direction remain to be elucidated, but the coexistence of drugs, risky sex, and mental health problems remains a consistent observation in epidemiological studies. ^{5 10}

Department of Adolescent Medicine, Royal Alexandra Hospital for Children, Sydney, Australia

Adrian Bauman, head. 

Epidemiology Unit, Liverpool Hospital, Sydney, Australia