High-Risk Sex Common in Youth With Mental Health Disorders

Liam Davenport

October 26, 2016

MILAN — In young people with mental health disorders, the rates of sexually transmitted infection (STI) and unplanned pregnancies are high, and contraception is often not used, new research shows.

Data presented at the IEPA 10th International Conference on Early Intervention in Mental Health showed that more than three quarters of young people attending a mental health clinic had a history of sexual intercourse, and a quarter tested positive for an STI. The same proportion of patients had been pregnant themselves or their partner had been pregnant.

The team, led by Brian O'Donoghue, MD, PhD, the National Center of Excellence in Youth Mental Health and the University of Melbourne, Australia, said that young people with mental health disorders "have high needs in regards to their sexual health, which could be addressed by incorporating sexual health clinics into early intervention services."

Dr O'Donoghue told Medscape Medical News that, although there are few comparable data for young people without mental health disorders, rates of risky sexual behaviors and STIs are "much higher" than in the general youth population.

He noted that there is a "complex relationship" between mental health disorders and high-risk sexual behaviors. "There's probably a two-way relationship, in that young people who are perhaps vulnerable or have risk factors for developing mental health illness might also be at risk of high-risk sexual behaviors," he said.

"Therefore, the two could be connected in that way. But it is possible that mental health disorders themselves could place people at higher risk for high-risk sexual behaviors."

Dr O'Donoghue said that the impact of engaging in those sexual behaviors could "itself then be trigger for developing mental illness," adding: "We can't tell from our study which direction it is ― for example, whether engaging in the high-risk sexual behavior predisposes young people to developing mental health disorder, or if it's the other way around."

Because there has been little research into the interaction between mental health disorders and high-risk sexual behaviors, the team studied 103 individuals aged 15 to 24 years who attended their clinic for treatment of psychosis, personality disorders, or mood disorders.

Participants completed the Brief Psychiatric Rating Scale as well as questionnaires on sexual health and sexual functioning. Fifty-four percent of the participants identified themselves as heterosexual, 32% as bisexual or pansexual, and 5% as homosexual.

The results indicated that 78% of the participants had a history of sexual intercourse, at a mean age of sexual debut of 16 years. Fewer than half of those who were sexually active were using contraception.

Of those who were tested for an STI, 24% tested positive. Approximately 25% of participants either had been pregnant themselves or their partner had been pregnant, with 95% of the pregnancies unplanned.

The team also found that almost two thirds of the young people they studied had used alcohol during sex, and 43% had used cannabis. Moreover, 39% had clinically relevant sexual dysfunction, which was associated with more negative emotions about and experiences of sex.

The team would next like to examine how they can address the sexual health needs of the young people they see at their clinic. Dr O'Donoghue said: "We're looking towards bringing in a sexual health nurse into the service but also looking at training up our own clinicians so that they are more aware of sexual health issues, and also making things like contraception available.

"So that should reduce the consequences of that [high-risk] behavior, if we can't actually reduce the behavior itself."

Accurate Picture

Approached for comment, Moira Rynn, MD, co–program director at New York-Presbyterian's Youth Anxiety Center and director of child and adolescent psychiatry at New York–Presbyterian/Columbia University Medical Center, New York City, told Medscape Medical News that the picture painted by the findings reflects that seen in the United States.

She believes that better integration of mental health services into the wider care setting is required to tackle both high-risk sexual behavior and its consequences. She said: "One of the challenges when you have young people who are busy, going to school, managing relationships is they don't want to go to so many doctor appointments.

"If they're having trouble managing their lives and organizing themselves, they don't necessarily have all of the organizing capacity to get themselves to multiple appointments," Dr Rynn said.

She said that it would be "really helpful" if young people could go to one place "where they could get their mental health care needs met as well as their medical needs, their birth control needs, and their sexual healthcare at the same time.

"It would be great if they could see their psychologist or their psychiatrist in the same setting where they could then get their appointment with their gynecologist or their pediatrician or their family doctor and have these other needs addressed."

Dr Rynn noted that there is a "lot of talk" in the United States about the "better integration of mental health treatment throughout the lifespan, not only for adolescents and young adults but children and adults as well."

She said a range of models are being used, but there remains the challenge of how to support such initiatives financially, as "we still don't have real parity for mental health in this country, so it makes it a bit challenging."

No funding for the study has been disclosed. The investigators have disclosed no relevant financial relationships.

IEPA 10th International Conference on Early Intervention in Mental Health. Oral Session 9.1. Presented October 20, 2016.

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