رفتارهای پرخطر جنسی، سلامت روان و سابقه سوء دوران کودکی در میان نوجوانان

Although it seems evident that attention should be paid to risky sexual behaviors and their association with mental health among young people, this topic has not been thoroughly investigated. The present study aims to explore the relationship between sexual risk behaviors and mental health among adolescents. The participants were 251 adolescents in a juvenile detention facility (221 males and 31 females) as the “delinquent” group and 367 high school students (167 males and 200 females) as the “non-delinquent” group. A questionnaire including the Kessler 10, the Impact of Event Scale-Revised, and the Adolescent Dissociative Experience Scale was employed to measure mental health status as well as sexual risk behaviors, suicidal ideation/attempts, and abuse history. Having a history of sexual abuse or of physical abuse was associated with age when one first had sex among males with delinquent behaviors, while same tendency was observed among males without delinquent behaviors. Among the female with delinquent behaviors group, past abuse history was significantly associated with higher number of sex partners. In the non-delinquent group, better mental health among males and, contrarily, worse mental health among females were associated with having more sex partners. The results highlight the importance of addressing abuse history among females and males. Given that poor mental health status in the adolescents was associated with risky sexual behaviors, adolescents are a vulnerable group that requires attention in terms of sexual and reproductive health that integrates mental health and psychosocial components.

The United Nations Population Fund (UNFPA) has stated that approximately one third of the world's population is between 10 and 24 years old, the largest-ever proportion for this age group, making them a primary demographic that is susceptible to global health problems (UNFPA, 2005). Of particular importance, the prevention and treatment of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is one of the global priorities defined in the millennium development goals (MDGs). In fact, 55% of new cases of HIV infection occur among people aged 15–24 (UNFPA, 2005). The World Health Organization (WHO) estimates that 340 million new cases of curable STIs occur annually throughout the world among people aged 15–49 years (WHO, 2007). Maternal health among adolescents is another key issue. Maternal mortality is a huge public health problem in many developing countries, and incidences of maternal morbidity such as obstetric fistula and perinatal depression are prevalent among young women. Each year, women undergo an estimated 50 million abortions, 20 million of which are unsafe, resulting in the deaths of 78,000 women; at least one fourth of all the unsafe abortions are among females aged 15–19 (UNFPA, 2000). Universal access to reproductive health including increased access to family planning is a key solution to these issues (UNFPA, 2000). Sexual behaviors such as having sex with multiple partners, not using a condom, and younger age when first had sex among young people are related to higher risk of HIV and other STIs as well as unintended pregnancy. The result often increases maternal morbidity and mortality, as well as more school drop-outs, poverty, and marginalization. Compromised mental health is both a cause and consequence of these sexual and reproductive health problems. Meanwhile, adolescents are particularly susceptible to mental health problems since they have to deal with drastic physical, mental, and social changes during puberty and sexuality development, while establishing their own identity including gender identity. Previous studies have indicated mental health problems are associated with risky sexual behaviors in adolescents, including the early initiation of sexual activity, multiple sexual partners, and less likelihood to use condoms (Baker and Mossman, 1991, Brown et al., 1997, Joffe and Radius, 1993, Pao et al., 2000, Seal et al., 1997, Shrier et al., 1997, Smith, 2001, Stiffman et al., 1992 and Valois et al., 1997). In this present study, with following the global perspectives and considering the Japanese culture, the items of sexual risk behaviors in this study were age at first sexual intercourse, the number of sex partners, and condom use. In fact, the relationship between individuals having a history of sexual abuse and their sexual risk behaviors has been explored. The findings include: history of sexual abuse is related to engaging in sexual risk behaviors among adolescents and young adults (Cunningham et al., 1994) and females (Browne and Finkelhor, 1986); alcohol and drug use is associated with having experienced child abuse (Felitti et al., 1998 and Wilsnack et al., 1997); and incarcerated males are significantly more likely to have had a history of sexual abuse than the general population (Johnson et al., 2006). Moreover, male perpetrators of sexual assault are also more likely to have a history of being sexually abused (Lisak et al., 1996). These findings comprehensively indicate that the prevention of and intervention in mental health problems, including attention to sexual abuse history, are clearly important avenues for reducing sexual risk behaviors. However, integrating interventions of this kind into general sexual and reproductive health care for young people necessitates effective countermeasures along with treatment measures. Therefore, it is critical to pay greater attention to risky sexual behaviors and their association with mental health, while addressing any history of sexual abuse. However, evidence regarding the association between sexual risk behaviors of young people and their mental health status, considering sexual abuse history, is still limited. The present study thus aims to explore the relationship of sexual risk behaviors, such as younger age at first sexual intercourse, higher number of sexual partners, and less condom use, with mental health status including symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and suicidal ideation and its actual attempt. Also investigated was history of sexual abuse and of physical abuse as well as illicit drug use experience, comparing adolescents incarcerated in a juvenile detention facility with adolescents attending high school.