Association between Early Sexual Intercourse and Sexual Violence Victimization, Symptoms of Depression, and Suicidal Ideation Among Adolescents: Findings from 2017 to 2019 Youth Risk Behavior Survey

Background and Purpose: Sexual intercourse occurring prior to age 13 is associated with various sexual risk behaviors, including such as sex without regular condom use, having multiple sexual partners, sex under the influence of alcohol or drugs, and transactional sex. Additional consequences related to physical and mental health include increased risk of health conditions like cervical cancer and sexually transmitted infections, and attenuated self-esteem, which can be exacerbated by attitudes of shame and guilt surrounding sexual activity. While sexual violence victimization has been linked to depression and thoughts of suicide among adolescents, the role of early sexual intercourse as an antecedent is unclear. The purpose of this study was to investigate the association between early sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among adolescents who had engaged in sexual intercourse.

Methods: This study used data from the 2017 and 2019 iterations of the Youth Risk Behavior Survey. An analytic sample of 6,648 adolescents between the ages of 14–18 years old (49.7% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, and suicidal ideation, and the main explanatory variable was early sexual intercourse. Demographic covariates included age, sex assigned at birth, race, ethnicity, and sexual orientation, while also controlling for the potentially confounding influence of substance use.

Results: Of the 6,648 adolescents who reported ever having sexual intercourse, 7% had engaged in early sexual intercourse. Within the past year, 15.5% had experienced sexual violence, 42% reported symptoms of depression, and 23.2% experienced suicidal ideation. Results from the regression demonstrated that adolescents who engaged in early sexual intercourse were 1.71 times more likely to experience subsequent sexual violence (RR = 1.71, 95% CI = 1.33-2.20), 1.18 times more likely to experience symptoms of depression (RR = 1.18, 95% CI = 1.06-1.31), and 1.38 times more likely to report experiencing suicidal ideation (RR = 1.38, 95% CI = 1.17-1.64), while controlling for demographic characteristics and substance use variables.

Conclusions and Implications: Findings of this study suggest that early sexual intercourse is associated with poor mental health outcomes among adolescents. In an effort to prevent these outcomes, we caution against the use of shame-based approaches to youth sexual health interventions, especially those targeted towards early adolescents, and encourage the development of trauma-responsive sexual health interventions for youth that promote safety in the context of empowerment through knowledge and choice. Furthermore, future research could longitudinally examine trajectories of youth who engage in early sexual intercourse.