title: Associations of depression, self-esteem, and substance use with sexual risk among adolescents.
abstract: BACKGROUND
  Adolescents are the population at highest risk for acquiring sexually transmitted diseases (STDs). Previous research has suggested that mental health problems, including depression and low self-esteem, may play an important role in the development and maintenance of sexual risk behaviors.
  
  
  METHODS
  National Longitudinal Study of Adolescent Health data from baseline interviews of 7th-12th graders reporting sexual intercourse in the preceding year were analyzed. Using logistic regression, associations of depressive symptoms, self-esteem, and substance use with condom nonuse at last sexual intercourse and with ever having had an STD were explored separately for each gender.
  
  
  RESULTS
  Among boys (N = 3,192), depressive symptoms were associated with an increased risk of condom nonuse at last sexual intercourse. The association between depressive symptoms and STD appeared to be mediated by alcohol and marijuana use. For girls (N = 3,391), depressive symptoms were associated with a history of STD, but not with condom nonuse. Self-esteem was not significant in any model that included depressive symptoms.
  
  
  CONCLUSIONS
  Adolescents with depressive symptoms are at risk for not using a condom and for having an STD. Further research is needed to elucidate the relationship among depression, substance use, and sexual risk to optimize STD prevention strategies for adolescents.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. shrier@a1.tch.harvard.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Shrier
authors.forename: S K
authors.initials: SK
authors.lastname: Harris
authors.forename: M
authors.initials: M
authors.lastname: Sternberg
authors.forename: W R
authors.initials: WR
authors.lastname: Beardslee
mesh_terms: D000293:Adolescent; D017280:Condoms; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012649:Self Concept; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D019966:Substance-Related Disorders / Q000523:psychology*; D014481:United States / Q000453:epidemiology