title: Men's pathways to risky sexual behavior: role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories.
abstract: Recent reports of sexually transmitted infection-rate increases among men indicate the need for renewed study of male sexual risk behavior to aid development of updated and novel risk reduction interventions. Men who have childhood sexual abuse (CSA) histories consistently report frequent sexual risk behavior. The objective of this sturdy is to explore whether posttraumatic stress disorder (PTSD) and depression are moderators and/or mediators of the association between CSA and sexual risk in adult men. A cross-sectional survey study employing random digit dial recruitment was administered to men aged 18-49 years from Philadelphia County. Two hundred ninety eight men were recruited and screened for CSA history, administered items from the Posttraumatic Stress Diagnostic Scale (PDS) and Center for Epidemiologic Studies- Depression (CES-D), and asked to estimate their number of lifetime sexual partners (LSPs). Effects of sociodemographic characteristics, CSA, PTSD, and depression on the number of LSPs were modeled using Poisson regression. Results show that 197 (66%) men participated; 43 (22%) had CSA histories. CSA was significantly associated with PTSD/depression (P=.03). Four sociodemographic variables (age, race, sexual identity, and education), CSA (incidence rate ratio, IRR=1.47, P<.001), PTSD (IRR=1.19, P=.04), depression (IRR=1.29, P=.001), all 2-way interactions, and the 3-way CSA/PTSD/depression interaction (IRR=11.00, P<.001) were associated with the number of LSPs (R2=0.27). In conclusion, sexual partnership patterns unique to men with CSA histories and comorbid PTSD/depression appear to lead to substantially higher numbers of LSPs. Estimates of this relationship may have been biased toward the null by underreporting that can occur with phone surveys. Cross-sectional studies do not support causal inferences; however, the identification of a moderating and mediating influence of PTSD/depression on the relationship between CSA and sexual risk behavior is important and suggests the need for future studies with larger samples that examine trajectories for CSA, psychiatric illness, and sexual partnerships.
authors.affiliation: Philadelphia Veterans Affairs Medical Center, MSCE University of Pennsylvania School of Medicine, 733 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. holmeswc@mail.med.upenn.edu
authors.forename: William C
authors.initials: WC
authors.lastname: Holmes
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
mesh_terms: D000293:Adolescent; D000328:Adult; D002650:Child Abuse, Sexual / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology
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