Early or Forced Sexual Intercourse Tied to Poor Mental Health Outcomes in Adolescents

A burgeoning number of studies suggest a link between early sexual intercourse (ESI) and risky sexual behaviors. Now, using nationally representative data, Henry K. Onyeaka, MBChB, MPH, research fellow in the Department of Psychiatry at Massachusetts General Hospital, Philip Baiden, PhD, at the University of Texas at Arlington School of Social Work, and colleagues have documented that ESI and forced sexual intercourse are associated with negative mental health outcomes in U.S. adolescents.

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In the International Journal of Environmental Research and Public Health, the team specifies that a history of forced sexual intercourse predicted subsequent sexual violence victimization and depressive symptoms, and was a stronger predictor than ESI of suicidal behaviors.

Study Methods

Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey, which the Centers for Disease Control and Prevention conducts in schools every two years. The researchers included 6,252 adolescents, ages 14 to 18, who reported ever having had sexual intercourse.

The respondents were evenly divided by sex and 85% self-identified as heterosexual, 10% as bisexual, 3% as lesbian/gay, and 2% as unsure.

Characteristics of the Sample

• 7% reported ESI (defined here as first intercourse before age 13)
• 15% had ever experienced forced sexual intercourse
• 16% had experienced sexual violence victimization during the past year (any unwanted sexual contact including kissing and touching)
• 43% had experienced depressive symptoms in the past year
• During the past year, 24% had seriously considered attempting suicide, 19% had made a suicide plan and 11% had attempted suicide

Associations with ESI

Controlling for the effects of forced sexual intercourse and demographic factors:

• There was no significant association between ESI and subsequent sexual violence victimization or depressive symptoms
• Adolescents who had engaged in ESI were significantly more likely than those who had not to report past-year suicidal behaviors: suicidal ideation (RR, 1.15), suicide plan (RR, 1.18), and/or suicide attempt (RR, 1.36)

Associations with Forced Sexual Intercourse

Controlling for the effects of ESI and demographic factors, adolescents who had ever experienced forced sexual intercourse had significantly poorer outcomes than those who had not:

• Subsequent sexual violence victimization (RR, 6.01)
• Depressive symptoms (RR, 1.59)
• Suicidal ideation (RR, 2.09)
• Suicide plan (RR, 2.22)
• Suicide attempt (RR, 2.74)

Being female was tied to significantly increased risk of each outcome, including a 2.5 times greater risk than males of being a repeat victim of sexual violence. Each year of increased age was associated with significant improvement in each outcome, including a 19% reduction in the risk of suicide attempts.

Recommendation for Clinicians and Public Health Professionals

This study emphasizes the importance of offering psychological support to adolescents who have experienced forced sexual intercourse, which can overlap with ESI.

In most states, sexual intercourse with a child of either gender before age 16 is legally defined as nonconsensual and can reflect abusive or exploitative relationships. Clinicians and sex educators should not stigmatize ESI or make adolescents feel ashamed of having experienced it, as that could exacerbate distressing emotions, especially among youth who have also experienced sexual violence.

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