Abstract
This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.
Highlights
Adolescents with elevated symptoms of mania (ESM) should be regularly screened for sexual risk behaviors and receive HIV prevention skills
Adolescents with psychiatric illness are at increased risk for HIV, those with elevated symptoms of mania (ESM) might be at even greater risk
A manic episode is defined by the DSM-IV (APA, 1994) as a distinct period of an abnormal and persistent elevated, expansive, or irritable mood with at least one week duration or requiring hospitalization accompanied by three of the following symptoms being present to a significant degree: inflated self-esteem or grandiosity, decreased need for sleep, abnormally talkative or pressured speech, flight of ideas or racing thoughts, distractibility, increased goal-directed activity or psychomotor agitation, and excessive involvement in pleasurable activities that have a high potential for unpleasant consequences
Summary
Eight hundred and forty adolescents (56% female, 58% African American, mean age 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders, sexual and substance use behaviors, and provided urine to screen for sexually transmitted infections (STI). Data for this study are from baseline assessments for Project STYLE, a multi-site study testing the comparative efficacy of a family HIV prevention program relative to two adolescent only control interventions among adolescents recruited from outpatient and inpatient psychiatric settings (see Brown et al, 2010 for study details; see Figure 1 for recruitment and retention data). Adolescents under 18 years of age gave assent; parents gave informed consent for their child’s participation and their own participation. Adolescents over 18 years of age gave informed consent.
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