Abstract
BackgroundReproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.MethodsA structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.ResultsOf 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.ConclusionsThese findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.
Highlights
Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood
An association between early sexual initiation and psychopathology manifestations such as depression has been reported by studies that mostly proceed from the USA [5, 14,15,16,17], whereas fewer similar findings are available from European countries [18, 19]
This study evaluated the association between psychopathology and reproductive health risk in a large, multinational and representative sample of more than 11,000 European adolescents
Summary
Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents. Developing sexuality is physiologic during adolescence, but early debut implies a risk for immediate or future adverse reproductive health outcomes, such as unwanted teenage pregnancies and their consequences [1, 2]. There is evidence that early sexual debut may lead to adverse mental health outcomes [17], depression has been observed to precede and predict sexual initiation, multiple partners and inconsistent condom use among adolescents [5, 16, 18]. Other longitudinal studies have found that mental health problems predict poor compliance to prescribed contraception [20] and depressive symptoms are associated with an increased risk of unintended pregnancies [21]
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