Depressed young people may have sexual intercourse (sex) to regulate their disordered affective states. This study sought to determine how momentary positive and negative affect relate to subsequent sex events in depressed adolescents and young adults. Fifty-four outpatients (87% female) 15-22 years who reported clinically significant depressive symptoms and having sex at least once a week completed a baseline survey, then reported momentary affective states and the occurrence of sex events on a handheld computer in response to 4-6 random signals per day for 2 weeks. Participants identified 387 unique sex events (median, 3.5/participant/week) on 3,159 reports (median, signal response rate 80%). Most (86-96%) reported low burden of participation on questions asked at study completion. Similar to what has been reported in non-depressed young people, momentary positive and negative affect were both improved beginning approximately 6 h before until approximately 6 h after a sex event. Positive affect was lower in the 24 h before this pericoital period, compared to other times. Negative affect did not significantly differ between before the pericoital period and other times. The findings suggest that depressed youth may have sex to regulate their positive affect and have implications for provision of their mental and physical health care.

Purpose To examine daily- and event-level associations of substance use with occurrence of sex and condom nonuse among depressed youth. Methods Depressed, sexually active outpatients age 15–22 reported alcohol use, marijuana use, and sex on a personal digital assistant for 2 weeks. If they reported sex, participants indicated partner type and condom use. Data were analyzed for participants who reported both substance use and sex events (N=39) using generalized estimating equations. Daily-level models compared the likelihood of sex and of condom nonuse between days on which participants did or did not use substances. Event-level models examined the likelihood of sex in the 2, 6, and 12 hours following substance use and the likelihood of condom nonuse if substances were used in the preceding 2, 6, and 12 hours. Results Participants reported 307 sex events (180 unprotected) and 391 substance use events on 572 days. Substance use was associated with increased odds of sex on the same day, but not after adjusting for weekend. Depressed youth were less likely to have sex within 2 hours following substance use and more likely to have sex within 12 hours after marijuana use. There was no main effect of substance use on condom nonuse; however, there was a significant interaction such that on weekdays, condom nonuse was less likely when substances were used within 6 hours before sex. Conclusions The findings from this small, predominantly female sample suggest that contextual factors, not intoxication, influence associations of substance use with sexual behavior in depressed youth.

Study Objective Depressed young women are at particularly high risk of STIs, yet little is known about their condom use practices. This study sought (1) to describe condom use errors among depressed adolescent and young adult women and (2) to identify event- and individual-level correlates of incorrect use. Design Depressed, sexually active outpatients ages 15 to 22 responded to a computer-based questionnaire, then reported on penile-vaginal sex events on a handheld computer several times/day for two weeks. For each sex event with a condom, incorrect condom use was defined as a response indicating incorrect use on at least one of five questions. Event- and individual-level correlates of incorrect use were analyzed using logistic regression adjusted for age and within-individual clustering. Setting Participants were recruited from two adolescent clinics, a psychiatric clinic, and a young parents’ program of an urban children’s hospital and collected data in the settings of their everyday lives. Participants Thirty-one young women contributed 143 condom use events to these analyses. Interventions None. Main Outcome Measure Incorrect condom use. Results Incorrect condom use was reported for 51% of condom use events. The most common error was not holding the condom on withdrawal (31%). Having sex to change mood, to relax, or for physical pleasure increased the odds of incorrect condom use, but was no longer significant when individual-level variables were included in the model. In the multiple logistic regression model, impulsiveness increased and stronger belief that mood affects sexual behaviors decreased the odds of incorrect condom use (adjusted OR 1.3 and 0.81, respectively). Conclusions Even if they use condoms, depressed adolescent and young adult women are at increased risk of STIs because they frequently use condoms incorrectly. Psychological factors may help identify depressed young women who are at particularly high risk of incorrect condom use.

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