Mental disorders do potentially influence sexual risk taking, although one can find a somewhat equivocal picture that seems to evolve over time as research progresses. There are also explanations for how mental conditions influence the control of sexual practices. And, what does it take for successful interventions to reduce sexual health risk such as from unprotected sex?
Limited relationship between mental health and sexual risk behavior
Beidas, Birkett, Newcomb, and Mustanski (2012) however found in their study that mental health variables did not significantly predict sexual risk behavior; the study was limited to men having sex with men (MSM). Similarly, another study found that related to MSM further research needs to be undertaken to understand how, if at all, depression relates to sexual risk practices (Klein, 2013).
Associations between mental illness and sexual risks
Tsai et al. (2013) found that depressed mood has been correlated with sexual risk such as HIV transmission risk behavior. Braje, Eddy, and Hall (2016) state that both male and female study individuals with diagnosed depression showed a higher likelihood of risky sexual behavior including unprotected sex. They explain that risky sex is, like, for example, drinking alcohol, a distracting activity serving to elevate depressive mood. According to Munroe, Kibler, Ma, Dollar, Coleman (n.d), mechanisms underlying the relationship between post-traumatic stress disorder (PTSD) and sexual risk is little understood; they found, however, that low perceived sexual self-control led to higher frequency of unprotected sex, what underlines that PTSD is associated with risky sexual behavior (RSB). Men in Tanzania with anxiety and depression were associated with less frequent condom use (Hill, Maman, Kilonzo, and Kajula, 2017). Furthermore, Husky, Guignard, Beck, and Michel (2013) report already earlier findings conﬁrming that suicidal symptoms link to sexual risk taking behavior.
Self-control seems to play a major role in the decision whether one engages in unprotected sexual intercourse. Skakoon-Sparling and Crame (2016) are seeing sexual arousal is negatively impacting the capability for self-control and consequently the degree of sexual self-restraint. Braje et al. (2016) found that risky sexual behavior and impulsiveness are positively related. More impulsive people are more likely to engage in RSB. Therefore, impulsiveness may serve as the mediator between PTSD and RSB.
Sexual health risk reduction interventions
Above findings provide evidence for the need to consider mental health issues for the prevention of sexual risk behavior. However, Pandor et al. (2015) report from their study that only addressing mental illness doesn’t seem to be sufficient to reduce risky sexual behavior. The same observation comes from Tsai et al. (2013) who emphasize that depression treatment needs to be combined with specific skills training for better HIV prevention results. Even for well-informed people, more specific and ongoing focus on risk awareness may be required.
Beidas, R. S., Birkett, M., Newcomb, M. E., & Mustanski, B. (2012). Do Psychiatric Disorders Moderate the Relationship Between Psychological Distress and Sexual Risk-Taking Behaviors in Young Men Who Have Sex with Men? A Longitudinal Perspective. AIDS Patient Care & Stds, 26(6), 366-374. doi:10.1089/apc.2011.0418
Braje, S. E., Eddy, J. M., & Hall, G. N. (2016). A Comparison of Two Models of Risky Sexual Behavior During Late Adolescence. Archives Of Sexual Behavior, 45(1), 73-83. doi:10.1007/s10508-015-0523-3
Hill, L. M., Maman, S., Kilonzo, M. N., & Kajula, L. J. (2017). Anxiety and depression strongly associated with sexual risk behaviors among networks of young men in Dar es Salaam, Tanzania. AIDS Care, 29(2), 252-258. doi:10.1080/09540121.2016.1210075
Husky, M. M., Guignard, R., Beck, F., & Michel, G. (2013). Research report: Risk behaviors, suicidal ideation and suicide attempts in a nationally representative French sample. Journal Of Affective Disorders, 1511059-1065. doi:10.1016/j.jad.2013.08.035
Klein, H. (2013). Mental health functioning among men who use the Internet specifically to find partners for unprotected sex. Mental Illness (2036-7457), 5(1), 18-25. doi:10.4081/mi.2013.e6
Munroe, C., Kibler, J., Ma, M., Dollar, K., & Coleman, M. (n.d). The Relationship Between Posttraumatic Stress Symptoms and Sexual Risk: Examining Potential Mechanisms. Psychological Trauma-Theory Research Practice And Policy, 2(1), 49-53.
Pandor, A., Kaltenthaler, E., Higgins, A., Lorimer, K., Smith, S., Wylie, K., & Wong, R. (2015). Sexual health risk reduction interventions for people with severe mental illness: a systematic review. BMC Public Health, 15138. doi:10.1186/s12889-015-1448-4
Skakoon-Sparling, S., & Cramer, K. M. (2016). The impact of sexual arousal on elements of sexual decision making: Sexual self-restraint, motivational state, and self-control. Canadian Journal Of Human Sexuality, 25(2), 119-125. doi:10.3138/cjhs.252-A1
Tsai, A. C., Mimiaga, M. J., Dilley, J. W., Hammer, G. P., Karasic, D. H., Charlebois, E. D., & … Bangsberg, D. R. (2013). Does effective depression treatment alone reduce secondary HIV transmission risk? Equivocal findings from a randomized controlled trial. AIDS And Behavior, 17(8), 2765-2772. doi:10.1007/s10461-013-0600-3