Pa en al in ol emen , dep ession, and sexual expe iences
ac oss adolescence: a c oss-sec ional su ey among
adolescen s o di e en ages
Hanna Sa ioja
a
, Mika Helminen
b,c
, Sa i F öjd
c
, Mau i Ma unen
d
and
Rii ake u Kal iala-Heino
a,e
a
School o Medicine, Uni e si y o Tampe e, Tampe e, Finland;
b
Science Cen e, Pi kanmaa Hospi al Dis ic ,
Tampe e, Finland;
c
Facul y o Social Sciences/Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland;
d
Adolescen Psychia y, Uni e si y o Helsinki and Helsinki Uni e si y Hospi al, Helsinki, Finland;
e
Depa men
o Adolescen Psychia y, Tampe e Uni e si y Hospi al, Tampe e, Finland
ABSTRACT
Backg ound: Ea ly sexual ac i i y and mul iple sexual pa ne s a e
deemed isky sexual beha io s and connec ed o men al diso de s
such as dep ession. Pa en –adolescen ela ionship is connec ed
bo h o isky sexual beha io s and dep ession.
Objec i e: To asce ain i he e is a connec ion be ween pa en al
in ol emen and adolescen sexual beha io in di e en age
g oups om ea ly o la e adolescence, and he ole o dep ession
in his associa ion.
Me hods: Da a om School Heal h P omo ion S udy, a c oss-
sec ional school su ey in Finland om he yea s 2010 and 2011
wi h 186,632 adolescen s as in o man s was used. We examined
he associa ion o sexual beha io s and pa en al in ol emen wi h
sel - epo ed dep ession, a i s sepa a ely and hen in he same
model. Analyses we e conduc ed in se en age g oups, sepa a ely
o gi ls and boys. The main ou comes we e analyzed by χ
2
es
and logis ic eg ession.
Resul s: Among bo h gi ls and boys, low le el o pa en al
in ol emen was connec ed o ha ing expe ienced sexual
in e cou se and, among hose sexually ac i e, epo ing mo e
sexual pa ne s in ea ly and middle adolescence. Pa en al
in ol emen and dep ession we e independen ly associa ed wi h
he sexual beha io s s udied and had only a sligh modi ying
e ec on each o he in his con ex .
Conclusion: P omo ing pa en al in ol emen in adolescen s’li es is
likely o be bene icial o adolescen s’sexual heal h.
ARTICLE HISTORY
Recei ed 27 Feb ua y 2017
Accep ed 20 Ap il 2017
KEYWORDS
Adolescence; isky sexual
beha io ; dep ession;
pa en al in ol emen ; sel -
epo ed measu es
In oduc ion
Sexual de elopmen in adolescence equi es ma u a ion in physical, psychological, and
social domains. Emo ional de elopmen akes place o e a much longe pe iod han
does physical and cogni i e de elopmen (S einbe g, 2005). Fi s in e cou se is o en
© 2017 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup.
This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/
licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
CONTACT Hanna Sa ioja sa ioja.hanna.k@s uden .u a. i School o Medicine, Uni e si y o Tampe e, Tampe e,
Finland
HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE, 2017
VOL. 5, NO. 1, 258–275
h ps://doi.o g/10.1080/21642850.2017.1322908
cha ac e ized as sexual debu . I is no ma i e and de elopmen ally app op ia e o ha e
expe iences o in e cou se in la e adolescence, while sexual debu in ea ly adolescence
can be seen as p oblem beha io (Madkou , Fa ha , Halpe n, Godeau, & Gabhainn,
2010; Sa ioja, Helminen, F öjd, Ma unen, & Kal iala-Heino, 2015). Ea ly sexual ac i i y
is connec ed o isky sexual beha io s such as a g ea e numbe o sexual pa ne s and
ailu e o use con acep ion, which in u n exposes hese adolescen s o unwan ed p eg-
nancies and sexually ansmi ed in ec ions (Edga dh, 2000,2002; Ko chick, Sha e , Fo e-
hand, & Mille , 2001;O’Donnell, O’Donnell, & S ue e, 2001). Wha is mo e, a la ge body
o esea ch shows ha sexual ac i i y pe se among ea ly and middle adolescen s, and
sexual isk- aking in pa icula , a e connec ed o low socioeconomic s a us, li ing
wi hou bo h pa en s, and con lic s be ween pa en s and be ween pa en and adolescen
(Boisla d P & Poulin, 2011; Da ila e al., 2009; Ko chick e al., 2001; Madkou e al.,
2010; Mille , Benson, & Galb ai h, 2001; Wigh , Williamson, & Hende son, 2006). All
hese co ela es sugges ha ea ly and isky sexual ac i i y a e indica i e o de elopmen al
p oblems a he han o apid and a o able ma u a ion.
In addi ion o sociodemog aphic amily cha ac e is ics, esea ch on ea ly and/o isky
sexual beha io in adolescence has ocused on aspec s o pa en ing as a isk/p o ec i e
ac o . Low le el o pa en al moni o ing is connec ed o ea ly sexual ac i i y, mo e
sexual pa ne s, and less condom use, while con e sely highe le els o pa en al moni o -
ing a e a p o ec i e ac o (DiClemen e, Wingood, C osby, Sionean, e al., 2001; Ma kham
e al., 2010; Meschke, Ba holomae, & Zen all, 2002; Wigh e al., 2006). In he USA, i was
ound ha adolescen s spending mo e ime alone a home and wi h less supe ision han
hei pee s we e mo e likely o be sexually ac i e, and among boys he amoun o unsupe -
ised ime also co ela ed wi h mo e li e ime sexual pa ne s (Cohen, Fa ley, Taylo ,
Ma in, & Schus e , 2002). Adolescen s whose pa en s know hei iends and whe eabou s
a e less likely o ha e engaged in isky sexual beha io s (Coley, Vo uba-D zal, & Schind-
le , 2009). On he o he hand, posi i e, open pa en –adolescen communica ion was con-
nec ed o g ea e use o con acep ion (DiClemen e, Wingood, C osby, Cobb, e al., 2001;
S an on, Li, Pack, & Co ell, 2002), pos poning i s sexual in e cou se (Rai e al., 2003),
and less sexual isk- aking in gene al (Wang e al., 2013). Howe e , excessi e pe cei ed
pa en al con ol o s ic e pa en al ules we e conside ed a isk ac o o e e ha ing
sex in adolescence (Ma kham e al., 2010).
The p e alence o dep essi e diso de s ises signi ican ly om childhood o adoles-
cence (Cos ello, E kanli, & Angold, 2006; Egge & Angold, 2006; Wichs øm e al.,
2012). Dep ession is almos wice as common among adolescen gi ls as among adolescen
boys (Pa on e al., 2014). Sexual ac i i y in ea ly adolescence is connec ed o dep ession
(Hall o s e al., 2004; Jamieson & Wade, 2011; Kal iala-Heino, Kosunen, & Rimpelä, 2003;
Osh i, Tubman, & Jacca d, 2011; Valle, Roysamb, Sundby, & Klepp, 2009) and he e is also
e idence ha his associa ion pe sis s un il middle adolescence (Hall o s, Walle , Baue ,
Fo d, & Halpe n, 2005;Sa ioja e al., 2015). This associa ion has been shown o g adually
disappea , and o be e en e e sed in la e adolescence (Sa ioja e al., 2015), concu ing
wi h de elopmen al heo ies (Moshman, 2011; S einbe g, 2005). Adolescen s su e ing
om dep essi e symp oms a e u he a g ea e isk o sexual isk- aking (B own
e al., 2006; Donenbe g, Eme son, & Mackesy-Ami i, 2011; Hall o s e al., 2004,2005;
Kosunen, Kal iala-Heino, Rimpelä, & Laippala, 2003; Langille, Asb idge, Kisely, &
Wilson, 2012; Leh e , Sh ie , Go make , & Buka, 2006; Mazza e o e al., 2006; Mun,
HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE 259
Windle, & Schainke , 2008; Pax on & Valois, 2007; Rubin, Gold, & P imack, 2009; Se h
e al., 2011; Tu ne , La kin, Sonens ein, & Tandon, 2011).
Posi i e aspec s o pa en ing, such as pa en al in ol emen , app op ia e moni o ing
and ca e oge he wi h sound in e pe sonal ela ions in a amily a e bene icial o an
adolescen ’s men al heal h (Bu ne -Zeigle e al., 2012; F öjd, Kal iala-Heino, &
Rimpelä, 2007; Yu, Clemens, Yang, Li, & S an on, 2006). Adolescen s whose pa en s
know hei iends and whe eabou s a e less likely o ha e dep essi e symp oms (F öjd
e al., 2007; Hamza & Willoughby, 2011). Dep essi e symp oms a e mo e common
among adolescen s who ha e di icul ies communica ing wi h pa en s (Fle che , 2004;
F öjd e al., 2007; Schwa z e al., 2012; S an on, Li, & Galb ai h, 2000; Yu e al., 2006).
Dep essed adolescen s pe cei e pa en al moni o ing o be a lowe le els han a e age
(Yu e al., 2006).
To summa ize, esea ch has associa ed ce ain aspec s o pa en ing/ pa en –adolescen
ela ionships wi h bo h adolescen dep ession and ea ly and isky sexual beha io and has
demons a ed an associa ion be ween adolescen dep ession and sexual ac i i y.
Dep ession could explain he associa ions be ween pa en –adolescen ela ionship and
sexual beha io , o ice e sa, o dep ession and aspec s o pa en ing could be indepen-
den ly associa ed wi h sexual beha io . Schus e , Me mels ein, and Wakschlag (2013)
did no ind pa en al con ol o pa en –adolescen communica ion o be signi ican
ac o s o dep essi e symp oms and isky sexual beha io in adolescence. Wilson and
Donenbe g (2004) ound ha high-quali y pa en –adolescen sexual heal h communi-
ca ion was connec ed o less sexual isk- aking among adolescen s ecei ing psychia ic
ea men . These indings sugges an independen ole o aspec s o pa en ing in adoles-
cen sexual beha io .
The s udies e iewed abo e ha e ocused on sligh ly di e en aspec s o pa en ing and
pa en –adolescen in e ac ion. Te ms desc ibing aspec s o pa en ing, such as in ol e-
men , moni o ing, and ca e may also o some ex en be used in e changeably, o a
leas hey likely o e lap, e en i some ocus mo e on limi se ing and di ec ing by
pa en s, and o he s on showing in e es and communica ing posi i ely. Ne e heless, i
can be summa ized ha posi i e pa en al in ol emen ha includes pa en al in e es in
and knowledge abou he adolescen ’s pe sonal li e, and good pa en –adolescen com-
munica ion ha e been connec ed o be e ou comes ega ding adolescen s’sexual beha -
io and men al heal h. Howe e , he e a e ha dly any s udies ocusing simul aneously on
he associa ions be ween all h ee ac o s, aspec s o pa en ing, sexual beha io , and
men al heal h in adolescence. Taking simul aneous accoun o all h ee ac o s can
esul in an impo an e idence base o p omo ing adolescen sexual heal h.
The aim o his s udy was o asce ain i he e is a connec ion be ween pa en al in ol-
emen and adolescen sexual beha io in di e en age g oups om ea ly o la e adoles-
cence, and he ole o dep ession in his associa ion. This s udy add essed he ollowing
ques ions:
(1) Is pa en al in ol emen connec ed o adolescen sexual beha io , namely o ha ing
expe ienced sexual in e cou se and ha ing had sexual in e cou se wi h i e o mo e
pa ne s?
(2) Do he possible associa ions be ween pa en al in ol emen and adolescen sexual
beha io pe sis when dep ession is adjus ed o ?
260 H. SAVIOJA ET AL.
(3) A e he associa ions be ween pa en al in ol emen , dep ession, and adolescen sexual
beha io simila o di e en among ea ly, middle, and la e adolescen s?
(4) A e he possible associa ions in (1), (2), and (3) simila among adolescen boys and
gi ls?
In ligh o he exis ing li e a u e, we hypo hesized ha low le els o pa en al in ol emen
epo ed by adolescen s would be associa ed wi h mo e expe iences o sexual in e cou se
and mo e sexual isk- aking in ea ly and middle adolescence. Dep ession could be a cause
and also a consequence o bo h adolescen ’s ea ly and isk- aking sexual beha io and o
low pa en al in ol emen . Low pa en al in ol emen and dep ession could each indepen-
den ly be associa ed wi h adolescen s’ea ly and isky sexual beha io s o one o hem could
cancel ou he o he when s udied simul aneously. We le he hypo hesis open as o
whe he dep ession would pa ially o o ally explain he possible associa ions be ween pa -
en alin ol emen andsexualbeha io s.Al hough dep ession is mo e common among gi ls
han boys, he associa ion be ween dep ession and expe ience o sexual in e cou se has
been shown o be qui e simila ac oss gende s (Sa ioja e al., 2015). We he e o e an icipa ed
no majo gende di e ences in he associa ions o be s udied. Howe e , because o he known
gende di e ences in he p e alence o adolescen dep ession, we s ill deemed i wo hwhile o
conduc he analyses sepa a ely o gi ls and boys.
Ma e ials and me hods
This s udy used he da a o he Finnish School Heal h P omo ion S udy (SHPS), which is a
na ionwide class oom su ey dealing wi h heal h beha io s and is based on sel - epo ed
measu es (www. hl. i/koulu e eyskysely). E e y s uden answe ed he ques ionnai e
anonymously. The SHPS has been conduc ed yea ly since 1995. O iginally only 14- o
16-yea -old seconda y school s uden s esponded o he su ey, bu since 1999 he
su ey has also been conduc ed among uppe seconda y and oca ional school s uden s
(16–20 yea s old). Un il 2011, he SHPS was ca ied ou in al e na e yea s in wes e n
pa s o Finland and eas e n pa s and hen he esul s o wo consecu i e yea s we e com-
bined o ep esen he whole o Finland. The SHPS was g an ed app o al by he e hics
commi ees o Pi kanmaa Hospi al Dis ic and he Na ional Ins i u e o Heal h and
Wel a e. This s udy u ilized he da a o he SHPS om 2010 o 2011 including all he
age g oups, 14- o 20-yea -olds, included in he s udy.
In Finland he as majo i y, 99% o 14- o 16-yea -old adolescen s a end seconda y
school. Al hough compulso y educa ion ends a e seconda y school, a endance a
uppe seconda y educa ion, whe e s uden s a e ypically 16–18 yea s old, is abou 93%.
Acco dingly, he da a o he SHPS co e ed he majo i y o 14- o 18-yea -old Finnish ado-
lescen s. S uden s aged 19–20 we e no so well ep esen ed in he s udy because hey ha e
usually al eady g adua ed om he schools a which he s udy is conduc ed. S uden s
a ending school on he s udy day esponded o he su ey. S uden s absen on he
su ey day (10–15%) we e no con ac ed. Fu he mo e, a sligh loss o po en ial espon-
den s was due o he ac ha no e e y school pa icipa es in he SHPS. The su ey
was sen o e e y municipali y, and each municipali y decided i he schools in hei
a ea would pa icipa e in he su ey. The inal co e age o he 2010–2011 s udy was
80% o all 14- o 16-yea -old seconda y school s uden s, 73% o 16- o 18-yea -old
HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE 261
uppe seconda y school s uden s, and 43% o 16- o 18-yea -old oca ional school s uden s
in he whole o Finland.
1
The o al numbe o esponden s was 186,632 o whom 92,478
(49.6%) we e boys and 94,154 (50.4%) we e gi ls. The esponden s canno be iden i ied
om he da a.
Sexual ac i i y was elici ed by he ques ion ‘Ha e you e e had sexual in e cou se?’The
esponse al e na i es we e ‘yes’and ‘no’. In he whole sample (n= 186,632), 36.9% o he
gi ls and 32.7% o he boys had expe ienced sexual in e cou se. In Finland, gi ls expe ience
hei i s sexual in e cou se a age 16.5 on a e age and boys a age 17.5.
2
The numbe o sexual pa ne s was elici ed by he ques ion ‘How many sexual pa ne s
ha e you had sexual in e cou se wi h?’The esponse al e na i es we e ‘one’,‘ wo’,‘ h ee o
ou ’, and ‘ i e o mo e’. The numbe o sexual pa ne s was analyzed as a dicho omized
a iable, he cu poin being in i e o mo e sexual pa ne s, which, acco ding o ea lie
esea ch, was ega ded as isky sexual beha io (Kal iala-Heino, F öjd, & Ma unen,
2015). Among hose adolescen s who we e sexually ac i e (n= 65,063), 15.2% o he
gi ls and 16.9% o he boys epo ed ha ing had in e cou se wi h i e o mo e sexual
pa ne s.
Dep essi e symp oms we e measu ed wi h a Finnish modi ica ion o he sho (13-
i em) Beck Dep ession In en o y (Beck & Beck, 1972; Beck, Rial, & Rickels, 1974), Rai a-
salo's modi ica ion o he BDI (R-BDI) (Rai asalo, 2007). The Beck Dep ession In en o y
is a widely used scale wi h es ablished alidi y and eliabili y among bo h adul s and ado-
lescen s (Beck e al., 1974; Benne e al., 1997; Olsson & Von Kno ing, 1997). The 13-
i em BDI has been shown o be a alid me hod o iden i ying dep essi e symp oms
among adolescen s (Beck & Beck, 1972; Beck e al., 1974; Benne e al., 1997; Kal iala-
Heino, Rimpela, Ran anen, & Laippala, 1999). The Finnish e sion, R-BDI, is equi alen
o he o iginal 13-i em BDI, bu o e e y i em an opening ques ion and one posi i e
esponse al e na i e ha e been added. The sco ing is as in he o iginal 13-i em e sion
(Kal iala-Heino e al., 1999). Each i em is sco ed 0–3 and he maximum sco e is 39. Ado-
lescen s wi h a sum sco e o 0–4 we e ca ego ized as non-dep essed, hose sco ing 5–7as
mildly dep essed, 8–15 as mode a ely dep essed and hose sco ing 16 and o e as se e ely
dep essed. Sco es indica ing mode a e o se e e dep ession (8 o mo e) a e e e ed o as
sel - epo ed dep ession. Mode a e o se e e sel - epo ed dep ession was p esen in
16.9% o he gi ls and 7.7% o he boys.
Pa en al in ol emen was measu ed wi h h ee ques ions. The i s ques ion was ‘Do
you pa en s know mos o you iends?’wi h esponse al e na i es ‘ hey bo h know’
(coded o he analyses (=2), ‘only a he knows’(=1), ‘only mo he knows’(=1), and
‘nei he o hem knows’(=0)). The second ques ion was ‘Do you pa en s know abou
you whe eabou s on F iday and Sa u day nigh s?’wi h esponse al e na i es ‘always’
(=2), ‘some imes’(=1), and ‘mos ly no ’(=0). The hi d ques ion was ‘A e you able o
alk wi h you pa en s abou ma e s impo an o you?’wi h esponse al e na i es
‘o en’(=3), ‘ ai ly o en’(=2), ‘now and hen’(=1), and ‘ha dly e e ’(=0). A sum sco e
was o med o he esponses so ha he maximum sco e was 7. Sco es 0–3 we e e e ed
o as low pa en al in ol emen , sco es 4–5 o as a e age pa en al in ol emen , and sco es
6–7 o as high pa en al in ol emen . O he gi ls (boys), 17.7% (18.4%) epo ed low,
44.7% (44.3%) a e age, and 37.6% (37.2%) high pa en al in ol emen .
The sociodemog aphic a iables used we e amily s uc u e (li ing wi h mo he and
a he s. in any o he amily cons ella ion) and mo he ’s and a he ’s highes educa ional
262 H. SAVIOJA ET AL.

quali ica ion (comp ehensi e school only/ uppe seconda y school o oca ional school/
uppe seconda y school o oca ional school and u he oca ional s udies/uni e si y
o uni e si y o applied sciences).
Da a analysis
Dis ibu ions a e gi en abo e o ha ing expe ienced sexual in e cou se, o pa en al
in ol emen , and o dep ession in he whole sample, and o ha ing had i e o mo e
pa ne s o in e cou se among hose sexually ac i e, sepa a ely o gi ls and boys. Bi a i-
a e associa ions be ween ha ing expe ienced sexual in e cou se and pa en al in ol emen ,
and, among hose who we e sexually ac i e, ha ing had i e o mo e pa ne s o in e -
cou se and pa en al in ol emen we e examined wi h c oss- abula ions and signi icance
was es ed wi h χ
2
es /Fishe ’s exac es whe e app op ia e. In all he analyses we used
all a ailable da a. Those pa icipa ing in he su ey may ha e occasionally skipped
some ques ions, and due o his, he e may be sligh a ia ion in numbe o esponden s
in di e en analyses. Mul i a ia e associa ions we e s udied using logis ic eg ession.
Ha ing expe ienced sexual in e cou se was en e ed as he dependen a iable. Fi s ,
dep ession (yes s. no) and hen pa en al in ol emen (high/a e age/low, using high as
e e ence ca ego y) we e en e ed each alone as independen a iables. C ude odds a ios
(ORs) wi h 95% con idence in e als (CI) we e calcula ed. Nex dep ession and pa en al
in ol emen we e en e ed simul aneously, yielding adjus ed ORs (95% CI) (Model 1).
Finally, sociodemog aphic a iables we e adjus ed o (Model 2). The analyses we e un
sepa a ely o boys and gi ls, among he whole sample and s a i ied o age g oup (age
in yea s: 14/15/16 …). Age g oups 19 and 20 we e combined because o hei smalle
size and because hey we e less ep esen a i e han age g oups 14–18. Among hose
epo ing hey we e sexually ac i e, simila analyses we e pe o med using isk- aking
sexual beha io (ha ing had i e o mo e pa ne s o in e cou se) as he dependen a i-
able. Because o he la ge da a size, and o a oid bias due o mul iple es ing, we se he
limi o s a is ical signi icance a p< .01.
A i ion
O he esponden s, 1230 (0.7%) had skipped ques ions on pa en al in ol emen i ems, 31
(0.0%) had skipped he dep ession scale, and 4929 (2.6%) had no esponded on i hey
had expe ienced sexual in e cou se. O hose who had expe ienced in e cou se, 449
(0.7%) had no epo ed wi h how many di e en pa ne s hey had had in e cou se.
No esponding on pa en al in ol emen ques ions and expe ience o in e cou se we e
mo e common among boys (3.1% s. 2.1% and 0.9% s. 0.4%, espec i ely; in bo h,
p< .001). Non- esponse in all was s a is ically signi ican ly associa ed wi h younge age
(mean (SD), bu in p ac ice, di e ences in age be ween hose esponding and hose skip-
ping we e negligible: non- esponse o pa en al in ol emen 16.1 (1.2) s. 16.3 (1.3); non-
esponse o dep ession scale 16.2 (1.3) s. 16.3 (1.3); and non- esponse o expe ience o
in e cou se 16.2 (1.2) s. 16.3 (1.3). Among hose who had expe ienced in e cou se,
non- esponse on numbe o pa ne s was mo e common among boys (1.0% s. 0.4%,
p< .0001), and hose no esponding we e sligh ly younge (mean (SD) 16.3 (1.3) s.
16.9 (1.2) yea s, p< .001).
HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE 263
Resul s
Bi a ia e associa ions
Ac oss age g oups 14–18, he p opo ion o hose who had expe ienced sexual in e cou se
was lowes among adolescen s who epo ed high pa en al in ol emen . Expe ience o
sexual in e cou se was mo e common among hose epo ing a e age pa en al in ol e-
men , and mos common among hose epo ing low pa en al in ol emen (Table 1).
Di e ences be ween pa en al in ol emen g oups we e g ea e in he younge age g oups.
Among sexually ac i e gi ls, epo ing i e o mo e pa ne s o in e cou se was mo e
common in he a e age pa en al in ol emen g oup han in he high pa en al in ol emen
g oup, and mos common in he low pa en al in ol emen g oup. This was seen in all age
g oups (Table 2). Among sexually ac i e boys, he p opo ion o hose epo ing i e o
mo e pa ne s o in e cou se was highe in he g oup wi h low pa en al in ol emen
han among hose epo ing high pa en al in ol emen , bu no such sys ema ic di e ences
we e seen be ween high and a e age pa en al in ol emen g oup (Table 2).
In he whole sample, 44.5% o dep essed adolescen s had had sexual in e cou se, while
among non-dep essed adolescen s, he igu e was 34.6% (p≤.001). Among sexually ac i e
adolescen s, 25.1% o dep essed adolescen s had had i e o mo e pa ne s o in e cou se,
while among non-dep essed esponden s he igu e was 14.4% (p≤.001).
Mul i a ia e associa ions be ween pa en al in ol emen , dep ession, and sexual
beha io
In he whole sample, ORs o ha ing expe ienced in e cou se we e inc eased in he a e age
pa en al in ol emen g oup and highes in he low pa en al in ol emen g oup, among
bo h boys and gi ls. The inding pe sis ed when dep ession, and inally sociodemog aphics
we e adjus ed o (Table 3). Among hose sexually ac i e, ORs o isk- aking sexual
beha io ( i e o mo e pa ne s) we e inc eased in hose who epo ed low pa en al in ol-
emen among bo h boys and gi ls, and his pe sis ed when dep ession, and inally socio-
demog aphics we e adjus ed o (Table 4).
Table 1. P opo ions (% (n/N)) o hose ha ing expe ienced sexual in e cou se among adolescen s wi h
high, a e age, and low pa en al in ol emen .
High pa en al in ol emen A e age pa en al in ol emen Low pa en al in ol emen p-Value
Age (yea s) Gi ls
14 6.8 (378/5530) 12.6 (861/6834) 26.0 (708/2720) <.001
15 16.2 (1375/8511) 23.7 (2613/11016) 38.3 (1678/4383) <.001
16 34.2 (2884/8435) 40.4 (4019/9938) 50.8 (2012/3960) <.001
17 50.5 (4092/8107) 55.9 (4840/8657) 63.4 (2064/3256) <.001
18 63.8 (2056/3225) 64.2 (2196/3423) 69.6 (960/1379) <.001
19–20 78.2 (583/746) 79.8 (863/1082) 83.4 (456/547) .064
all 32.9 (11368/34554) 37.6 (15392/40950) 48.5 (7878/16245) <.001
Age (yea s) Boys
14 8.2 (462/5625) 13.3 (830/6226) 25.4 (576/2266) <.001
15 16.2 (1379/8524) 21.6 (2242/10384) 32.8 (1406/4287) <.001
16 31.1 (2496/8021) 35.3 (3431/9715) 43.1 (1712/3971) <.001
17 44.6 (3375/7574) 47.9 (4163/8188) 53.6 (1972/3683) <.001
18 53.9 (1640/3041) 58.5 (2126/3616) 63.4 (1089/1719) <.001
19–20 66.8 (270/404) 73.8 (484/656) 73.2 (300/410) .038
all 29.0 (9622/33189) 33.8 (13276/39285) 43.2 (7055/16335) <.001
No e: S a is ically signi ican di e ences a e shown in bold.
264 H. SAVIOJA ET AL.
Mul i a ia e analyses s a i ied o age
ORs o ha ing expe ienced sexual in e cou se among 14- o 16-yea -old gi ls we e
inc eased among hose wi h dep ession and among hose epo ing a e age and low pa -
en al in ol emen when dep ession and pa en al in ol emen we e s udied sepa a ely
(Table 3 c ude ORs), simul aneously (Table 3 Model 1), and a e sociodemog aphic a i-
ables we e adjus ed o (Table 3 Model 2). Expe ience o sexual in e cou se was also
associa ed wi h a e age and low pa en al in ol emen among 17-yea -old gi ls. In age
g oups 18 and 19–20, associa ions be ween low pa en al in ol emen and ha ing expe i-
enced sexual in e cou se we e le eled ou in he mul i a ia e models. Among boys aged
14–16 ORs o ha ing expe ienced sexual in e cou se we e inc eased among hose display-
ing dep ession as well as among hose epo ing a e age and low pa en al in ol emen ,
when dep ession and pa en al in ol emen we e en e ed sepa a ely (Table 3 c ude
ORs), simul aneously (Table 3 Model 1), and a e adjus ing o sociodemog aphic a i-
ables (Table 3, Model 2). An associa ion be ween low pa en al in ol emen and ha ing
expe ienced in e cou se also pe sis ed among 17- and 18-yea -olds in he mul i a ia e
models. A e age 17, dep ession was no longe associa ed wi h expe ience o in e cou se
among boys. Among he oldes , 19- o 20-yea -old boys, adjus ing o sociodemog aphics
le eled ou associa ions be ween pa en al in ol emen and ha ing expe iences sexual
in e cou se.
Among sexually ac i e gi ls, ORs o epo ing i e o mo e pa ne s o in e cou se
we e inc eased among hose displaying dep ession and among hose epo ing low pa -
en al in ol emen in all 15- o 20-yea -olds when each o hese a iables was en e ed
in o he model alone (Table 4 c ude ORs) o simul aneously (Table 4 Model 1). A e
u he adjus ing o sociodemog aphics, hese indings pe sis ed in all age g oups
excep he oldes (19–20), whe e only dep ession was associa ed wi h isk- aking sexual
beha io (Table 4 Model 2). In 14-yea -old gi ls, only dep ession was s a is ically signi i-
can ly associa ed wi h expe ience o in e cou se wi h mul iple pa ne s, and his inding
pe sis ed a e adjus ing o sociodemog aphics (Table 4).
Table 2. P opo ions (% (n/N)) o hose ha ing had i e o mo e sexual pa ne s among sexually ac i e
adolescen s wi h high, a e age, and low pa en al in ol emen .
High pa en al in ol emen A e age pa en al in ol emen Low pa en al in ol emen p-Value
Gi ls
Age (yea s)
14 6.4 (24/373) 7.4 (63/856) 12.5 (88/702) <.001
15 5.1 (69/1365) 7.6 (197/2592) 12.5 (208/1669) <.001
16 9.9 (285/2879) 11.4 (456/4006) 16.2 (325/2004) <.001
17 14.3 (585/4086) 15.6 (751/4283) 22.0 (451/2052) <.001
18 17.6 (362/2051) 21.4 (468/2190) 27.6 (263/954) <.001
19–20 31.5 (183/581) 33.9 (292/861) 42.1 (191/454) <.001
all 13.3 (1508/11335) 14.5 (2227/15328) 19.5 (1526/7835) <.001
Boys
Age (yea s)
14 13.9 (62/445) 19.1 (154/806) 31.7 (178/562) <.001
15 12.9 (176/1360) 12.6 (277/2194) 24.0 (334/1389) <.001
16 12.8 (318/2477) 12.3 (419 / 3407) 19.9 (336/1690) <.001
17 14.5 (487/3362) 13.0 (537/4141) 20.3 (397/1954) <.001
18 18.1 (295/1633) 18.3 (387/2110) 25.9 (281/1083) <.001
19–20 29.6 (80/270) 32.6 (157/481) 42.4 (126/197) .003
all 14.9 (1418/9547) 14.7 (1931/13139) 23.7 (1652/6975) <.001
No e: S a is ically signi ican di e ences a e shown in bold.
HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE 265
Among sexually ac i e boys, simila ly, epo ing i e o mo e pa ne s o in e cou se
was associa ed wi h dep ession and low pa en al in ol emen among 14- o 18-yea -
olds when each o hese independen a iables was en e ed in o he model alone
(Table 4 c ude ORs) o simul aneously (Table 4, Model 1). In 14- and 15-yea -olds,
Table 3. ORs (95% CI) o ha ing expe ienced sexual in e cou se acco ding o sel - epo ed dep ession
(yes s. no) and pa en al in ol emen (a e age s. high, low s. high), s a i ied o age g oups.
Gi ls Boys Gi ls Boys
14 Sociodemog aphics con olled o
C ude Dep ession 2.7 (2.4–3.0)** 4.7 (4.1–5.4)**
A e age in ol emen 2.0 (1.7–2.2)** 1.7 (1.5–1.9)**
Low in ol emen 4.8 (4.2–5.5)** 3.8 (3.3–4.4)**
M1 Dep ession 1.9 (1.7–2.1)** 3.6 (3.1–4.1)** M2 1.8 (1.6–2.1)** 3.4 (2.9–4.0)**
A e age in ol emen 1.8 (1.6–2.0)** 1.6 (1.4–1.8)** 1.7 (1.5–2.0)** 1.5 (1.3–1.7)**
Low in ol emen 3.8 (3.3–4.4)** 2.9 (2.5–3.4)** 3.3 (2.8–3.9)** 2.6 (2.2–3.0)**
15
C ude Dep ession 2.0 (1.9–2.2)** 2.6 (2.3–2.8)**
A e age in ol emen 1.6 (1.5–1.7)** 1.4 (1.3–1.5)**
Low in ol emen 3.2 (3.0–3.5)** 2.5 (2.3–2.8)**
M1 Dep ession 1.6 (1.5–1.7)** 2.3 (1.8–2.3)** M2 1.5 (1.4–1.6)** 1.9 (1.7–2.1)**
A e age in ol emen 1.5 (1.4–1.6)** 1.4 (1.3–1.5)** 1.5 (1.4–1.6)** 1.3 (1.2–1.4)**
Low in ol emen 2.8 (2.5–3.0)** 2.2 (2.0–2.4)** 2.4 (2.2–2.6)** 2.0 (1.8–2.2)**
16
C ude Dep ession 1.5 (1.4–1.6)** 1.6 (1.4–1.8)**
A e age in ol emen 1.3 (1.2–1.4)** 1.2 (1.1–1.3)**
Low in ol emen 2.0 (1.8–2.1)** 1.7 (1.6–1.8)**
M1 Dep ession 1.3 (1.2–1.4)** 1.4 (1.3–1.6)** M2 1.2 (1.1–1.3)** 1.3 (1.2–1.5)**
A e age in ol emen 1.3 (1.2–1.4)** 1.2 (1.1–1.3)** 1.2 (1.2–1.3)** 1.2 (1.1–1.2)*
Low in ol emen 1.9 (1.7–2.0)** 1.6 (1.5–1.7)** 1.7 (1.6–1.8)** 1.5 (1.4–1.6)**
17
C ude Dep ession 1.1 (1.1–1.2)** 1.1 (1.0–1.2)
A e age in ol emen 1.2 (1.2–1.3)** 1.1 (1.1–1.2)**
Low in ol emen 1.7 (1.6–1.8)** 1.4 (1.3–1.6)**
M1 Dep ession 1.0 (0.9–1.1) 1.0 (0.9–1.1) M2 1.0 (0.9–1.1) 0.9 (0.8–1.0)
A e age in ol emen 1.2 (1.2–1.3)** 1.1 (1.1–1.2)** 1.2 (1.1–1.3)** 1.0 (1.0–1.2)
Low in ol emen 1.7 (1.6–1.8)** 1.4 (1.3–1.6)** 1.5 (1.4–1.7)** 1.3 (1.2–1.5)**
18
C ude Dep ession 1.0 (0.9–1.1) 1.1 (0.9–1.3)
A e age in ol emen 1.0 (0.9–1.1) 1.2 (1.1–1.3)**
Low in ol emen 1.3 (1.1–1.5)** 1.5 (1.3–1.7)**
M1 Dep ession 0.9 (0.8–1.1) 1.0 (0.9–1.2) M2 0.9 (0.8–1.0) 1.0 (0.8–1.1)
A e age in ol emen 1.0 (0.9–1.1) 1.2 (1.1–1.3)** 1.0 (0.9–1.1) 1.2 (1.1–1.3)*
Low in ol emen 1.3 (1.2–1.5)** 1.5 (1.3–1.7)** 1.1 (1.0–1.3) 1.3 (1.1–1.5)**
19–20
C ude Dep ession 0.9 (0.7–1.1) 0.8 (0.6–1.1)
A e age in ol emen 1.1 (0.9–1.4) 1.4 (1.1–1.8)
Low in ol emen 1.4 (1.1–1.9) 1.4 (1.0–1.8)
M1 Dep ession 0.8 (0.6–1.0) 0.7 (0.5–1.0) M2 0.8 (0.7–1.0) 0.7 (0.5–1.0)
A e age in ol emen 1.1 (0.9–1.4) 1.4 (1.1–1.9)* 1.1 (0.9–1.4) 1.3 (1.0–1.8)
Low in ol emen 1.5 (1.1–2.0)* 1.5 (1.1–2.0) 1.3 (1.0–1.8) 1.3 (0.9–1.9)
All
C ude Dep ession 1.4 (1.3–1.4)** 1.7 (1.7–1.8)**
A e age in ol emen 1.2 (1.2–1.3)** 1.3 (1.2–1.3)**
Low in ol emen 1.9 (1.8–2.0)** 1.9 (1.8–1.9)**
M1 Dep ession 1.2 (1.1–1.2)** 1.5 (1.4–1.6)** M2 1.1 (1.1–1.2)* 1.4 (1.3–1.5)*
A e age in ol emen 1.2 (1.2–1.2)** 1.2 (1.2–1.3)** 1.2 (1.1–1.2)* 1.2 (1.1–1.2)*
Low in ol emen 1.8 (1.8–1.9)** 1.7 (1.7–1.8)** 1.6 (1.5–1.7)* 1.6 (1.5–1.6)*
No e: Fi s , c ude ORs a e gi en. In Model 1 (M1), dep ession and pa en al in ol emen a e en e ed as independen a i-
ables, and in Model 2 (M2), sociodemog aphic a iables a e adjus ed o .
**ORs s a is ically signi ican a le el p< .001.
*A le el .01 < p< .001.
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