Depression, suicidality, and alcohol abuse among sexual risk behavior subgroups of female high school students

This study identified sexual risk behavior subgroups among female adolescents based on the presence or absence of early sexual intercourse (ESI), forced sexual intercourse (FSI), and 4 or more lifetime sexual partners (4 or more LSP). Subgroups were compared on rates of recent alcohol abuse, depression, and suicide risk. This secondary analysis utilized data from the 2021 Youth Risk Behavior Survey, employed cluster analysis to derive subgroups of female US high school students, and multinomial regression analysis to compare subgroups on mental health problems. A total of 1,967 female adolescents were identified across four cluster subgroups. Higher proportions reporting alcohol abuse (52.8% vs 20.8%), depressive symptoms (80.5% vs 63.6%), and suicide attempts (30.8% vs 12.5%), predicted membership in Cluster 2 (4+ Lifetime Sexual Partners) versus the Low Sexual Risk Reference Cluster 1. Higher proportions reporting suicide contemplation (69.7% vs 32.3%) and suicide attempts (50.0% vs 12.5%) predicted membership in Cluster 3 (Early Sex) versus Cluster 1. Finally, alcohol abuse (33.9% vs 20.8%), depression (84.7% vs 63.6%), suicide contemplation (62.3% vs 32.3%), and suicide attempts (34.9% vs 12.5%) were linked with membership in Cluster 4 (Forced Sexual Intercourse) versus Cluster 1. The cluster subgroups of sexually experienced female high school students varied significantly in proportions reporting early coitus, forced sexual intercourse, and 4 or more lifetime sexual partners, and appear to represent relatively distinct sexual risk profiles. Intervention implications associated with sexual risk behavior and mental health problems identified among sexually active male high school students are discussed. • Identified 4 Distinct Cluster Sexual Risk Behavior Subgroups Of US Female High School Students • Sexual Risk Clusters Display Clinically Significant Patterns of Substance Abuse and Psychiatric Symptoms • Early Onset Sexual Activity and Forced Sexual Intercourse Strongly Linked with Suicidal Ideation and Suicide Attempts