Mental Health Correlates of Sexual Risk Behaviors among High School Students: A Cross-Sectional Survey in Guilan Province, Iran
Abstract:
Background: Adolescence constitutes a critical developmental window characterized by heightened neurobio logical plasticity and concurrent vulnerability to psychopathology and health-compromising behaviors. The in tersection of mental health symptomatology and sexual risk behaviors remains inadequately characterized within conservative sociocultural contexts, particularly the Islamic Republic of Iran.
Methods: A stratified multistage probability sampling design recruited 850 students (grades 10-12) from 12 high schools in Guilan Province (Iran) during 2024-2025. Validated Persian-language versions of the Depression Anx iety Stress Scales-21 (DASS-21) and a researcher-developed Sexual Risk Behavior Inventory were administered. Multivariable logistic regression analyses quantified independent associations, with interaction terms evaluating moderating effects of family support and academic performance.
Results: The analytical sample comprised 764 participants (response rate: 95.5%; 54.7% female; mean age:16.4±1.1 years). Prevalence estimates indicated 24.4% for clinically significant depressive symptoms, 41.4% for anxiety, and 15.6% for stress. Moderate-to-severe depression was independently associated with increased odds of sexual activity (AOR=1.82; 95% CI: 1.24-2.67; p=0.002), inconsistent condom use (AOR=1.94; 95% CI:1.31-2.87; p<0.001), and composite sexual risk scores≥2 (AOR=2.15; 95% CI:1.48-3.12; p<0.001). Anxiety demonstrated comparable associations. Significant interaction effects were observed between depression and academic underachievement (p=0.042) and low family support (p=0.038).
Conclusions: These findings substantiate the syndemic relationship between internalizing psychopathology and sexual risk behaviors among Iranian adolescents. Integration of mental health screening within school-based sexual health frameworks represents an evidence-informed strategy for reducing adolescent morbidity in conser vative settings.
