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Park, Lee, and Kim: Influence of Sexual Behavior and Emotional State on Suicidal Ideation among Female Adolescents with Sexual Intercourse Experience
Original Article

J Korean Acad Psychiatr Ment Health Nurs 2018;27(1):15-27.

Published online: 17 March 2018

DOI: https://doi.org/10.12934/jkpmhn.2018.27.1.15

Influence of Sexual Behavior and Emotional State on Suicidal Ideation among Female Adolescents with Sexual Intercourse Experience

Suin Park1, Jina Lee2, Hyunlye Kim3

1Graduate School, College of Nursing, Yonsei University, Seoul, Korea

2Graduate School, Department of Nursing, Chosun University, Gwangju, Korea

3Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea

Corresponding author: Kim, Hyunlye https://orcid.org/0000-0001-6279-6559 Department of Nursing, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea. Tel: +82-62-230-6324, Fax: +82-62-232-9213, E-mail: hlkim5207@chosun.ac.kr

Received 1 February 20182 March 2018       Accepted 8 March 2018

Copyright © 2018 The Korean Academy of Psychiatric and Mental Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study investigated the sexual behaviors, emotional state, and suicide-related characteristics of female adolescents with sexual experience.

Methods

This is a secondary data analysis study using the data of the 11th (2015) Youth Health Behavior Online Survey. The subjects were 889 female students who had sexual intercourse experience in middle and high schools in the Republic of Korea. For data analysis, descriptive statistics, x2 test, and hierarchical logistic regression were used.

Results

Among the subjects, 22.2% reported having experienced homosexual or bisexual relations. The sexual debut time of 31.9% of the subjects was in elementary school or earlier, while 8.1% and 10.7% experienced pregnancy and sexually transmitted diseases, respectively. They reported negative emotional states (high stress 51.7%, unhappiness 17.8%, depressive mood 9.8%) and substantial suicide experiences (suicidal ideation 33.6%, suicidal plan 16.6%, suicidal attempt 13.2%). Through hierarchical logistic regression (Cox & Snell R2=.31), the influencing factors for suicide ideation identified included being subjected to sexual relations, experience of pregnancy, perceived stress and happiness, and depressive mood.

Conclusion

It is important to prevent negative mental health consequences among female students with early sexual experience. Sexual education should strengthen their physical and mental safety through psychological care strategies.

Keywords: Female adolescents, Sexual behavior, Emotions, Suicidal ideation

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Figure 1.
Conceptual framework of this study.
jkapmhn-27-15f1.tif
Table 1.
General Characteristics of Adolescent Girls with Sexual Intercourse (N=889)
Variables Categories n (%) or M±SD Range
Age (year)   15.68±0.07 12~18
Age (year) Grade Middle school 304 (34.2)  
High school 585 (65.8)  
Academic achievement High 118 (13.3)  
Middle 606 (68.2)  
Low 165 (18.5)  
Residence Living with families 783 (88.1)  
Living with relatives 29 (3.2)  
Living with friends or in a dormitory 39 (4.4)  
In a nursery facility 38 (4.3)  
Economic status High 99 (11.1)  
Middle 701 (78.9)  
Low 89 (10.0)  
Weekly allowance (won) ＜50,000 642 (72.2)  
≥50,000, ＜100,000 128 (14.4)  
≥100,000 119 (13.4)  
Usual counselor Families 278 (31.2)  
Friends 400 (45.0)  
Teacher or others 78 (8.8)  
Nothing 133 (15.0)  
Sex education in school (within recent 1 year) Yes 593 (66.7)  
No 296 (33.3)  
Table 2.
Sexual Behaviors, Emotional State, Mental Health Outcome of Subjects (N=889)
Variables   Categories n (%)
Sexual behaviors Subject of sexual relations Intersexual 691 (77.7)
Homosexual 123 (13.8)
Bisexual 75 (8.5)
Sexual debut time† Before elementary school 96 (11.1)
Elementary school 180 (20.8)
Middle school 279 (32.3)
High school 310 (35.8)
Contraceptive practice Always 396 (44.5)
Sometimes 102 (11.5)
No 391 (44.0)
Pregnancy experience† Yes 68 (8.1)
No 771 (91.9)
Artificial abortion experience‡ Yes 50 (73.5)
No 18 (26.5)
STD experience Yes 95 (10.7)
No 794 (89.3)
Emotional state Perceived stress Very stressful 460 (51.7)
A little stressful 304 (34.2)
Rarely stressful 125 (14.1)
Perceived happiness Happy 449 (50.5)
Moderate 282 (31.7)
Unhappy 158 (17.8)
Depressive mood Yes 443 (49.8)
No 446 (50.2)
Mental health outcome Suicidal ideation Yes 299 (33.6)
No 590 (66.4)
Suicidal plan Yes 148 (16.6)
No 741 (83.4)
Suicide attempt Yes 117 (13.2)
No 772 (86.8)

STD=Sexual transmitted disease;

† Excluded missing values;

‡ Among pregnant experience.

Table 3.
Differences in Suicidal Ideation by General Characteristics (N=889)
Variables Categories n (%) Suicidal ideation χ2 (p)
No
 Yes
n (%) n (%)
Grade Middle school 304 (34.2) 198 (65.1) 106 (34.9) 0.01
High school 585 (65.8) 392 (67.0) 193 (33.0) (.945)
Academic achievement High 118 (13.3) 84 (71.2) 34 (28.8) 5.72
Middle 606 (68.2) 406 (67.0) 200 (33.0) (.075)
Low 165 (18.5) 100 (60.6) 65 (39.4)  
Residence Living with families 783 (88.1) 536 (68.5) 247 (31.5) 17.67
Living with relatives 29 (3.2) 12 (41.4) 17 (58.6) (＜.001)
Living with friends or in a dormitory 39 (4.4) 26 (66.7) 13 (33.3)  
In a nursery facility 38 (4.3) 16 (42.1) 22 (57.9)  
Economic status High 99 (11.1) 62 (62.6) 37 (37.4) 7.36
Middle 701 (78.9) 479 (68.3) 222 (31.7) (.034)
Low 89 (10.0) 49 (55.1) 40 (44.9)  
Weekly allowance (won) ＜50,000 642 (72.2) 431 (67.1) 211 (32.9) 7.02
≥50,000, ＜100,000 128 (14.4) 90 (70.3) 38 (29.7) (.042)
≥100,000 119 (13.4) 69 (58.0) 50 (42.0)  
Usual counselor Families 278 (31.2) 190 (68.3) 88 (31.7) 11.04
Friends 400 (45.0) 275 (68.8) 125 (31.2) (.014)
Teacher or others 78 (8.8) 53 (67.9) 25 (32.1)  
Nothing 133 (15.0) 72 (54.1) 61 (45.9)  
Sex education in school Yes No 593 (66.7) 296 (33.3) 399 (67.3) 191 (64.5) 194 (32.7) 105 (35.5) 1.46 (.249)
Table 4.
Differences in Suicidal Ideation by Sexual Behaviors and Emotional State (N=889)
Variables   Categories n (%)
 Suicidal Ideation
 x2 (p)
No
 Yes
n (%) n (%)
Sexual behaviors Subject of sexual relations Intersexual 691 (77.7) 473 (68.5) 218 (31.5) 3,207.20
Homosexual 123 (13.8) 75 (61.0) 48 (39.0) (＜.001)
Bisexual 75 (8.5) 42 (56.0) 33 (44.0)  
Sexual debut time† Before elementary school 96 (11.1) 61 (63.5) 35 (36.5) 382.80
Elementary school 180 (20.8) 113 (62.8) 67 (37.2) (＜.001)
Middle School 279 (32.3) 175 (62.7) 104 (37.3)  
High School 310 (35.8) 223 (71.9) 87 (28.1)  
Contraceptive practice Always 396 (44.5) 255 (64.4) 141 (35.6) 1,172.09
Sometimes 102 (11.5) 70 (68.6) 32 (31.4) (＜.001)
No 391 (44.0) 265 (67.8) 126 (32.2)  
Pregnancy experience† Yes 68 (8.1) 28 (41.2) 40 (58.8) 22.99
No 771 (91.9) 537 (69.6) 234 (30.4) (＜.001)
Artificial abortion experience‡ Yes 50 (73.5) 21 (42.0) 29 (58.0) 21.84
No 18 (26.5) 7 (38.9) 11 (61.1) (＜.001)
STD experience Yes 95 (10.7) 46 (48.4) 49 (51.6) 5437.80
No 794 (89.3) 544 (68.5) 250 (31.5) (＜.001)
Emotional state Perceived stress Very stressful 460 (51.7) 240 (52.2) 220 (47.8) 83.92
A little stressful 304 (34.2) 247 (81.3) 57 (18.7) (＜.001)
Rarely stressful 125 (14.1) 103 (82.4) 22 (17.6)  
Perceived happiness Happy 449 (50.5) 359 (80.0) 90 (20.0) 115.65
Moderate 282 (31.7) 179 (63.5) 103 (36.5) (＜.001)
Unhappy 158 (17.8) 52 (32.9) 106 (67.1)  
Depressive mood Yes 443 (49.8) 195 (44.0) 248 (56.0) 200.72
No 446 (50.2) 395 (88.6) 51 (11.4) (＜.001)

† Excluded missing values;

‡ Among pregnant experience.

Table 5.
Influencing Factors of Suicidal Ideation among Adolescent Girls with Sexual Intercourse
Variables Categories Model 1
 Model 2
 Model 3
OR 95% CI p OR 95% CI p OR 95% CI p
Residence Living with families† Living with relatives 3.56 1.64~7.77 .001 3.57 1.16~10.95 .026 3.11 0.87~11.16 .082
Living with friends or 0.97 0.48~1.93 .923 0.52 0.23~1.21 .129 0.56 0.21~1.48 .241
in a dormitory                  
In a nursery facility 1.45 0.69~3.04 .329 0.67 0.24~1.84 .434 0.88 0.34~2.29 .796
Economic status High† Middle 0.97 0.59~1.60 .915 1.23 0.70~2.17 .474 1.08 0.60~1.95 .801
Low 1.27 0.67~2.41 .464 1.78 0.88~3.61 .108 1.04 0.47~2.34 .920
Weekly allowance (won) ＜50,000† ≥50,000, ＜100,000 ≥100,000 0.87 1.43 0.56~1.36 0.91~2.26 .552 .123 0.91 1.10 0.57~1.15 0.63~1.90 .686 .746 0.74 0.88 0.45~1.23 0.49~1.58 .245 .658
Usual counselor Families† Friends 1.17 0.84~1.63 .343 1.47 1.02~2.12 .037 1.19 0.77~1.84 .421
Teacher or others 1.14 0.66~1.97 .648 1.21 0.67~2.20 .531 0.86 0.45~1.65 .652
Nothing 1.85 1.13~3.01 .014 2.26 1.36~3.75 .002 1.32 0.75~2.33 .343
Subject of sexual relations Intersexual† Homosexual       1.47 0.83~2.61 .192 1.95 0.85~4.46 .113
Bisexual       1.83 1.05~3.20 .033 2.34 1.30~4.19 .005
Sexual debut time‡ High school† ＜Elementary school       0.55 0.26~1.16 .114 0.78 0.65~1.73 .538
Elementary school       0.88 0.51~1.50 .631 1.03 0.59~1.82 .908
Middle school       1.41 0.97~2.05 .069 1.30 0.86~1.98 .218
Pregnancy experience‡ No† Yes       2.40 1.13~5.09 .022 2.33 1.08~5.02 .031
STD experience No† Yes       2.20 1.12~4.33 .022 2.01 0.97~4.15 .060
Perceived stress Rarely stressful† Very stressful             3.99 1.99~8.02 ＜.001
A little stressful             1.22 0.61~2.42 .573
Perceived happiness Happy† Moderate             1.21 0.79~1.86 .376
Unhappy             2.80 1.73~4.55 ＜.001
Depressive mood No† Yes             6.73 4.40~10.28 ＜.001

† Reference group;

‡ Excluded missing values.

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