Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships

Abstract

Objective: Severely mentally ill youths are at elevated risk for human immunodeficiency virus infection, but little is known about acquired immunodeficiency syndrome (AIDS) risk behavior in adolescents who seek outpatient mental health services or about the links between psychiatric problems and particular high-risk behaviors. This pilot study used structural equation modeling to conduct a path analysis to explore the direct and indirect effects of adolescent psychopathology on risky sex, drug/alcohol use, and needle use.

Method: Ethnically diverse youths (N = 86) and their caregivers who sought outpatient psychiatric services in Chicago completed questionnaires of adolescent psychopathology. Youths reported their relationship attitudes, peer influence, sexual behavior, and drug/alcohol use.

Results: Different AIDS-risk behaviors were associated with distinct forms of adolescent psychopathology (e.g., delinquency was linked to drug/alcohol use, whereas aggression was related to risky sexual behavior), and peer influence mediated these linkages. Some patterns were similar for caregiver- and adolescent-reported problems (e.g., peer influence mediated the relation between delinquency and drug/alcohol use), but others were different (e.g., caregiver-reported delinquency was associated with risky sex, whereas adolescent-reported delinquency was not).

Conclusions: Findings underscore the complexity of factors (types of informants and dimensions of psychopathology) that underlie AIDS risk in troubled youths, and they offer specific directions for designing and implementing uniquely tailored AIDS prevention programs, for example, by targeting delinquent behavior and including high-risk peers and important family members in interventions.

Fig. 1

Mediational path model linking the adolescent-reported, broad-band measure of psychopathology (i.e., externalizing problems) to AIDS-risk behaviors through relationship attitudes (N = 86). Data are standardized path coefficients that attained statistical significance in the model, as well as the proportion of unexplained residual variance for each of the three AIDS-risk behaviors. For presentational clarity, we omitted path coefficients for those linkages that were statistically nonsignificant, as well as the unexplained residual variance for each relationship attitude. These data are available on request. AIDS = acquired immunodeficiency syndrome. *p < .05; **p < .01; ***p < .001.

Fig. 2

Mediational path model linking adolescent-reported, narrow-band measures of psychopathology (i.e., delinquency and aggression) to AIDS-risk behaviors through relationship attitudes (N = 86). Data are standardized path coefficients that attained statistical significance in the model, and the proportion of unexplained residual variance for each of the three AIDS-risk behaviors. For presentational clarity, we omitted path coefficients for those linkages that were statistically nonsignificant, as well as the unexplained residual variance for each relationship attitude. These data are available on request. AIDS = acquired immunodeficiency syndrome. *p < .05; **p < .01; ***p < .001.

Fig. 3

Mediational path model linking parent-reported, narrow-band measures of psychopathology to AIDS-risk behaviors through relationship attitudes (N = 86). Data are standardized path coefficients that attained statistical significance in the model, and the proportion of unexplained residual variance for each of the three AIDS-risk behaviors. For presentational clarity, we omitted path coefficients for those linkages that were statistically non-significant, as well as the unexplained residual variance for each relationship attitude. These data are available on request. AIDS = acquired immunodeficiency syndrome. *p < .05; **p < .01; ***p < .001.