Community Mental Health Journal

, Volume 47, Issue 6, pp 679–687 | Cite as

Psychosocial Risk Factors for Inconsistent Condom Use in Young People with First Episode Psychosis

  • Adrienne P. Brown
  • Dan I. Lubman
  • Susan J. Paxton
Original Paper


There is evidence of high rates of unprotected sex among young people with first episode psychosis compared to their peers. Little research has explored factors associated with condom use in this population. The current study examined the association between previously identified psychosocial risk factors and condom use in young people with early psychosis and their peers. Sixty-seven sexually active young people with first episode psychosis and 48 sexually active control participants matched on a number of sociodemographic factors completed a self-report survey. Increased probability of inconsistent condom use was associated with clinical status, younger age, unemployment, and the absence of peer support for condom use. Psychological distress, self-esteem, social support, substance use, and impulsivity were not associated with condom use. The results suggest that sexual risk-reduction interventions for young people with psychosis should target peer norms, particularly among those who are younger and unemployed.


First episode psychosis Psychosocial risk factors Condom use Sexual risk-reduction Young people 


Conflicts of interest

There are no conflicts of interest.


  1. Abraham, C., & Sheeran, P. (1994). Modelling and modifying young heterosexuals’ HIV-preventive behaviour; a review of theories, findings and educational implications. Patient Education and Counseling, 23(3), 173–186.PubMedCrossRefGoogle Scholar
  2. Abrantes, A. M., Strong, D. R., Ramsey, S. E., Kazura, A. N., & Brown, R. A. (2006). Hiv-Risk Behaviors among Psychiatrically Hospitalized Adolescents with and without Comorbid Sud. Journal of Dual Diagnosis, 2(3), 85–100.PubMedCrossRefGoogle Scholar
  3. Adelekan, M., Green, A., Dasgupta, N., Tallack, F., Stimson, G. V., & Wells, B. (1996). Reliability and validity of the Opiate Treatment Index among a sample of opioid users in the United Kingdom. Drug Alcohol Review, 15(3), 261–270.CrossRefGoogle Scholar
  4. Ajzen, I. (1985). From intentions to actions: a theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action control: from cognition to behavior. Berlin: Springer.Google Scholar
  5. Bandura, A. (1977). Social learning theory. Englewood Cliffs: Prentice-Hall.Google Scholar
  6. Barratt, E. S. (1985). Impulsiveness subtraits: arousal and information processing. In J. T. Spence & J. Butcher (Eds.), Advances in personality assessment (Vol. 5). Hillsdale: LawrenceErlbaum.Google Scholar
  7. Black, R. A., Serowik, K. L., & Rosen, M. I. (2009). Associations between impulsivity and high risk sexual behaviors in dually diagnosed outpatients. Americal Journal of Drug Alcohol Abuse, 35(5), 325–328.CrossRefGoogle Scholar
  8. Brooks, R. T., Beard, J., & Steel, Z. (2006). Factor structure and interpretation of the K10. Psychological Assessment, 18(1), 62–70.PubMedCrossRefGoogle Scholar
  9. Brown, A. P., Lubman, D. I., & Paxton, S. J. (2008). STIs and blood borne viruses—risk factors for individuals with mental illness. Australian Family Physician, 37(7), 531–534.PubMedGoogle Scholar
  10. Brown, A., Lubman, D., & Paxton, S. (2010a). Reducing sexually transmitted infection risk in young people with first episode psychosis. International Journal of Mental Health Nursing, 20, 12–20. (accepted 12 July).CrossRefGoogle Scholar
  11. Brown, A., Lubman, D., & Paxton, S. (2010b). Sexual risk behaviour in young people with first episode psychosis. Early Intervention in Psychiatry, 4, 234–242. (published online 26 Apr).PubMedCrossRefGoogle Scholar
  12. Brown, A., & Siahpush, M. (2006). Socioeconomic predictors of a sedentary lifestyle: results from the 2001 National Health Survey. Journal of Physical Activity and Health, 3(1), 90–101.Google Scholar
  13. Brown, A., & Siahpush, M. (2007). Risk factors for overweight and obesity: results from the 2001 National Health Survey. Public Health, 121(8), 603–613.PubMedCrossRefGoogle Scholar
  14. Brown, A., Yung, A., Cosgrave, E., Killackey, E., Buckby, J., Stanford, C., et al. (2006). Depressed mood as a risk factor for unprotected sex in young people. Australasian Psychiatry, 14(3), 310–312.PubMedGoogle Scholar
  15. Capaldi, D. M., Stoolmiller, M., Clark, S., & Owen, L. D. (2002). Heterosexual risk behaviors in at-risk young men from early adolescence to young adulthood: Prevalence, prediction, and association with STD contraction. Developmental Psychology, 38(3), 394–406.PubMedCrossRefGoogle Scholar
  16. Carey, M. P., Carey, K. B., Maisto, S. A., Gordon, C. M., & Vanable, P. A. (2001). Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients. Journal of Consulting and Clinical Psychology, 69(5), 846–850.PubMedCrossRefGoogle Scholar
  17. Catania, J. A., Kegeles, S. M., & Coates, T. J. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Education Quarterly, 17(1), 53–72.PubMedCrossRefGoogle Scholar
  18. Cecil, H., Stanley, M. A., Carrion, P. G., & Swann, A. (1995). Psychometric properties of the MSPSS and NOS in psychiatric outpatients. Journal of Clinical Psychology, 51(5), 593–602.PubMedCrossRefGoogle Scholar
  19. Cerwonka, E. R., Isbell, T. R., & Hansen, C. E. (2000). Psychosocial factors as predictors of unsafe sexual practices among young adults. AIDS Education and Prevention, 12(2), 141–153.PubMedGoogle Scholar
  20. Darke, S., Hall, W., Wodak, A., Heather, N., & Ward, J. (1992). Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: The Opiate Treatment Index. British Journal of Addiction, 87(5), 733–742.PubMedCrossRefGoogle Scholar
  21. de Visser, R. O. (2000). Predictors of heterosexual condom use: A diary-based study. Unpublished PhD thesis. Victoria: La Trobe University.Google Scholar
  22. Donenberg, G. R., Emerson, E., Bryant, F. B., Wilson, H., & Weber-Shifrin, E. (2001). Understanding AIDS-risk behavior among adolescents in psychiatric care: Links to psychopathology and peer relationships. Journal of the American Academy of Child & Adolescent Psychiatry , 40(6), 642–653.CrossRefGoogle Scholar
  23. Eaton, L., Flisher, A. J., & Aaro, L. E. (2003). Unsafe sexual behaviour in South African youth. Social Science and Medicine, 56(1), 149–165.PubMedCrossRefGoogle Scholar
  24. Eker, D., & Arkar, H. (1995). Perceived social support: psychometric properties of the MSPSS in normal and pathological groups in a developing country. Social Psychiatry and Psychiatric Epidemiology, 30(3), 121–126.PubMedCrossRefGoogle Scholar
  25. Essau, C. A. (2010). Comorbidity of substance use disorders among community-based and high-risk adolescents. Psychiatry Research, 185, 176–184.PubMedCrossRefGoogle Scholar
  26. Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological bulletin, 111(3), 455–474.PubMedCrossRefGoogle Scholar
  27. Friedman, H. L. (1992). Changing patterns of adolescent sexual behavior: Consequences for health and development. Journal of Adolescent Health, 13(5), 345–350.PubMedCrossRefGoogle Scholar
  28. Gordon, C. M., Carey, M. P., Carey, K. B., Maisto, S. A., & Weinhardt, L. S. (1999). Understanding HIV-related risk among persons with a severe and persistent mental illness: Insights from qualitative inquiry. The Journal of Nervous and Mental Disease, 187(4), 208–216.PubMedCrossRefGoogle Scholar
  29. Guillon, M. S., Crocq, M. A., & Bailey, P. E. (2003). The relationship between self-esteem and psychiatric disorders in adolescents. European Psychiatry, 18(2), 59–62.PubMedCrossRefGoogle Scholar
  30. Hayaki, J., Anderson, B., & Stein, M. (2006). Sexual risk behaviors among substance users: Relationship to impulsivity. Psychology of addictive behaviors, 20(3), 328–332.PubMedCrossRefGoogle Scholar
  31. Henrich, C. C., Brookmeyer, K. A., Shrier, L. A., & Shahar, G. (2006). Supportive relationships and sexual risk behavior in adolescence: An ecological-transactional approach. Journal of pediatric psychology, 31(3), 286–297.PubMedCrossRefGoogle Scholar
  32. Henry, D. B., Schoeny, M. E., Deptula, D. P., & Slavick, J. T. (2007). Peer selection and socialization effects on adolescent intercourse without a condom and attitudes about the costs of sex. Child Development, 78(3), 825–838.PubMedCrossRefGoogle Scholar
  33. Hercus, M., Lubman, D. I., & Hellard, M. (2005). Blood-borne viral and sexually transmissible infections among psychiatric populations: What are we doing about them? The Australian and New Zealand journal of psychiatry, 39(10), 849–855.PubMedCrossRefGoogle Scholar
  34. Howard, M., & McCabe, J. (1990). Helping teenagers postpone sexual involvement. Family Planning Perspectives, 22(1), 21–26.PubMedCrossRefGoogle Scholar
  35. Kalichman, S. (1998). Preventing AIDS: A sourcebook for behavioral interventions. Mahwah: Lawrence Erlbaum Associates Inc.Google Scholar
  36. Kelly, J. A. (1997). HIV risk reduction interventions for persons with severe mental illness. Clinical Psychology Review, 17(3), 293–309.PubMedCrossRefGoogle Scholar
  37. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.PubMedCrossRefGoogle Scholar
  38. Klein, J. D., Allan, M. J., Elster, A. B., Stevens, D., Cox, C., Hedberg, V. A., et al. (2001). Improving adolescent preventive care in community health centers. Pediatrics, 107(2), 318–327.PubMedCrossRefGoogle Scholar
  39. Lambert, M., Conus, P., Lubman, D. I., Wade, D., Yuen, H., Moritz, S., et al. (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatrica Scandinavica , 112(2), 141–148.PubMedCrossRefGoogle Scholar
  40. Malatestinic, D., Micovic, V., Kendel, G., & Baricev-Novakovic, Z. (2005). Assessment of psychological and social factors in adolescents risk behavior: Questionnaire study. Croatian Medical Journal, 46(1), 81–87.PubMedGoogle Scholar
  41. Mathias, S., Lubman, D. I., & Hides, L. (2008). Substance-induced psychosis: A diagnostic conundrum. Journal of Clinical Psychiatry, 69(3), 358–367.PubMedCrossRefGoogle Scholar
  42. McGorry, P. D., & Yung, A. R. (2003). Early intervention in psychosis: An overdue reform. The Australian and New Zealand Journal of Psychiatry, 37(4), 393–398.PubMedCrossRefGoogle Scholar
  43. Meade, C. S., & Sikkema, K. J. (2005). HIV risk behavior among adults with severe mental illness: A systematic review. Clinical Psychology Review, 25(4), 433–457.PubMedCrossRefGoogle Scholar
  44. PA, A. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  45. Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768–774.PubMedCrossRefGoogle Scholar
  46. Raj, R., & Verghese, A. (2000). Human immunodeficiency virus infections in adolescents. Adolescent Medicine, 11(2), 359–374.PubMedGoogle Scholar
  47. Romer, D., & Hornik, R. (1992). HIV education for youth: The importance of social consensus in behaviour change. AIDS Care, 4(3), 285–303.PubMedCrossRefGoogle Scholar
  48. Rosenberg, M., & Pearlin, L. I. (1978). Social class and self-esteem among children and adults. American Journal of Sociology, 84, 53–75.CrossRefGoogle Scholar
  49. Rosenberg, S. D., Trumbetta, S. L., Mueser, K. T., Goodman, L. A., Osher, F. C., Vidaver, R. M., et al. (2001). Determinants of risk behavior for human immunodeficiency virus/acquired immunodeficiency syndrome in people with severe mental illness. Comprehensive Psychiatry, 42(4), 263–271.PubMedCrossRefGoogle Scholar
  50. Rosenstock, I. M. (1974). The health belief model and personal health behavior. Thorofare: Charles B. Slack.Google Scholar
  51. Sattler, J. M., & Ryan, J. J. (1999). Assessment of children: WAIS-III supplement (3rd ed.). San Diego: Jerome Sattler.Google Scholar
  52. Sawyer, M. G., Arney, F. M., Baghurst, P. A., Clark, J. J., Graetz, B. W., Kosky, R. J., et al. (2000). Mental health of young people in Australia. Canberra: Commonwealth Department of Health and Aged Care.Google Scholar
  53. Shrier, L. A., Goodman, E., & Emans, S. J. (1999). Partner condom use among adolescent girls with sexually transmitted diseases. Journal of Adolescent Health, 24(5), 357–361.PubMedCrossRefGoogle Scholar
  54. Siahpush, M., & Borland, R. (2001). Socio-demographic variations in smoking status among Australians aged ≥18: multivariate results from the 1995 National Health Survey. Australian and New Zealand Journal of Public Health, 25(5), 438–442.PubMedGoogle Scholar
  55. Silbert, E., & Tippett, J. (1965). Self-esteem: Clinical assessment and measurement validation. Psychological Reports, 16, 1017–1071.CrossRefGoogle Scholar
  56. Smith, M. D. (2001). HIV risk in adolescents with severe mental illness: Literature review. Journal of Adolescent Health, 29(5), 320–329.PubMedCrossRefGoogle Scholar
  57. Sterk, C. E., Klein, H., & Elifson, K. W. (2004). Self-esteem and “at risk” women: determinants and relevance to sexual and HIV-related risk behaviors. Women Health, 40(4), 75–92.PubMedGoogle Scholar
  58. Svenson, G. R., Ostergren, P. O., Merlo, J., & Rastam, L. (2002). Action control and situational risks in the prevention of HIV and STIs: Individual, dyadic, and social influences on consistent condom use in a university population. AIDS Education Preview, 14(6), 515–531.CrossRefGoogle Scholar
  59. Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed.). UK: Allyn & Bacon.Google Scholar
  60. UNAIDS. (1999). Sexual behavioural change for HIV: Where have the theories taken us? Geneva: World Health Organisation.Google Scholar
  61. Waterston, A. (1997). Anthropological research and the politics of HIV prevention: Towards a critique of policy and priorities in the age of AIDS. Social Science and Medicine, 44(9), 1381–1391.PubMedCrossRefGoogle Scholar
  62. Weschler, D. (1997). Weschlet adult intelligence scale (3rd ed.). San Antonio: Pearson.Google Scholar
  63. Wiggers, L. C., de Wit, J. B., Gras, M. J., Coutinho, R. A., & van den Hoek, A. (2003). Risk behavior and social-cognitive determinants of condom use among ethnic minority communities in Amsterdam. AIDS Education Preview, 15(5), 430–447.CrossRefGoogle Scholar
  64. Winters, K. C., Botzet, A. M., Fahnhorst, T., Baumel, L., & Lee, S. (2009). Impulsivity and its relationship to risky sexual behaviors and drug abuse. Journal of Child and Adolescent Substance Abuse, 18(1), 43–56.PubMedCrossRefGoogle Scholar
  65. Yung, A. R., Killackey, E., Hetrick, S. E., Parker, A. G., Schultze-Lutter, F., Klosterkoetter, J., et al. (2007). The prevention of schizophrenia. International Review of Psychiatry, 19(6), 633–646.PubMedCrossRefGoogle Scholar
  66. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.CrossRefGoogle Scholar
  67. Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3–4), 610–617.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Adrienne P. Brown
    • 1
  • Dan I. Lubman
    • 2
  • Susan J. Paxton
    • 1
  1. 1.School of Psychological ScienceLa Trobe UniversityBundooraAustralia
  2. 2.Turning Point Alcohol and Drug CentreEastern Health and Monash UniversityMelbourneAustralia

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