Emotion Regulation Intervention for Reducing Sexual Risk Among Early Adolescents with Mental Health Symptoms: Factors Moderating Treatment Response

Introduction: Adolescents with mental health concerns are more likely to engage in sexual risk. Difficulties in emotion regulation (ER) may be particularly influential on decision making related to risk, particularly for this group. Project TRAC (Talking about Risk and Adolescent Choices) is a small-group prevention intervention for 7th graders with mental health symptoms that targeted ER training as a mechanism of prevention. It found those in the intervention condition were significantly less likely to engage in sexual risk behavior during a 30-month follow-up period (AOR=2.16). Understanding potential moderators of this effect is important for potential dissemination of the intervention.

Methods: Data were collected from 420 7th graders as part of the trial comparing an ER condition to a health promotion (HP) comparison. Adolescents completed baseline surveys as well as reports of sexual behavior at 6-month intervals for 2.5 years. Sexual risk was defined as any report of condomless sex, multiple partners in any 6-month period, or substance use before sex. Predictive causal modeling was used to estimate individual treatment effects for each participant. Simulations were run using R package ‘mice’ v2.30, followed by analyses for hypothesized moderators, using Mplus 7.3.

Results: Subgroups showed differential responding to the interventions. Sexual experience (oral, vaginal, or anal) prior to starting the study was associated with endorsing risk behavior, which differed by condition (ER group- Active: 30%, Not active: 10%; HP group- Active: 26%, Not active: 19%). The presence of clinically significant mental health symptoms also differentiated response (ER group- Clinical subgroup: 15%, Non-clinical subgroup: 11%; HP group- Clinical subgroup: 27%, Non-clinical subgroup: 15%). Minimal differences were observed in the treatment effect between conditions by race (White vs. non-White), SES (households making $20,000 or less vs. others), gender, or baseline emotional awareness (as measured by the Difficulties in Emotion Regulation Scale).

Discussion: These exploratory results suggest that an emotion regulation intervention was able to prevent risk for youth across gender, race, and SES, as well as regardless of their baseline emotional awareness. However, the ER intervention worked particularly well with the target audience, youth with mental health symptoms, further supporting the notion that addressing emotion regulation can affect risk in this population. The results also indicate that the ER intervention was more effective in preventing risk for those who had not had sex, providing additional data for its utility as a prevention strategy, but suggesting that additional work may be needed with those who are sexually active in early adolescence.