Mediating role of mental health status on sexual risk behavior among young adults attending higher education institutions in Malaysia

Young adulthood is a critical stage where individuals have the highest tendency to engage in various of risky activities including sexual risk behavior (SRB). Sexual risk behavior encompasses various unsafe sexual practices such as premarital sex, early sexual initiation, unprotected sexual intercourse, and involvement with multiple sexual partners, including those at high-risk for sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). The escalating prevalence of sexual risk behavior raises global health concerns due to its potential negative consequences, such as STIs, HIV, severe obstetric complications, abortion, and other detrimental effects on individuals’ lives, such as suicide. Emerging evidence has also reported an association between mental health and sexual risk behavior; however, limited research has been done on the mediating effect of mental health status on sexual risk behavior. The Problem-Behavior Theory (PBT) by Jessor & Jessor (1977) has been widely used to discuss the factors that may influence risky behavior, therefore, PBT may be useful to understand the sexual risk behavior among Malaysian young adults. This study aims to determine the associated factors of sexual risk behavior and the mediating effect of mental health status on the relationship between the factors (adverse childhood experiences, religiosity, knowledge on sexuality, and attitude towards premarital sex) and sexual risk behavior among Malaysian young adults attending local higher education institutions. The study utilized a quantitative, cross-sectional survey design to examine the relationship between predictor factors and sexual risk behavior. Stratified random sampling was conducted at university levels. Malaysia was divided into five regions (northern, eastern, southern, central 1, central 2, and Sabah/Sarawak), and respondents were selected proportionally based on the distribution of higher education institution students. A total of 1171 young adults aged 18 to 24, attending higher institutions across Malaysia, responded to the study. Data were collected through online self-report questionnaire, assessing variables related to sociodemographic, the predictor factors, mental health status, and sexual risk behavior. Data analyses were conducted using SPSS for descriptive and logistic regressions, and SPSS AMOS for mediation analysis. The findings revealed that 7.2% of the Malaysian young adults were engaging in sexual risk behavior, and predictor factors such as age, living arrangements, adverse childhood experiences, religiosity, attitude towards premarital sex, and anxiety symptoms significantly influence the sexual risk behavior among them. The study indicated a significant partial mediation effect for adverse childhood experiences on sexual risk behavior through mental health status, as well as for religiosity on sexual risk behavior through the mental health status among young adults in Malaysia. Based on these findings, institutional counselors, and public health practitioners could consider the risk factors contributing to the alarming issue of sexual risk behavior among Malaysian students in tertiary higher education institutions for the prevention of future health problems in the country.

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