Sexting Among Adolescents Associated With Sexual Behavior, Mental Health Issues

young teenager girl hand using mobile phone or smartphone on gray wall background
Associations were observed between sexting and sexual activity, multiple sexual partners, anxiety/depression, and substance use in adolescents.

Sexting among adolescents, and particularly among young adolescents, is associated with sexual experimentation and mental health problems, according to a meta-analysis published in JAMA Pediatrics.

Sexting, which is defined as the exchange of sexual messages, photos, or videos by electronic devices, is a relatively recent phenomenon. Data from an analysis of 39 studies covering more than 100,000 individuals suggest that 1 in 4 adolescents are receiving sexts and 1 in 7 are sending them.

Related Articles

Camille Mori of the Department of Psychology, University of Calgary, Alberta, Canada, and colleagues used random-effects meta-analyses to determine the relationship between sexting and sexual behaviors, such as sexual activity, multiple sexual partners, and failure to use contraception, and mental health risk factors such as anxiety, depression, delinquent behavior, smoking, and use of alcohol and drugs. 

The study population included 41,723 adolescents from 23 studies. The mean age of participants was 14.9 years (range 11.9 to 16.8 years); females constituted 52.1% of the study population. Sexual activity was analyzed in 16 studies (n=35,467). Adolescents who sexted were 3.66 times more likely to engage in sexual activity. In 5 studies (n=6466), the odds ratio (OR) for having multiple sexual partners among those who sexted was 5.37. The effect sizes diminished as the adolescents got older, however. The OR for failure to use contraception was 2.16 for those who sexted in 6 studies (n=7388).

Analysis of the 3 studies that reported on the association between sexting and delinquent behavior in 3024 participants found an OR of 2.50. The association between sexting and depression/anxiety was looked at in 7 studies (n=29,559). The pooled effect size across studies was significant, with an OR of 1.79. Effect size appeared to diminish as the adolescents grew older.

Alcohol use was examined in 8 studies and drug use in 5. For alcohol, the pooled effect size was significant, with an OR of 3.78, while the OR for drug use was 3.48. Four studies looked at smoking and again, the pooled effect size was significant, with an OR of 2.66. 

The investigators noted that the nature of meta-analyses dictate that although associations can be determined, causation cannot. Furthermore, missing data precluded exploration of some associations, for example what percentage of participants were in romantic relationships or were single.

The investigators called for research to determine the directionality of the associations between sexting, sexual behaviors, and mental health problems. They also contended that educating youth to the potential consequences of sexting and ensuring they are equipped to deal with their personal and social development in an increasingly technological world is crucial.


Mori C, Temple JR, Browne D, Madigan S. Association of sexting with sexual behaviors and mental health among adolescents. A systematic review and analysis [published online June 17, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.1658