The mediating effect of mental health status between self-system and sexual risk behaviour among university students in Malaysia

Azlan SM 1 , Mohamad F 2 , Mohd Nazan AIN 3 , Dahlan R 4 , Kamaruddin KN 5 , Shibraumalisi NA 5 Show all authors , Syed Mohamad SN 6 , Ismail IZ 1 , Kadir Shahar H 3 , Shamsuddin NH 1

Affiliations 

  • 1 Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Family Medicine, Serdang, Selangor, Malaysia
  • 2 Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Family Medicine, Serdang, Selangor, Malaysia. ilafadzilah@upm.edu.my
  • 3 Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Community Health, Serdang, Selangor, Malaysia
  • 4 Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Psychiatry, Serdang, Selangor, Malaysia
  • 5 Universiti Teknologi MARA, Faculty of Medicine, Department of Primary Care Medicine, Sg. Buloh, Selangor, Malaysia
  • 6 Universiti Sains Islam Malaysia, Faculty of Medicine and Health Sciences, Department of Primary Health Care, Nilai, Negeri Sembilan, Malaysia
Med J Malaysia, 2025 Mar;80(2):183-190.
PMID: 40145161

Abstract

INTRODUCTION: Young adults' engagement in sexual risk behaviour (SRB) is a growing concern worldwide. Addressing this issue is crucial as it can lead to various detrimental effects on individuals, including psychological, behavioural, and, in severe cases, suicidal tendencies and mortality. This nationwide study aimed to determine the mediating roles of depressive, anxiety, and stress symptoms in the relationship between adverse childhood experiences (ACE), religiosity, knowledge on sexuality, attitude towards premarital sex, and SRB among young Malaysian adults using structural equation modelling (SEM).

MATERIALS AND METHODS: A quantitative, cross-sectional design was employed in this study. Respondents were recruited from June to December 2021 among students attending higher education institutions in Malaysia. Institutions were sampled using stratified random sampling and the respondents were selected via convenience sampling. Data were collected via an online survey that inquired about respondents' socio-demographic characteristics, ACE, religiosity, knowledge on sexuality, attitude towards premarital sex, mental health status (MHS), and engagement in SRB. The data were analysed using SPSS version 27 for descriptive analysis, and SPSS AMOS version 27 for structural equation modelling (SEM) analysis.

RESULTS: A total of 1171 respondents were recruited in this study. From the SEM analysis, the proposed model indicated a good fit, and it explained 26% of the SRB variance. There was a partial mediation effect of the relationship between ACE on SRB through MHS (p<0.05), as well as religiosity on SRB through MHS (p<0.05). There was no significant mediation effect was found for the other variables.

CONCLUSION: This study highlighted the mediation effect of MHS between ACE on SRB, as well as between religiosity and SRB. Apart from addressing ACE and religiosity of the young adults, MHS should also need to be explored when dealing with SRB issues and vice versa. Preventive measures should be considered at younger stage to prevent high risk behaviour among young adults.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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