LAUSR

Background: Research suggests age at first sex, particularly early sexual debut, is associated with mental distress in adolescence. However, we know little about whether mental health deficits related to age at first sex last into adulthood, and whether this differs by gender, in low-income settings. Objective: We estimate associations between age at first sex and adult mental distress in Nicaragua. Given the gendered nature of sexual norms and higher rates of mental distress among Nicaraguan women, we assess gender differences in associations. We consider number of sexual partners and births as potential mediators. Methods: We use data from the 2011/2012 Nicaragua Reproductive Health Survey (N = 10,893 women; N = 3,495 men) and negative binomial regression to assess how age at first sex is associated with adult mental distress. Results: Women and men whose first sex occurred during early adolescence had higher rates of adult mental distress than those who delayed sex until ages 15‒17. Delaying first sex after age 17 was associated with decreased mental distress for women only. We found little evidence of mediation. Conclusions: Early first sex is associated with increased adult mental distress in Nicaragua. This finding is particularly robust for women. In this setting, women whose sexual debut begins before adulthood (age 18) have higher rates of mental distress. Contribution: Findings suggest that early first sex may contribute to long-term mental distress, and gender disparities, in low-income settings. Providing resources to help delay first sex beyond early adolescence may be critical for mental health in adulthood.