Int. J. Environ. Res. Public Health 2019, 16, 2364; doi:10.3390/ijerph16132364 www.mdpi.com/journal/ijerph
Sexting, Mental Health, and Victimization Among
Adolescents: A Literature Review
Aina M. Gassó 1,*, Bianca Klettke 2, José R. Agustina 1 and Irene Montiel 1
1 Faculty of Law, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
2 School of Psychology, Deakin University, Victoria 3125, Australia
* Correspondence: firstname.lastname@example.org; Tel.: +34-659-026-014
Received: 28 May 2019; Accepted: 2 July 2019; Published: 3 July 2019
Abstract: The practice of creating and sharing sexual images via technological devices, known as
sexting, has received crescent attention in the past years, especially due to the increase of adolescent
engagement in this behavior. Although consensual sexting is not prima facie a crime, as some
research has shown, it has the potential to be a risky behavior, and a threshold to get exposure to
dangerous kinds of victimization as sextortion, online grooming or cyberbullying. In this context,
teenagers represent a vulnerable group due to their limited ability of self-regulation, their high
susceptibility to peer pressure, their technophilia, and their growing sexual curiosity. The present
paper aims to review the scientific literature to analyze the relationship between mental health and
sexting as a potentially risky behavior and its association with online victimization. The results and
implications will be discussed.
Keywords: adolescents; sexting; child victimization; mental health; threshold
The term sexting was first used in 2005 by the Daily Telegraph, to unify the terms “sex” and
“texting” and became an official word in 2009 . It is generally known as “Sending and receiving
sexual content (e.g., photos, videos) via the Internet and mobile phones” , but there is no consensus
around the definition of the term sexting in the scientific community. Therefore, it has been diversely
defined, including from broad definitions that include the sending of any kind of sexual content to
narrower definitions, which are image-based only . Some authors include coercion as part of the
sexting behavior , while others consider that sexting is voluntary by definition ; some definitions
include sending text messages (non-image based) as part of the sexting behaviors [6,7], while others
exclude them from the definition [8,9]. The existing literature on sexting also differs in the population
samples used for the research (teens vs. adults), and in the items used to measure sexting, which
might be some of the reasons for the lack of a unified definition of the term.
The research on sexting has widely grown over the past few years, especially regarding
adolescents and the negative effect it might have on their sexual development and mental health,
specifically after the publication of the Sex and Tech Survey (2008) results, which was the first broad
survey to examine this phenomenon [10,11]. There is a conceptual debate in the scientific community
that distinguishes between two clear arguing lines: one side tends to argue for a normalizing
discourse whereby authors believe sexting to be a normative behavior as a part of sexual expression
in a relationship [10,12], and it is possible to practice “safe sexting” to avoid negative consequences.
The other side tends to argue that sexting is a risky behavior that requires intervention and
prevention to diminish its prevalence, and has been labeled as “deviance discourse” [10,13–15].
Although sexting is a common behavior among the adolescent and young population, the deviance
discourse seems to have more scientific support than the normalizing discourse. For example, a recent
meta-analysis published by Kosenko et al.  found a significant relationship between sexting and
Int. J. Environ. Res. Public Health 2019, 16, 2364 2 of 16
three aspects of sexual behavior: general sexual activity, unprotected sex history, and number of
sexual partners, that are all considered sexual risk behaviors. Similarly, a recent meta-analysis by
Mori, Temple, Browne, and Madigan  has indicated that sexting behaviors were significantly
associated with sexual behaviors, such as sexual activity, having more than one sexual partner, and
lack of contraception use. It was also found that sexting behaviors and internalizing problems, such
as anxiety and depression, were significantly associated. Importantly, the younger the adolescents,
the stronger the observed association.
Klettke et al.  in their literature review found significant relationships between sexting and
risky sexual behavior and with several other adverse outcomes, such as (a) the sharing of sexual
content without consent, (b) legal consequences, and (c) negative mental health repercussions .
Furthermore, research highlights an existing relationship between mental health or psychological
health and online victimization behaviors, such as cyberbullying, online dating violence or revenge
porn [18–21], which are closely related to sexting [5,15,22,23].
Several studies have identified a relationship between cyberbullying and sexting behaviors [24,25].
Fahy et al.’s  investigation emphasizes the high prevalence of cyberbullying and the potential of
cyber-victimization as a risk factor for future depressive symptoms, social anxiety symptoms, and
below average well-being among adolescents. Their results show that cyber-victims and cyberbully-
victims were significantly more likely to report symptoms of depression and social anxiety.
According to these results, it would be expected that sexting behaviors as a form of victimization
might also be related to a higher likelihood of reporting depressive and anxiety symptoms. Along the
same line of reasoning, research findings indicate that a higher degree of depressive symptoms is
associated with greater Internet use [26,27], and a more frequent and problematic internet use is
associated with higher rates of sexting behavior [27,28]. Therefore, it would be reasonable to
hypothesize that higher engagement in sexting behaviors might predict higher rates of depressive
Considering the increasing number of suicides related to sexting , the relationship between
sexting and mental health seems of particular interest, even though results up to date are somewhat
mixed [18,29]. A few studies have investigated personality traits and their relationship with sexting
[2,30]; others have explored the relationship between sexting and sexual risky behaviors or substance
abuse and emotional problems [8,31–33]. However, only a few studies have investigated the
relationship between negative mental health symptoms and sexting [4,34,35]. Discrepancies found in
the literature may be due to differences in the definition of sexting, its measurement, methodologies
or even due to the difference between those teens that sext consensually versus those who are
pressured into sexting [29,36]. For the purpose of the present review, Wolak and Finkelhor’s
conceptual framework of sexting will be used . According to these authors’ typology, sexting
behaviors can be divided into two broad categories: aggravated sexting and experimental sexting.
Aggravated sexting behaviors encompass all types of sexting that may involve criminal or abusive
elements beyond the creation, sending or possession of youth-produced sexual content, including (1)
adult involvement; or (2) criminal or abusive behavior by minors. On the other hand, experimental
sexting behaviors comprise those instances that do not include abuse or coercion, whereby teens
voluntarily took pictures of themselves to create flirting or romantic interest in others.
The main research questions this narrative review seeks to answer is: Is there a relationship
between teen sexting behaviors and mental health? And, if so, which negative mental health impacts
have been found when teens engage in sexting behaviors? Considering this, the present study aims
to review research studies which have explored mental health variables associated with sexting
behaviors and whether a significant relationship between sexting and negative mental health
symptoms has been found. If sexting were found to have a negative mental health impact on
adolescents, these results could have important implications to inform prevention campaigns
targeted at schools, parents, educational communities, and healthcare providers.
Int. J. Environ. Res. Public Health 2019, 16, 2364 3 of 16
In previous years, the body of research regarding sexting behaviors has increased dramatically,
especially research focused on adolescent and teenage population. As such, several studies have
highlighted that sexting behaviors increase as adolescents grow older [2,10]. Furthermore, an
extended body of literature suggests that some sexting behaviors (e.g., sending or distributing) can
be a risk behavior that can lead to or be seen as a form of online victimization of those depicted in the
images, similarly, to cyberbullying or grooming [15,20]. On the other hand, the number of studies
exploring the relationship between sexting and psychological variables has been growing in the past
years, focusing especially on young adults or adult popu lation [2,18,28], even though up to date there
have been no conclusive results on the matter. For this reason, this narrative review aims to identify
both empirical and non-empirical research addressing the relationship between sexting behaviors
among teenagers and mental health. We consider this topic to be of considerable relevance to parents,
the education community, and health care practitioners working with young people who engage in
Criteria for the inclusion in the review were as follows:
● Research (either empirical or non-empirical but excluding doctoral dissertations) exploring
sexting behaviors amongst adolescent population between the ages of 10 and 21 years old.
● Examination of the relationship between sexting behaviors and mental health variables either as
predictors or as consequences.
● Discussions around any psychological consequences related to young people’s sexting practices,
emotional well-being or psychosocial health.
The following databases were searched: SCOPUS, PsycInfo, MEDLINE, and PUBMED, using
the key words “sexting” AND “mental health”, “anxiety”, “depression”, and “psychology”. In
addition, reference lists of reviewed articles were examined in relation to the topic of search, such as
the one found in .
Keeping in mind the extensive body of existing literature and the continually changing nature
of online media technology-related research, the review was restricted to search literature published
between January 2012 and March 2019, written either in English or Spanish, and appearing in peer-
reviewed journals. The search was conducted in April 2019. A visual summary of the process is
presented as a flow chart in Figure 1.
Int. J. Environ. Res. Public Health 2019, 16, 2364 4 of 16
Figure 1. Flow chart of record identification, selection, and inclusion of articles.
As exclusion criteria, those articles that did not include the review topics in their abstracts or
were not directly related to the topic were excluded from the review. For instance, studies
investigating sexting prevalence or mental health variables in adults, or mental health variables
associated to other forms of victimization, such as bullying, were excluded.
The initial bibliographic database search produced 212 articles. In addition to this, 19 articles
were added following hand-searches through reference lists. These 231 articles were included in the
first review and were screened by title and abstract. A total of 138 articles were excluded for not
meeting the inclusion criteria, as they did not address the key areas of interest.
The remaining 93 articles were then assessed for eligibility based on their full text. At this point,
any articles that focused on mental health related to sexting in an adult population were excluded.
Similarly, articles were excluded if they focused on information regarding new technologies, social
media, sexting or cyberbullying in teenage population but did not relate to mental health. Finally,
given the wide amount of international literature based on legal aspects of sexting, articles relating
to this topic were excluded. This led to the exclusion of 63 more articles, for not meeting the relevant
search areas. In total, 30 studies were identified for inclusion in this review.
3.1. Psychosocial Health and Sexting
The results shown by Mitchell et al.  reveal that 21% of teens appearing or creating sexually
explicit images and 25% of teens that had received such images reported feeling very or extremely
upset, embarrassed or afraid as a result of their actions. Livingstone and Görzig’s  research
focused on explaining the incidence of risk and harm reported by children and adolescents in relation
to sexting behaviors. In a sam ple of 2036 European 11 to 16 year-olds reporting that they had received
Int. J. Environ. Res. Public Health 2019, 16, 2364 5 of 16
a sexual message on the Internet in the last 12 months, 24% responded “yes” when asked: “In the last
12 months, has any sexual message that you have seen or received bothered you in any way? For
example, made you feel uncomfortable, upset, or feel that you should not have seen it?” . Subjects
who were younger, female, less sensation seeking, had pre-existing psychological difficulties and
used the Internet less, were more likely to experience harm from the message. The details of the
studies included in the review can be found in Table 1.
Int. J. Environ. Res. Public Health 2019, 16, 2364 6 of 16
Table 1. Details of studies included in the review.
Author Type of
Range Definition of Sexting Results (Mental Health)
Mechling  NE - -
“Sexting (texting plus sex) includes behaviors, such
as sending, receiving, or forwarding of nude or
partially nude images via cell phones”
Sexting may be associated with depression, contemplation
of/attempted suicide, or a victimization of physical abuse or
Bauman  NE - -
“The term sexting refers to the practice of
transmitting sexual content via digital technology
and includes images, video, and text”. According to
this author, sexting is a form of cyberbullying when
“the messages or images are used to inflict harm on a
target by causing humiliation and embarrassment”
Targets of cyberbullying and young people involved in sexting
had higher rates of suicidal thoughts than those who were not
involved, and they also had higher rates of high-risk behaviors
(alcohol, drugs, stealing).
and Rankin  E 169 (80) 18–25
“The sending or receiving of sexually suggestive
written messages, pictures, or videos”
The authors found three significant predictors of sexting
experiences and evaluations of sexting and sexting victimization:
anxious and avoidant attachment and rejection sensitivity.
E 181 (46.9) 15–16
“Sexting refers to sending sexually explicit or
suggestive images, videos, or text messages via
Sending sex texts at age 16 predicted for borderline personality
traits at age 18.
and Shegog 
E 1760 (52.4)
“The practice of sending or posting sexually
suggestive text messages, videos, and images,
including nude or semi-nude photographs or videos,
via cellular telephones or over the Internet (such as
email or social networking sites, such as Facebook)”
Authors found that youth who reported sexting were
significantly more likely to report symptomatology for
depression and anxiety as compared to those who did not report
sexting (between 20% and 27% of youth who sexted had
depression, and between 57% and 61% of youth who sexted had
NE - -
“Sending or posting of sexually suggestive text
messages and images, including nude or semi-nude
photographs, via mobiles or over the Internet”
Research findings suggest a link between sexting behaviors and
higher rates of problematic alcohol and recreational drug use.
Dake et al.  found a correlation between self-producing and
sending sexual images and being depressed, having
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contemplated or attempted suicide in the past year, having been
cyber or indirectly bullied, and having encountered physical
force within a relationship.
Victimization corresponded with negative psychological
outcomes including feelings of sadness, anger and anxiety
disorders as well as depression and ultimately, suicide.
E 1289 (48) 12–18
“Sending, receiving, or forwarding sexually explicit
messages or nude, partially nude, or sexually
suggestive digital images of one’s self or others via a
cell phone, e-mail, Internet, or SMS”
Associated with sexting: emotional health issues, including
being depressed, having contemplated or attempted suicide in
the past year, having been cyber or indirectly bullied, and
having encountered physical force used against the student in
the form of being hit by a boyfriend or girlfriend or being forced
to have sexual intercourse.
Döring  NE - - “The private exchange of self-produced sexual
images via cell phone or the internet”
Sexting is related to suicide. Sexting behavior is placed in a
context of adolescent impulsivity, bad judgment, sensation
seeking, and problematic alcohol and drug use. Sexting is seen
as a manifestation or moderator of problematic and age-
inappropriate sexual behavior.
Englander, E.  E 617 (-) 18 only “Sending nude pictures of yourself” Sexters had less depression than non-sexters but more anxiety.
Relationship not significant.
Eugene,  NE - - “Sending or showing someone sexual pictures of
yourself nude or nearly nude”
Sexting linked to risky sexual behaviors and a number of
psychosocial issues, such as depression, anxiety, and low self-
and Brown, 
E 6021 (49.4) 14–18
“To share nude, sexually explicit, or sexually
suggestive photos via text or social media platforms”
Significant relationship found between consensual sexting and
depressive symptoms, suicide attempt and self-harm, but
depressive symptoms were more prevalent in students who
reported non-consensual sexting.
E 1208 (52.8) 12–16
“The voluntary creation and delivery of text
messages, photos, or videos, with personal sexual
content via the Internet or mobile devices”
The authors found that more depressive symptoms predicted
more sexting. Regarding psychological adjustment, adolescents
presenting more depression symptoms tended to participate
more in sexting over time.
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and Resett, 
E 3223 (49.9) 12–17
“The voluntary creation and delivery of text
messages, photos, or videos, with personal sexual
content via the Internet or mobile devices.”
The personality profile of those involved in sexting was
characterized by higher Extraversion and Neuroticism and by
lower scores in Conscientiousness and Agreeableness.
NE - -
“It generally involves the transmission of text,
pictures, or videos containing sexual material”
The evidence regarding the relationship between teen sexting
and specific psychiatric disorders or psychological sequelae
remains scant and inconclusive.
Judge,  NE “The exchange of sexually explicit images between
adolescents via cell phone”
Sexting may be viewed as an emotionally driven behavior that is
often impulsive and without a clear anticipation or
understanding of the potential adverse consequences.
and Mellor,  NE - - -
While some findings indicate sexting behavior as being
associated with lower well-being or higher psychological
distress, findings across the literature appear to be mixed.
E 444 (50.7) 18–21
“The sending, receiving, or forwarding of sexually
explicit messages, images, or photos to others
through electronic means, primarily between cellular
The results showed that having sent or received sexts was not
associated with any psychological variables. Receiving
unwanted sexts and sending sexts under coercion were
associated with poorer mental health. Specifically, when
receiving or sending unwanted but consensual sexts,
respondents reported higher depression, anxiety, and stress, and
“Sending, receiving or forwarding of sexually
explicit messages, images or photos to others
through electronic means, primarily between cellular
Only higher levels of stress were significantly associated with
sending sexts, not depression or anxiety.
Billick.  NE - -
“Sexting refers to the practice of sending sexually
explicit material including language or images to
another person’s cell phone”
Depression, suicide, mood disorder, adjustment reactions, and
anxiety disorders are some of the potential psychiatric sequelae
of falling victim to sexting.
Görzig,  E 18,709 (50) 11–16
“The peer-to-peer exchange of sexual messages using
digital technologies (known popularly as sexting).
Such messages may be created and exchanged via
The risk of receiving sexually explicit images was higher for
those with psychological difficulties. Adding the behavioral
variables reduced the effect of the psychological variables and
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text or image messaging on mobile phones, though
they also include peer-to-peer messaging on diverse
internet-enabled devices, particularly using social
networking sites and instant messaging services.”
age, suggesting that the behavioral variables mediate the effect
of the psychological variables and age.
and Binder,  NE - -
“Sexting is the sending or forwarding of sexually
explicit photographs or videos of the sender or
someone known to the sender via cell phone”
Sexting cases followed by suicide.
and Wolak, 
E 1560 (50) 10–17
“Sexting generally refers to sending sexual images
and sometimes sexual texts via cell phone and other
21% of respondents appearing in or creating images reported
feeling very or extremely upset, embarrassed, or afraid as a
result of engaging in sexting, as did 25% of youth receiving
E 1334 (68) 13–30
“Sexting is the exchange of sexually explicit or
provocative content (text messages, photos, and
videos) via smartphone, Internet, or social
Results showed that high/moderate users of sexting committed
more offline and online dating violence. Regarding
psychological distress, no differences were found between high
and low/moderate users of sexting.
No relationship with anxiety and depression symptoms.
and Cortez, 
NE - -
“The act of sending, receiving or publishing sexually
provocative or explicit messages, images or videos
through a mobile phone or social media”
Studies showed that the practice of sexting is increased by
consuming some type of drug, as well as engaging in risky
Ševčíková,  E 17,016 (50) 11–16
“Sexting refers to the electronic exchange of sexually
suggestive messages (i.e., sexts), mainly pictures
depicting their authors in nude or semi-nude
Having more emotional problems was associated to having a
higher likelihood of involvement in sexting behavior. Sexting
might not necessarily be a marker of poor mental health.
NE - -
“The sending, receiving, and forwarding of sexually
explicit messages, images or photos to others
through electronic means, primarily between cellular
Predictors of risk of harm from receiving sexts are being
younger, female, and scoring higher on psychological difficulties
and lower on sensation seeking. Other predictors of involvement
in sexting are being sexually active, involvement in alcohol and
drug use, having unprotected sex, engaging in web-based
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chatting with strangers and viewing adult pornography and
personality variables of neuroticism and low agreeableness.
Temple, Le, van
den Berg, Ling,
Paul, and Temple,
E 937 (57) 14–18
“Electronically sending sexually explicit images from
one adolescent to another”
Significant association between sexting and symptoms of
depression, impulsivity, and substance abuse but not when
adjusted for other variables: sexting is not a marker of mental
Van Ouytsel, Van
Gool, Ponnet, and
E 1028 (58) 15–18
“Sending sexually explicit pictures through the
internet or the mobile phone”
Significant relationship between depression and engagement in
and Heirman, 
NE - -
“The exchange of sexually explicit content
communicated via text messages, smartphones, or
visual and web 2.0. activities, such as social
Adolescents who engaged in sexting were more likely to ever
have become victims of traditional forms of bullying. Youth
who engaged in sexting had lower awareness and
understanding of their emotions and experienced more
difficulties with regulating their emotions. And an association
between sexting and impulsivity was found.
Mitchell,  E 3715 (56.6) 13–18
“Sending and sharing sexual photos online, via text
messaging, and in person”
Adolescents who sexted were more likely to use substances and
less likely to have a high self-esteem.
Note: E = empirical study, NE = non-empirical study; - = no data found
Int. J. Environ. Res. Public Health 2019, 16, 2364 11 of 16
A study carried out by Ybarra & Mitchell  evaluating psychosocial problems from a sample
of 3715 teens aged 13 to 18 years old, found that psychosocial problems were more frequently
observed in teens who had sent or showed sexual photos of themselves. In addition, they found that
high self-esteem was negatively associated with having sent or showed sexual pictures, and for
female teens, results showed a significant association between sexting and depressive
symptomatology. Similarly, Ševčíková  found that sexting was associated with emotional
problems, and explored the possibility that this correlate might be both a predictor, as well as an
outcome of sexting behaviors.
Regarding sexting and personality, the research carried out by Gámez-Guadix et al.  shows
an existing significant positive relationship between sexting and higher scores in Extraversion and
Neuroticism and a negative relationship between sexting and Conscientiousness and Agreeableness.
Brinkley et al.  conducted a study with a sample of 181 adolescents to evaluate the relationship
between sexting and Borderline Personality Disorder (BPD), amongst other variables. Their results
supported the hypothesis that sexting at age 16 would be associated with borderline personality
feature at age 18. In addition, the authors affirm that their findings suggest that sexting may
contribute to psychological distress for adolescents.
Following these results, many investigations have linked sexting behaviors to impulsivity and
substance abuse problems. Döring  points out that sexting is related to impulsivity, bad judgment,
sensation seeking, and problematic alcohol and drug use, as well as to suicide. This author considers
sexting to be either a manifestation or moderator of problematic sexual behavior. On the other hand,
Judge  defines sexting as an emotionally-driven behavior, that is often related to impulsivity and
a lack of anticipation of adverse consequences.
Englander , on the other hand, distinguished between pressured-sexters and non-pressured
sexters, and her results show that pressured-sexters were more likely to report having problems
during high school with excessive anxiety, although results were not statistically significant. Along
the same line, Temple et al. , did not find sexting to be a marker of mental health. In their study,
they evaluated 937 teens from Texas public high schools on rating scales for depression, anxiety,
impulsivity, and a positive response for a history of substance use. Their results show that subjects
who had sent naked pictures of themselves to someone else through text or email were more likely
to score higher on scales of depression and impulsivity, as well as more likely to report a history of
substance use. However, when the results were adjusted for prior sexual behavior, age, gender,
race/ethnicity, and parent education, sexting was only related to impulsivity and high-risk behaviors,
but not to depressive symptoms.
3.2. Sexting and Depression
When considering research regarding sexting and depression, specifically, the vast majority of
studies have found a positive association between depressive symptoms and sexting behaviors. Out
of a total of 14 publications addressing this issue, 12 found a positive association between sexting
behaviors and depressive symptoms [4,6,24,29,31,34–36,38, 41-43, 45].
One such example is a study by Dake, Price, Maziarz & Ward  who conducted research based
on 1289 middle school and high school students. Their results showed that being depressed, having
contemplated or attempted suicide in the past year, or having been cyber or indirectly bullied were
significantly correlated with sexting. Similarly, Van Ouytsel et al.  found a significant relation
between teen sexting and depressive symptoms. These results are in line with those found by
Chaudhary et al. , who conducted a study with 1760 teens and found that youth who reported
sexting were significantly more likely to report symptomatology of depression and anxiety, as
compared to those who did not report sexting. Specifically, their results showed that between 20%
and 27% of youth who sexted had depressive symptoms. In addition, Bauman  in a book chapter
regarding sexting and cyberbullying and mental health consequences, explains that young people
involved in sexting had higher rates of suicidal thoughts than those who were not involved, and they
also showed higher rates of high-risk behavior.
Int. J. Environ. Res. Public Health 2019, 16, x 12 of 16
Finally, Gámez-Guadix and De Santisteban  in a recent study carried out with 1208 Spanish
adolescents between ages 12 and 16, found that a higher degree of depressive symptoms predicted a
higher degree of sexting behaviors. At the same time, they found that teens who presented greater
depressive symptoms were more likely to participate in sexting behaviors over time. Findings
suggested a significant association between sexting behaviors and suicidal thoughts, suicide
attempts, depressive symptoms, and feelings of sadness . Teenage boys and girls who engaged
in sexting behaviors showed a higher risk of reporting suicidal thoughts even after controlling for
cyber victimization and depression . One explanation for this relationship has been suggested by
Medrano et al. , who proposed that the relationship between sexting behaviors and depressive
symptoms may be partially mediated by cyber-victimization. The exchange of intimate photos or
videos increases the risk of being victimized, not only by the direct sender of the image-based sexual
content but by anyone who might have access to it, as teens might find themselves involuntarily
exposed to unwanted sexual content .
However, some research has found no association between mental health symptoms and sexting
behavior. Morelli and colleagues  conducted a study with 1334 teens and young adults between
the ages of 13 and 30 years old, trying to assess the relationship between sexting, psychological
distress, and online dating violence. Their results showed that a higher engagement in sexting was
associated to a higher likelihood of offline and online dating violence. Moreover, their findings show
no differences in psychological distress between people who sexted frequently and those who did
not. Further, no relationship was found between sexting behaviors and symptoms of anxiety or
depression. Finally, recent research conducted by Klettke and colleagues  based on 598 young
Australian and Indian adults did not find an association between the sending of sexts, depression, or
anxiety. However, higher levels of stress were significantly associated with the sending of sexts.
Regarding gender, for males overall, higher levels of stress and lower levels of depression were
associated with sending sexts, while for females, there were no associations with mental health
variables. In terms of cultural differences, higher levels of stress were associated with sending sexts
for participants overall, and for Indian respondents, but not Australians when analyzed separately.
One explanation for why some studies have not found an association may be due to the level of
consent. Frankel et al.  collected data from a sample comprising 6021 US students between 9th
and 12th grade to examine the relationship between consensual and non-consensual sexting and
mental health. Their results show a correlation between consensual sexting and alcohol and tobacco
use, being cyber-bullied and reporting both depressive symptoms and previous suicide attempts,
especially in male respondents. Moreover, they found that non-consensual sexting was more
prevalent among students who reported serious depressive symptoms, attempting suicide and self-
3.3. Sexting and Anxiety Symptoms
Similar to the results observed regarding the analysis of the relationship between sexting
behaviors and depression, the existing literature was reviewed to explore the relationship between
sexting behaviors and symptoms of anxiety. Research exclusively investigating the relationship
between these two variables is scarce; however, the majority of studies have found an existing
relationship between the two variables. Out of a total of eight studies [4,6,24,36,40–42,45] seven
studies found a positive association between sexting behaviors and symptoms of anxiety.
For example, Chaudhary and colleagues  found that youth who reported having engaged in
sexting behaviors, based on 1760 teens, were significantly more likely to report symptomatology of
anxiety. Their results show that between 57% and 61% of adolescents who sexted had symptoms of
anxiety. Similarly, Cooper et al.  reported that sexting victimization corresponded with negative
psychological outcomes, including feelings of sadness, anger, and anxiety disorders. Finally, Klettke
and colleagues  collected data from a sample comprising 444 late teens and found that receiving
unwanted sexts and sending sexts under coercion was associated with poor mental health; they found
that, especially, when receiving or sending unwanted but consensual sexts, respondents reported
higher levels of depression, anxiety, stress, and lower self-esteem.
Int. J. Environ. Res. Public Health 2019, 16, x 13 of 16
Research on sexting has grown widely over the past few years, especially regarding adolescents
and the negative effect it might have on their sexual development and mental health, and specifically
after the publication of the Sex and Tech Survey (2008) results [10,11]. Many studies have defined
sexting as a form of victimization and have highlighted the potential for a relationship between
victimization and mental health or psychological health and other online victimization behaviors,
such as cyberbullying, online dating violence or revenge porn [18–21]. This review gathered the
existing literature published from January 2012 to March 2019 that fit under the inclusion criteria (30
articles), to explore the relationship between sexting and mental health variables in the adolescent
population. The relationship between these variables will be of interest to parents, educators, and the
health care community to have a deeper understanding of the phenomena, so that appropriate
prevention plans and campaigns, as well as intervention programs, can be developed and put into
Overall, and in line with Klettke et al.’s  results, the evidence regarding the relationship
between teen sexting and mental health symptoms remains scarce, to some degree inconclusive and
heterogeneous, and there is little empirical evidence on half-term and long-term consequences on
adolescents. While the majority of studies have found significant associations between sexting and
mental health symptoms, others did not find significant results . One of the reasons for these
equivocal findings may be because most studies do not differentiate between consensual
(experimental) and non-consensual (aggravated) sexting. This may be a critical factor, as it has been
shown that psychological outcomes vary when it comes to sexual coercion . Another reason might
be that different studies focus on measuring different psychological variables which could be
interrelated. For instance, some studies focused on measuring personality traits [2,30], while others
measured emotional problems , psychosocial problems, self-esteem, or depressive symptoms .
In addition, some studies explored the psychological variables as predictors of sexting [32,35], while
others measured them as consequences of the behavior .
However, in general, findings suggest a significant association between sexting behaviors and
suicidal thoughts, suicide attempts, depressive symptoms, and feelings of sadness . Teenage boys
and girls who engage in sexting behaviors have shown a higher risk of reporting suicidal thoughts
even after controlling for cyber victimization and depression . A possible explanation for this
relationship is that both sexting behaviors and suicidal thoughts are risky behaviors in the adolescent
population and tend to appear in conjunction .
The present review showed that 12 out of the 14 reviewed studies found a relationship between
sexting behaviors and depressive symptoms, and findings lead to the conclusion that this relationship
may be bi-directional. Gámez-Guadix and de Santisteban  argue that depressive symptoms and
low self-esteem can predict sexting over time because sexting might be a way for teens to feel
considered and desired. Moreover, they argued that adolescents with depressive symptoms might
have fewer coping skills when pressured by peers to engage in sexting, which would explain why
teenagers who sexts reported more depressive symptoms than those who do not.
According to Medrano et al. , the relationship between sexting behaviors and depressive
symptoms may be partially mediated by cyber-victimization. The exchange of intimate photos or
videos increases the risk of being victimized, not only by the direct sender of the image-based sexual
content but by anyone who might have access to it .
Similarly, seven out of the eight reviewed articles found a relationship between sexting
behaviors and anxiety symptoms. Chaudhary et al.  found a significant relationship between
youth who sexted and anxiety symptoms and argue that their results might be contrary to other
findings due to the young age of the participants. This supports results obtained by Klettke et al. 
who found a relationship between sexting and anxiety in an older sample but only related to
receiving unwanted or sending unwanted but consensual sexts.
Int. J. Environ. Res. Public Health 2019, 16, x 14 of 16
The findings of this narrative review seem to point towards the presence of mental health
symptomatology, particularly depression and anxiety, in the adolescent population when related to
sexting behaviors. However, the age of the adolescents also seems to play an important role, as
ob serve d by Mori et al [ 17]. A s ad olesce nts ge t ol der , menta l healt h sympt oms see m to be i ncr easin gly
associated with aggravated sexting, but not when related to consensual sexting behaviors whereby
older teens have not been pressured (experimental sexting) [36,37,51]. Therefore, it might be probable
that the relationship between sexting and poor mental health, depression, and anxiety symptoms is
mediated by coercion, victimization, and age. Future research is needed to explore this hypothesis
Despite the inconclusive results, this review shows that psychological aspects are related in some
way to sexting, potentially as predictors of sexting behavior or as consequences, however, especially
when taking into consideration sexting coercion or victimization. This finding is relevant because it
can help raise awareness about the fact that sexting in adolescent populations should be further
studied to establish effective mental health response programs and prevention programs, and that in
some individual cases it might be a risky or dangerous behavior for teens to engage in or an indicator
of some form of victimization. Along the same line, these findings suggest that both parents and
educational communities should pay attention to both psychological symptoms and sexting
behaviors since one can be a predictor of the other and vice versa.
Author Contributions: A.M.G. performed the literature review, analyzed the results, and wrote the paper. I.M.
and Agustina, J.R.A., contributed to conceiving the review, establishing the aims and review of the paper. B.K.
contributed to the methodology and review of the paper.
Funding: No funding for this study has been received.
Conflicts of Interest: The authors declare no conflict of interest.
1. Gaylord, F.S. Sex, cells, and Sorna. William Mary Law Rev. 2011, 52, 1717–1746.
2. Gámez-Guadix, M.; de Santisteban, P.; Resett, S. Sexting among Spanish adolescents: Prevalence and
personality profiles. Psicothema 2017, 29, 29.
3. Barrense-Dias Y, Berchtold A, Surís, J.-C.; Akre, C. Sexting and the definition issue. J. Adolesc. Health 2017,
4. Englander, E. Low Risk Associated with Most Teenage Sexting: A Study of 617 18-Year-Olds; MARC Research
Reports; Bridgewater State University: Bridgewater, MA, USA, 2012.
5. Gámez-Guadix, M.; Almendros, C.; Borrajo, E.; Calvete, E. Prevalence and association of sexting and online
sexual victimization among Spanish adults. Sex. Res. Soc. Policy 2015, 12, 145–154.
6. Morelli, M.; Bianchi, D.; Baiocco, R.; Pezzuti, L.; Chirumbolo, A. Sexting, psychological distress and dating
violence among adolescents and young adults. Psicothema 2016, 28, 137–142.
7. Hudson, H.K.; Fetro, J.V. Sextual activity: Predictors of sexting behaviors and intentions to sext among
selected undergraduate students. Comput. Hum. Behav. 2015, 49, 615–622, doi:10.1016/j.chb.2015.03.048.
8. Mitchell, K.J.; Finkelhor, D.; Jones, L.M.; Wolak, J. Prevalence and characteristics of youth sexting: A
national study. Pediatrics 2012, 129, 13–20.
9. Silva, R.R.; Teixeira, C.M.; Vasconcelos-Raposo, J.; Bessa, M. Sexting: Adaptation of sexual behavior to
modern technologies. Comput. Hum. Behav. 2016, 64, 747–753, doi:10.1016/j.chb.2016.07.036.
10. Döring, N. Consensual sexting among adolescents: Risk prevention through abstinence education or safer
sexting? Cyberpsychology J. Psychosoc. Res. Cyberspace 2014, 8, 9, doi:10.5817/CP2014-1-9.
11. Temple, J.R.; Lu, Y. Sexting from a Health Perspective: Sexting, Health, and Risky Sexual Behaviour. In
Sexting, 1st ed.; Walrave, M., van Ouytsel, J., Ponnet, K., Temple, J.R., Eds.; Palgrave Macmillan: Chicago,
IL, USA, 2018; pp. 53–61, ISBN 978-3-319-71882-8, doi:10.1007/978-3-319-71882-8.
12. Villacampa, C. Teen sexting: Prevalence, characteristics and legal treatment. Int. J. Law Crime Justice 2017,
Int. J. Environ. Res. Public Health 2019, 16, x 15 of 16
13. Agustina, J.R.; Gómez-Durán, E.L. Factores de riesgo asociados al sexting como umbral de diversas formas
de victimización. Estudio de factores correlacionados con el sexting en una muestra universitaria. IDP Rev.
De Internet Derecho Y Política 2016, 22, 5.
14. Rice, E.; Gibbs, J.; Winetrobe, H.; Rhoades, H.; Plant, A.; Montoya, J.; Kordic, T. Sexting and sexual behavior
among middle school students. Pediatrics 2014, 134, e21–e28.
15. Brenick, A.; Flannery, K.M.; Rankin, E. Victimization or entertainment? How attachment and rejection
sensitivity relate to sexting experiences, evaluations, and victimization. In Identity, Sexuality, and
Relationships among Emerging Adults in the Digital Age; IGI Global: Dove, PA, USA, 2017; pp. 203–225
16. Kosenko, K.; Luurs, G.; Binder, A.R. Sexting and sexual behavior 2011–2015: A critical review and meta-
analysis of a growing literature. J. Comput. Mediat. Commun. 2017, 22, 141–160.
17. Mori, C.; Temple, J.R.; Browne, D.; Madigan, S. Association of Sexting with Sexual Behaviors and Mental
Health Among Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics 2019,
18. Klettke, B.; Hallford, D.J.; Mellor, D.J. Sexting prevalence and correlates: A systematic literature review.
Clin. Psychol. Rev. 2014, 34, 44–53.
19. Fahy, A.E.; Stansfeld, S.A.; Smuk, M.; Smith, N.R.; Cummins, S.; Clark, C. Longitudinal associations
between cyberbullying involvement and adolescent mental health. J. Adolesc. Health 2016, 59, 502–509.
20. Drouin, M.; Ross, J.; Tobin, E. Sexting: A new, digital vehicle for intimate partner aggression? Comput. Hum.
Behav. 2015, 50, 197–204.
21. Bates, S. Revenge porn and mental health: A qualitative analysis of the mental health effects of revenge
porn on female survivors. Fem. Criminol. 2017, 12, 22–42.
22. Agustina, J.R. Analyzing sexting from a criminological perspective. beyond child pornography issues:
Sexting as a threshold for victimization. Cybercrime Secur. West Thomson Reuters 2012, 4, 64–96.
23. Reyns, B.W.; Burek, M.W.; Henson, B.; Fisher, B.S. The unintended consequences of digital technology:
Exploring the relationship between sexting and cybervictimization. J. Crime Justice 2013, 36, 1–17.
24. Korenis, P.; Billick, S.B. Forensic implications: Adolescent sexting and cyberbullying. Psychiatr. Q. 2014, 85,
25. Darden, M.C.; Ehman, A.C.; Lair, E.C.; Gross, A.M. Sexual Compliance: Examining the Relationships
Among Sexual Want, Sexual Consent, and Sexual Assertiveness. Sex. Cult. 2019, 23, 220–235.
26. Tokunaga, R.S.; Rains, S.A. An evaluation of two characterizations of the relationships between
problematic Internet use, time spent using the Internet, and psychosocial problems. Hum. Commun. Res.
2010, 36, 512–545.
27. Holoyda, B.; Landess, J.; Sorrentino, R.; Friedman, S.H. Trouble at teens’ fingertips: Youth sexting and the
law. Behav. Sci. Law 2018, 36, 170–181.
28. Medrano, J.L.J.; Lopez Rosales, F.; Gámez-Guadix, M. Assessing the links of sexting, cybervictimization,
depression, and suicidal ideation among university students. Arch. Suicide Res. 2018, 22, 153–164.
29. Frankel, A.S.; Bass, S.B.; Patterson, F.; Dai, T.; Brown, D. Sexting, risk behavior, and mental health in
adolescents: An examination of 2015 Pennsylvania Youth Risk Behavior Survey data. J. Sch. Health 2018, 88,
30. Brinkley, D.Y.; Ackerman, R.A.; Ehrenreich, S.E.; Underwood, M.K. Sending and receiving text messages
with sexual content: Relations with early sexual activity and borderline personality features in late
adolescence. Comput. Hum. Behav. 2017, 70, 119–130.
31. Dake, J.A.; Price, J.H.; Maziarz, L.; Ward, B. Prevalence and correlates of sexting behavior in adolescents.
Am. J. Sex. Educ. 2012, 7, 1–15.
32. Livingstone, S.; Görzig, A. When adolescents receive sexual messages on the internet: Explaining
experiences of risk and harm. Comput. Hum. Behav. 2014, 33, 8–15.
33. Ybarra, M.L.; Mitchell, K.J. “Sexting” and its relation to sexual activity and sexual risk behavior in a national
survey of adolescents. J. Adolesc. Health 2014, 55, 757–764.
34. Temple, J.R.; Le, V.D.; van den Berg, P.; Ling, Y.; Paul, J.A.; Temple, B.W. Brief report: Teen sexting and
psychosocial health. J. Adolesc. 2014, 37, 33–36.
35. Van Ouytsel, J.; Van Gool, E.; Ponnet, K.; Walrave, M. Brief report: The association between adolescents’
characteristics and engagement in sexting. J. Adolesc. 2014, 37, 1387–1391.
36. Klettke, B.; Hallford, D.J.; Clancy, E.; Mellor, D.J.; Toumbourou, J.W. Sexting and psychological distress: The role
of unwanted and coerced sexts. Cyberpsychology Behav. Soc. Netw. 2019, 827–832, doi:10.1089/cyber.2018.0291.
Int. J. Environ. Res. Public Health 2019, 16, x 16 of 16
37. Wolak, J.; Finkelhor, D. Sexting: A typology. Res. Cent. Crime Against Child.: Univ. Newhampshire 2011.
38. Ahern, N.R.; Mechling, B. Sexting: Serious problems for youth. J. Psychosoc. Nurs. Ment. Health Serv. 2013,
39. Bauman, S. Cyberbullying and sexting: School mental health concerns. Ment. Health Pract. Today’s Sch. Curr.
Issues Interv. 2015, 241–264.
40. Chaudhary, P.; Peskin, M.; Temple, J.R.; Addy, R.C.; Baumler, E.; Shegog, R. Sexting and Mental Health: A
School-based Longitudinal Study Among Youth in Texas. J. Appl. Res. Child. Inf. Policy Child Risk 2017, 8, 11.
41. Cooper, K.; Quayle, E.; Jonsson, L.; Svedin, C.G. Adolescents and self-taken sexual images: A review of the
literature. Comput. Hum. Behav. 2016, 55, 706–716.
42. Eugene, J. It’s More Than Just “Sext”—A Brief Discussion on Sexting Activity Among Teens. J. Adolesc.
Health 2015, 57, 128–129.
43. Gámez-Guadix, M.; De Santisteban, P. “Sex Pics?”: Longitudinal Predictors of Sexting Among Adolescents.
J. Adolesc. Health 2018, 63, 608–614.
44. Judge, A.M. “Sexting” among US adolescents: Psychological and legal perspectives. Harv. Rev. Psychiatry
2012, 20, 86–96.
45. Klettke, B.; Mellor, D.; Silva-Myles, L.; Clancy, E.; Sharma, M.K. Sexting and mental health: A study of
Indian and Australian young adults. Cyberpsychology J. Psychosoc. Res. Cyberspace 2018, 12,
46. Lorang, M.R. McNiel, D.E.; Binder, R.L. Minors and sexting: Legal implications. J. Am. Acad. Psychiatry Law
2016, 44, 73–81.
47. Moreno-Bernal, D.; Valdez-Montero, C.; Gámez-Medina, M.E.; Cortez, J.G.A. Sexting, consumo de drogas
y conducta sexual de riesgo en adolescentes: Una revisión sistemática. Available online:
http://www.riti.es/ojs2018/inicio/index.php/riti/article/view/64 (accessed on 3 July 2019).
48. Ševčíková, A. Girls’ and boys’ experience with teen sexting in early and late adolescence. J. Adolesc. 2016,
49. Smith, P.K.; Thompson, F.; Davidson, J. Cyber safety for adolescent girls: Bullying, harassment, sexting,
pornography, and solicitation. Curr. Opin. Obstet. Gynecol. 2014, 26, 360–365.
50. Van Ouytsel, J.; Walrave, M.; Ponnet, K.; Heirman, W. The association between adolescent sexting,
psychosocial difficulties, and risk behavior: Integrative review. J. Sch. Nurs. 2015, 31, 54–69.
51. Choi, H.; Van Ouytsel, J.; Temple, J.R. Association between sexting and sexual coercion among female
adolescents. J. Adolesc. 2016, 53, 164–168.
52. Jessor, R. Risk behavior in adolescence: A psychosocial framework for understanding and action. J. Adolesc.
Health 1991, 12, 597–605, doi:10.1016/1054-139x90007-k.
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