Data from four consecutive cohorts of students in Australia (2019-2022) show the impact of the COVID-19 pandemic on domestic and international university students' mental health.

INTRODUCTION: COVID-19 and related travel and social restrictions caused significant stress for university students in Australia and globally. Learning quickly moved online and many students (particularly international students) were separated from social and economic support. This study examined the impact of the pandemic from pre-pandemic (2019) to the COVID-19 Omicron wave (2022) on domestic and international students' mental health. METHODS: Participants were 1540 students (72% females, 28% international) in four first-year cohorts (2019, 2020, 2021, 2022). We screened for mental health concerns (% positive) and symptom scores for depression, anxiety and somatic distress using the PsyCheck, and general wellbeing using the Warwick-Edinburgh Mental Well-being scale. RESULTS: From pre-COVID (2019) to the first wave of COVID-19 (2020), the proportion of students screening positive for mental health problems rose in both domestic students (66-76%) and international students (46-67%). Depression symptoms and wellbeing were worse in 2020 than in 2019, 2021 and 2022. Anxiety symptoms increased from 2019 to 2020 and continued to rise in 2021 and 2022. Somatic symptoms did not show an effect of cohort. Contrary to expectations, domestic students reported higher distress and lower wellbeing than international students across cohorts. CONCLUSION: The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students.

Effectiveness of physical activity interventions on undergraduate students' mental health: systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effectiveness of physical activity interventions on undergraduate students' mental health. Seven databases were searched and a total of 59 studies were included. Studies with a comparable control group were meta-analysed, and remaining studies were narratively synthesized. The included studies scored very low GRADE and had a high risk of bias. Meta-analyses indicated physical activity interventions are effective in reducing symptoms of anxiety (n = 20, standardized mean difference (SMD) = -0.88, 95% CI [-1.23, -0.52]), depression (n = 14, SMD = -0.73, 95% CI [-1.00, -0.47]) and stress (n = 10, SMD = -0.61, 95% CI [-0.94, -0.28]); however, there was considerable heterogeneity (anxiety, I2 = 90.29%; depression I2 = 49.66%; stress I2 = 86.97%). The narrative synthesis had mixed findings. Only five studies reported being informed by a behavioural change theory and only 30 reported intervention fidelity. Our review provides evidence supporting the potential of physical activity interventions in enhancing the mental health of undergraduate students. More robust intervention design and implementation are required to better understand the effectiveness of PA interventions on mental health outcomes.

Misery loves company: Predictors of treatment response to a loneliness intervention.

OBJECTIVE: The last 10 years have seen a surge of interest in loneliness and interventions to reduce it. However, there is little evidence regarding differential treatment effectiveness and predictors of treatment outcome. This paper aimed to investigate possible predictors of treatment response. METHODS: We analysed data from two clinical trials of an evidence-based loneliness intervention: Groups 4 Health (G4H). Study 1 had 163 observations across two timepoints, n = 94; Study 2 had 297 observations across four timepoints; n = 84. Theorised predictors-symptom severity at baseline, program engagement, and demographic characteristics-were assessed for their effect on the primary outcome: loneliness. RESULTS: Across both trials, participants with more severe baseline loneliness or social anxiety, or who attended more sessions, experienced greater improvement in loneliness. In Study 2, those with diagnosed mental illness or more severe baseline depression also tended to have better outcomes. There was no evidence that age, gender, or ethnicity predicted program efficacy. CONCLUSION: Overall, those with greater need-reflected in either severity of loneliness or psychological distress-tended to show greater improvement over time. This was due, in part, to greater engagement with the program among those who were lonelier. We discuss how loneliness interventions can be deployed most effectively to combat this profound public health challenge.

Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes.

OBJECTIVE: To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS: A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS: A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS: Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.

Negative valence specific deficits in judgements of musical affective quality in alexithymia.

Alexithymia is characterised by a lack of words for emotional experiences and it has been implicated in deficits in emotion processing. Research in this area has typically focused on judgements of discrete emotions rather than of affect, which is a precursor to emotion construction. In the current study, higher alexithymia was predicted to be related to more neutral judgements of valence and arousal of music representing a range of emotions. Participants (N = 162) listened to ten 15-second musical pieces that represented five target emotions (happy, sad, tender, angry, and fearful) and rated the valence and arousal of each. Participants also listed emotion words they knew to be expressed in music. Analyses revealed that alexithymia was not related to the number of emotion words generated but was related to valence-specific affect judgements of music. Participants higher in alexithymia rated sad, angry, and fearful pieces as more neutral in valence and arousal. Alexithymia was not related to ratings of valence or arousal for happy and tender pieces. These findings suggest that perceptual deficits in alexithymia may be specific to negative emotions. Our results are consistent with the idea that alexithymia is related to the direction of attention away from negative stimuli.

Development of emotion recognition in popular music and vocal bursts.

Previous research on the development of emotion recognition in music has focused on classical, rather than popular music. Such research does not consider the impact of lyrics on judgements of emotion in music, impact that may differ throughout development. We had 172 children, adolescents, and adults (7- to 20-year-olds) judge emotions in popular music. In song excerpts, the melody of the music and the lyrics had either congruent valence (e.g. happy lyrics and melody), or incongruent valence (e.g. scared lyrics, happy melody). We also examined participants' judgements of vocal bursts, and whether emotion identification was linked to emotion lexicon. Recognition of emotions in congruent music increased with age. For incongruent music, age was positively associated with judging the emotion in music by the melody. For incongruent music with happy or sad lyrics, younger participants were more likely to answer with the emotion of the lyrics. For scared incongruent music, older adolescents were more likely to answer with the lyrics than older and younger participants. Age groups did not differ on their emotion lexicons, nor recognition of emotion in vocal bursts. Whether children use lyrics or melody to determine the emotion of popular music may depend on the emotion conveyed.

Does crying help? Development of the beliefs about crying scale (BACS).

Crying is often considered to be a positive experience that benefits the crier, yet there is little empirical evidence to support this. Indeed, it seems that people hold a range of appraisals about their crying, and these are likely to influence the effects of crying on their emotional state. This paper reports on the development and psychometric validation of the Beliefs about Crying Scale (BACS), a new measure assessing beliefs about whether crying leads to positive or negative emotional outcomes in individual and interpersonal contexts. Using 40 preliminary items drawn from a qualitative study, an exploratory factor analysis with 202 participants (50% female; aged 18-84 years) yielded three subscales: Helpful Beliefs, Unhelpful-Individual Beliefs, and Unhelpful-Social Beliefs, explaining 60% of the variance in the data. Confirmatory factor analysis on the 14-item scale with 210 participants (71% female; aged 17-48 years) showed a good fit to the three factors. The subscales showed differential relationships with measures of personality traits, crying proneness, emotion regulation and expressivity, and emotional identification (alexithymia). The BACS provides a nuanced understanding of beliefs about crying in different contexts and helps to explain why crying behaviour may not always represent positive emotion regulation for the crier.

Associations Between Unintended Pregnancy, Domestic Violence, and Sexual Assault in a Population of Queensland Women.

This study aimed to establish the proportion of women seeking information regarding unintended pregnancy in the context of domestic violence (DV) and/or sexual assault (SA) experiences in Queensland. Mental health, sociodemographic variables, and gestation at first and repeated contacts were examined for 6249 women primarily seeking information regarding abortion options during an unintended pregnancy over the 5-year period from July 2012 to June 2017. Reports of DV and SA and associations with mental health issues increased significantly across the 5 years. First contact rates of disclosure were 12.2% for DV and 3% for SA, and higher among repeat contacts (38.1% for DV and 14.1% for SA), with recurring contact facilitating violence disclosure. Restricting access to abortions in the context of violence impedes a woman's agency in attempts to separate from violence and highlights the need for safe, supportive, and accessible services, to assist in screening and assisting with violence.

Social Isolation Predicts Frequent Attendance in Primary Care.

Background: Frequent attenders in primary care have complex physical and mental healthcare needs as well as low satisfaction with their health care. Interventions targeting mental health or psychoeducation have not been effective in reducing attendance. Here, we test the proposition that both frequent attendance and poor health are partly explained by unmet social needs (i.e., limited social group support networks). Methods: Study 1 (N = 1,752) was a large, cross-sectional community sample of primary care attenders in Scotland. Study 2 (N = 79) was a longitudinal study of a group of young people undergoing a life transition (moving countries and commencing university) that increased their risk of frequent attendance. Study 3 (N = 46) was a pre-post intervention study examining whether disadvantaged adults who joined a social group subsequently had reduced frequency of primary care attendance. Results: All three studies found that low social group connectedness was associated with a higher frequency of primary care attendance. This was not attributable to poorer health among those who were socially isolated. In Study 3, joining a social group led to reduced primary care attendance to the extent that participants experienced a (subjective) increase in their social group connectedness. Conclusions: Unmet social needs among frequent attenders warrant closer consideration. Interventions that target social group connectedness show promise for reducing overutilization of primary care services.

A systematic review of mental health and wellbeing outcomes of group singing for adults with a mental health condition.

Background: A growing body of research has found that participating in choir singing can increase positive emotions, reduce anxiety and enhance social bonding. Consequently, group singing has been proposed as a social intervention for people diagnosed with mental health problems. However, it is unclear if group singing is a suitable and effective adjunct to mental health treatment. The current paper systematically reviews the burgeoning empirical research on the efficacy of group singing as a mental health intervention. Methods: The literature searched uncovered 709 articles that were screened. Thirteen articles representing data from 667 participants were identified which measured mental health and/or wellbeing outcomes of group singing for people living with a mental health condition in a community setting. Results: The findings of seven longitudinal studies, showed that while people with mental health conditions participated in choir singing, their mental health and wellbeing significantly improved with moderate to large effect sizes. Moreover, six qualitative studies had converging themes, indicating that group singing can provide enjoyment, improve emotional states, develop a sense of belonging and enhance self-confidence in participants. Conclusion: The current results indicate that group singing could be a promising social intervention for people with mental health conditions. However, these studies had moderate to high risk of bias. Therefore, these findings remain inconclusive and more rigorous research is needed.

Individual and interpersonal emotion regulation among adults with substance use disorders and matched controls.

OBJECTIVES: Self-report studies show that negative emotional states and ineffective use of emotion regulation strategies are key maintaining factors of substance use disorders (SUD). However, experimental research into emotional processing in adults with SUD is in its infancy. Theoretical conceptualizations of emotion regulation have shifted from a focus on individual (internal) processes to one that encompasses social and interpersonal functions - including the regulation of facial expression of emotion. The purpose of this study was to examine the individual and interpersonal emotion regulation capacity of 35 adults in residential treatment diagnosed with a SUD compared to 35 demographically matched controls (both samples Mage  = 25 years; 37% females). DESIGN AND METHODS: Participants completed a facial emotion expression flexibility task while viewing emotive images, as well as the Difficulties of Emotion Regulation Scale (DERS) and the Social (Emotion) Expectancy Scale (SES). RESULTS: Adults in SUD treatment experienced significantly more emotion regulation difficulties on all DERS subscales than controls. They also reported higher levels of negative self-evaluation and social expectancies not to feel negative emotions (anxiety and depression) compared to controls. Moreover, when viewing emotive images, the treatment sample showed significantly less flexibility of their emotional expression compared to the control sample. CONCLUSIONS: These findings demonstrate that the awareness, expression, and regulation of emotions are particularly difficult for people with SUD and this may maintain their substance use and provide an important target for treatment. PRACTITIONER POINTS: Compared to matched controls, adults with substance use disorders self-report significantly more difficulties with emotional awareness and regulation. Compared to matched controls, adults with substance use disorders report significantly greater expectancies not to show depression and anxiety. When viewing positive and negative images, adults with substance use disorders are significantly less flexible in their facial expression of emotion than matched controls in response to regulatory instructions. Emotion regulation should be measured and addressed as part of substance use disorder treatment.

The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application.

BACKGROUND: Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. METHODS: Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. RESULTS: The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. CONCLUSIONS: The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings.

Choir singing and creative writing enhance emotion regulation in adults with chronic mental health conditions.

OBJECTIVES: Adults with mental health conditions commonly experience difficulties with emotion regulation which affect their social functioning. Arts-based groups provide opportunities for shared emotional experiences and emotion regulation. This study explores emotion regulation strategies and the emotional effects of arts-based group participation in adults with mental health problems and in controls. DESIGN AND METHOD: The 62 participants included 39 adults with chronic mental health problems who were members of arts-based groups (ABG) and 23 comparison choir (CC) members who were not specifically experiencing mental health problems. The repeated measures design included self-reports of emotion upon waking (T1), the hour before group (T2), end of the group (T3), and evening (T4), as well as participant notes to explain their emotion ratings at each time. They also completed measures of individual and interpersonal emotion regulation. RESULTS: The ABG participants engaged marginally more in affect worsening strategies than CC (p = .057 and .08), but there were no other group differences. All participants reported a significant increase in positive emotions, F (3, 180) = 28.044, p < .001, np2 = .319; and a decrease in negative emotions during the arts-based activity: F (2.637, 155.597) = 21.09, p < .001, np2 = .263. The influence on positive emotions was short-lived, while the effect on negative emotions lasted until evening. CONCLUSION: Findings show that participation in arts-based groups benefits the emotions of both healthy adults and those experiencing mental health conditions through individual and interpersonal processes. PRACTITIONER POINTS: Individuals with chronic mental health conditions often experience difficulties in emotion processing Participation in arts-based groups was associated with significant increases in positive emotions although these were short-lived Negative emotion was significantly decreased during arts-based group activities, and sustained to the evening assessment Adults with chronic mental health conditions were equally able to derive emotional benefits as healthy adults.

Depression and Social Identity: An Integrative Review.

Social relationships play a key role in depression. This is apparent in its etiology, symptomatology, and effective treatment. However, there has been little consensus about the best way to conceptualize the link between depression and social relationships. Furthermore, the extensive social-psychological literature on the nature of social relationships, and in particular, research on social identity, has not been integrated with depression research. This review presents evidence that social connectedness is key to understanding the development and resolution of clinical depression. The social identity approach is then used as a basis for conceptualizing the role of social relationships in depression, operationalized in terms of six central hypotheses. Research relevant to these hypotheses is then reviewed. Finally, we present an agenda for future research to advance theoretical and empirical understanding of the link between social identity and depression, and to translate the insights of this approach into clinical practice.

Social isolation schema responds to positive social experiences: longitudinal evidence from vulnerable populations.

OBJECTIVES: Maladaptive schemas are stable cognitive working models of the world, learnt early in life, that interfere with effective functioning and underlie chronic mental illness. A major challenge for cognitive therapy has been how to modify schemas when they are so enduring and stable. We propose that because maladaptive schemas are formed through social experiences (typically abusive or neglectful ones), they might best be corrected through positive social experiences that directly challenge the schema. DESIGN: Two longitudinal studies were conducted, one with patients undergoing group cognitive-behavioural therapy (N = 92) and one with homeless individuals residing in temporary accommodation (N = 76). METHOD: In each study, social isolation schema was measured at Time 1 and again at Time 2 following a group-based social experience (group psychotherapy or temporary residence at a community organization). A positive experience of group life was operationalized as social identification with the therapy group in Study 1 or the community organization in Study 2. RESULTS: In both studies, social identification led to a significant reduction in social isolation schema. Study 2 indicated that these effects were fully mediated by the formation of ties to new social groups, such that social identification scaffolded the development of new group memberships, which in turn decreased the endorsement of maladaptive schema. CONCLUSIONS: Social identification facilitates the correction of socially situated schema such as social isolation. PRACTITIONER POINTS: Maladaptive schemas are modifiable in short-term therapy or even in community settings. The experience of being accepted and belonging to a social group can challenge a person's deep-seated belief that they are socially isolated. Positive social experiences may act as scaffolding to help socially isolated individuals build new social group memberships. Less positively, social isolation schema can also act as a feedback loop, preventing people from identifying with groups, resulting in a negative social experience that may further embed the schema. Further research is needed to determine how clinicians might facilitate social identification.

A controlled evaluation of social prescribing on loneliness for adults in Queensland: 8-week outcomes.

Introduction: There have been few controlled evaluations of Social Prescribing (SP), in which link workers support lonely individuals to engage with community-based social activities. This study reports early outcomes of a trial comparing General Practitioner treatment-as-usual (TAU) with TAU combined with Social Prescribing (SP) in adults experiencing loneliness in Queensland. Methods: Participants were 114 individuals who were non-randomly assigned to one of two conditions (SP, n = 63; TAU, n = 51) and assessed at baseline and 8 weeks, on primary outcomes (loneliness, well-being, health service use in past 2 months) and secondary outcomes (social anxiety, psychological distress, social trust). Results: Retention was high (79.4%) in the SP condition. Time × condition interaction effects were found for loneliness and social trust, with improvement observed only in SP participants over the 8-week period. SP participants reported significant improvement on all other outcomes with small-to-moderate effect sizes (ULS-8 loneliness, wellbeing, psychological distress, social anxiety). However, interaction effects did not reach significance. Discussion: Social prescribing effects were small to moderate at the 8-week follow up. Group-based activities are available in communities across Australia, however, further research using well-matched control samples and longer-term follow ups are required to provide robust evidence to support a wider roll out.

Efficacy of the Tuned In music emotion regulation program in international university students.

OBJECTIVE: Moving overseas to study can be exciting, however many international students find this transition stressful. Therefore, empirically supported strategies to assist with managing stress and supporting well-being are needed. Motivated music listening is an effective stress management strategy, and is linked with international student well-being. Tuned In is a group program designed to increase emotion awareness and regulation using motivated music listening. METHODS AND MEASURES: We evaluated a 4-session online version of Tuned In for motivated music use, emotion regulation, and well-being in international students. The study used a 2 (Treatment; Waitlist) x 3 (timepoints: pre = T1; +4 weeks = T2; +8 weeks = T3) randomised controlled cross-over design. Treatment participants (n = 23) completed Tuned In between T1 and T2, Waitlist participants (n = 27) completed Tuned In between T2 and T3. RESULTS: Between T1 and T2, motivated music use increased in Treatment participants but not for the Waitlist. Treatment participants were also more confident in maintaining happiness and in having healthy ways of managing emotions at T2. All participants enjoyed Tuned In. CONCLUSIONS: Tuned In, a group-based music listening program, even when delivered online, provides benefits for international students. With student well-being at risk as they begin university, enjoyable programs that help develop skills for students' academic journey should be a priority.

Expanding the social cure: a mixed-methods approach exploring the role of online group dance as support for young people (aged 16-24) living with anxiety.

There is an increased interest in whether online arts interventions support mental health and social connections. This study explored eight weeks of online group dance as support for young people (aged 16-24) living with anxiety. The applicability of the 'social cure' theoretical framework to the novel context of an online dance class was sought. The study utilised an embedded QUAL+quan design, incorporating participatory focus group discussions (n = 3 groups; n = 11 participants) and one-on-one interviews (n = 2 participants), creative reflections (n = 16 participants) and ethnographic fieldnotes, and a repeated measures design with surveys at three timepoints (week 1, n = 27; week 4, n = 18; week 8, n = 14). Thematic analysis identified two overarching themes demonstrating how the dance classes (i) provided the opportunity to co-construct a meaningful shared identity and (ii) supported holistic wellbeing. The quantitative findings supported this, suggesting lower anxiety, depression, and loneliness and higher wellbeing, self-esteem, self-efficacy, and group closeness. This study expands the social cure to its application to an online dance context for the first time.

Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment.

BACKGROUND: A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment. METHODS/DESIGN: Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period. DISCUSSION: This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioral therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000618954.

Testing a psychosocial model of sexual communication and sexual risk-taking: A cross-sectional, online survey study of Australian University students.

OBJECTIVE: Sexually transmitted infection rates are higher among young people relative to other age groups. Despite much investigation, there is not enough research about in-the-moment factors associated with risky sexual behaviour, such as relational and situational variables. The present study sought to test a comprehensive psychosocial model of sexual risk-taking that included a range of factors: individual (emotion dysregulation, impulsivity), relational (attachment, communication), societal (norms, gender), and situational (dating application use, alcohol use). METHODS: 1244 young people aged 18 to 25 years (82.9 % women; 59.2 % single, 36.0 % in a monogamous relationship) participated in an online survey. The cross-sectional model was tested using Structural Equation Modelling. RESULTS: Sexual communication mediated the relationship between attachment anxiety and sexual risk. However, contrary to predictions, greater sexual communication was related to higher risk. Post-hoc analysis showed that this unexpected relationship may be due to the way sexual risk was measured, as an alternative model specifying casual unprotected sex as the outcome showed no positive relationship between sexual communication and risk. CONCLUSION: Findings indicate that young people with anxious attachment are less confident communicating about sexual health. Measures of sexual risk focusing on specific risk activities in context yield different findings to those assessing general sexual behaviours. Findings support interventions focusing on addressing perceived sexual risk norms and the dating application context to reduce risk.