Internalizing Symptoms, Alcohol Use, and Protective Behavioral Strategies: Associations with Regretted Sexual Experiences of College Students

•Sexual regret is associated with mental health symptoms, alcohol, and PBS use.•Examining internalizing symptoms, alcohol, and PBS use in association with sexual regret is novel.•Mental health prevention efforts and interventions are warranted for sexual regret.•Future research is needed to understand temporal associations of sexual regret. One of the most pervasive forms of regret, often connected to alcohol use, is sexual regret. Lifetime rates of regretted sexual experiences (RSE) for college students is between 29%-71.9%, with 31.8% endorsing past year RSE and 31.7% stating alcohol negatively influenced decision making. While past research has focused on psychological symptoms following sexual assault, psychological effects and subsequent outcomes of RSE remains under-studied. Whether a history of sexual regret is associated with mental health symptoms, alcohol use, and protective behavioral strategy (PBS) use in the past month was analyzed. Participants (n = 1,394; 57.68% females, 26.96% racial/ethnic minority) reported on internalizing symptoms (anxiety, depression, trauma symptoms, and suicidal ideation) and externalizing and protective behaviors (problematic alcohol use and PBS). It was hypothesized that those with a history of RSE would report heightened current psychological symptoms compared to those without a history of RSE, regardless of when the RSE occurred. Of the n = 1,394 participants, 39.96% reported sexual regret and 26.11% endorsed a history of sexual victimization. Results indicate that among participants with an RSE, past month symptoms of anxiety, depression, trauma, and suicidal ideation were heightened. A similar pattern emerged for problematic alcohol use, as those with a history of RSE engaged in more problematic alcohol use in the past month. For PBS, those with a history of RSE engaged in fewer PBS than those without. Understanding these factors may provide novel insight for mental health prevention efforts and intervention targets for individuals who experience sexual regret.