High school students who send and receive sexually suggestive or explicit images are more likely to have symptoms of depression, according to a new study from the Education Development Center in Newton, Mass.
"I think in some cases sexting may be occurring in the context of cyberbullying behavior," said lead researcher, Shari Kessel Schneider, who has spent more than a decade studying adolescent behavior.
The preliminary results of the study, announced recently at the American Public Health Association's annual meeting in Washington, D.C., do not provide any information on whether sexting might be causing the depressive symptoms or vice versa.
But the results were especially interesting to Dr. Jill Murray, who runs a private practice in Laguna Niguel, Calif., specializing in adolescents, teen dating abuse and domestic violence.
"I have two girls who have made suicide attempts and several had to switch schools because of sexting," she said, adding that other patients of hers who sexted and then watched their picture get distributed to other teens, started cutting themselves. "I don't know any 16 year old boy who's going to keep a naked picture of a girl to himself."
Schneider and her colleagues at the EDC analyzed data from the 2010 MetroWest Adolescent Health Survey which included responses from more than 23,000 high school students located in the western suburbs of Boston.
Overall, 10 percent of the students said they had sent a sext message in the past year and 5 percent said someone else had sent a sexually suggestive photo of themselves.
One of the questions in the survey asked the teens if, during the past year, they ever felt "so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?" They were also asked if they had ever attempted suicide.
Those involved in sexting were not only more likely to report a suicide attempt, they also had twice the odds of reporting depressive symptoms as students who weren't involved in sexting.
As a caveat, the students surveyed in Schneider's study -- which has not yet been published -- were predominantly from middle or upper middle class neighborhoods. In addition, 74 percent of them were white, so the results of her research are most applicable in communities with similar demographics.
In Murray's practice, she says sexting typically has a greater impact on girls than boys.
"For girls who send the sexts I think that there is a disillusionment and a sense of betrayal when it's posted everywhere. When it gets forwarded to multiple boys at multiple schools and also other girls ... a girl starts getting called names and her reputation is ruined."
The sense of betrayal and shame is "horrid," Murray said. "Of course, all of that leads to depression and regret. These girls may act real tough and say this doesn't matter but a lot of them do wind up doing some sort of self harm ... cutting, bulimia, burning themselves, pulling out eyelashes or pubic hair, or some other sort of self-injurious behavior like alcohol and drug use."
As for the boys who receive the sexts, "there really isn't an emotional consequence for them," she said. Boys who are victims of sexually predatory teenage girls, however, can be devastated.
"I'm finding this very much in high schools and it's a very disturbing trend where girls choose a boy who is sexually naïve and she asks for pictures of him," Murray said. "He's sort of flattered and he feels like a big guy and then she sends them around."
Schneider found those who identified as gay, lesbian and bisexual, and students who had sexual intercourse were more likely to be involved in sexting than students who were heterosexual or who had never had sex.
In addition, the students who sext tend to use their cell phones more frequently.
That's why Murray recommends that parents monitor their children's cell phone bills to learn more about what's going on in their child's life.
"I believe very, very strongly in parents being parents and not pals," she said. "For some reason parents think they don't have a right to access children's Facebook accounts or their child's cell phones when in fact they own it all."
She recommends that parents establish a family rule that all cell phones are in lockdown in the parents' bedroom when their kids go to sleep.
"The most egregious cell phone behavior happens between midnight and 5 a.m.," she said.
Dr. Michael Rich, an associate professor at Harvard and renowned expert on the psychosocial effects of technology, told ABCNews.com the number of teens who sext appears to be dropping, "quite possibly because kids are cluing in more to what the repercussions are."
"In other words, their awareness of the risk is now increased," he said.
According to the latest national survey from the Pew Research Center just 2 percent of teens ages 12 to 17 say they have sent a sexually suggestive nude or nearly nude photo or video of themselves to someone else.
It's entirely possible, Rich said, that the teens who sext today are more aware that they're engaging in a risky behavior than they ever have been in the past, which would make sexting a potential red flag.
"If I, as a pediatrician, saw a kid who was sexting I would be more attuned to are you self harming, are you at risk for suicide," Rich said. But first, "you have to figure out if the kid was conscious if it was a risky behavior or not. It might just be a kid being a stupid kid, who was just playing. If they went into it knowing it put them at risk or put them in a situation where they could harm others then you may want to investigate. At first you just have to get to the bottom of what the intent of it was."
Peer pressure can also play a big role in a teen's decision to sext.
A recent MTV/Associated Press study surveyed 14-24 year olds. Among those polled, nearly half of those who shared naked photos or videos of themselves felt pressure to do so.
When parents discover their child has either sent or received a sext it's easy to lose your cool, said Larry Magid, co-director of ConnectSafely.org, a non-profit dedicated to educating the public about digital citizenship and reputation management.
"We really strongly believe young people need to be respected, not lectured to," Magid said. "Adults have a tendency to overact about a lot of things."
The first step, he said, is to stop, take a deep breath and "really think through what's going on in their child's life."
"Have a rational conversation with your child and explain why it's a bad idea, but try to be as non judgmental as you possibly can," he said.
Those who receive a sext message should never pass it around, he added.
"I personally wouldn't even send a picture like that to my own wife. There's accidental distribution, maybe you leave or phone somewhere and someone picks it up," he said. "If you receive a sext and it's from someone who you are close to, you have to be a friend. Stand up and do the right thing, which is not share it."
Teens need to understand that there is the possibility of prosecution for the possession of child pornography.
"It has happened," he said. "So the first thing you should probably do to protect yourself is delete them."
Good Morning America