WEDNESDAY, Nov. 2 (HealthDay News) -- Some Boston parents might be in for a rude awakening: 13 percent of area high school students say they've received "sext" messages and one in 10 has either forwarded, sent or posted sexually suggestive, explicit or nude photos or videos of people they know by cellphone or online.

So found a study of more than 23,000 students, with the results scheduled to be presented Wednesday at the American Public Health Association's annual meeting in Washington, D.C.

Sexting can include overtones of bullying and coercion, and teens who are involved were more likely to report being psychologically distressed, depressed or even suicidal, according to the 2010 survey of 24 (of 26) high schools in Boston's metro-west region.

Twice as many respondents who said they had sexted in the past year reported depressive symptoms, compared to teens who did not. Moreover, 13 percent of teen involved in sexting reported a suicide attempt during that period compared with 3 percent of non-sexting teens, according to the researchers at the Education Development Center in Newton, Mass.

That doesn't mean that sexting leads to depression or increases suicide risk. "It's a cross-sectional study -- it shows an association but not a causal relationship," explained lead researcher Shari Kessel Schneider.

However, she added, "It's important to know there's a link between sexting and psychological distress. It's something to be considered if you know of a youth who is involved in sexting."

Of the high-school students, 10 percent of boys and 11 percent of girls said they had sent one of these images in the past year, while 6 percent of males and 4 percent of females had had such an image sent of themselves.

The researchers also found that youths who did not self-identify as heterosexual -- that is, they described themselves as gay, lesbian, bisexual other or not sure -- were more likely to be involved in sexting.

Other studies have examined sexting on a national basis, prompting parents to question how they can prevent their own children from posting -- or posing for -- these images.

"I encourage parents to treat a kid's cellphone as a computer: thinking of securing, protecting and limiting it," said Marian Merritt, Internet safety advocate for Norton, part of Symantec Inc. As soon a child receives his or her first cell phone, "Set family rules. Age 12 is standard."

"If that phone is a smartphone, password protect it," she said. "It could prevent your child getting victimized" by someone else who picks it up and uses it. And to monitor your son's or daughter's use: "Check your online statement, to see if your child is sending a lot of photo messages."

Parents need to take back control of the technology, she said, whether it's by setting online time limits on the home wireless router or limiting access and privacy: "Charge the phone in the kitchen, some central location, so it's not on their pillow, buzzing late at night with text messages."

Talk to your children, she said. "Don't wait until they're 16, that's exactly the wrong way to do stuff. Start much earlier. Especially with boys, know how incredibly common it will be for them to receive a [sext] message. Ask them, 'What would you do?' What's the right thing to do to protect the girl? Delete it?' Try to make sure he shows empathy for the girl."

Some adolescents will be more affected than others, Merritt said. "In general, with all the things on the Internet, it's very hard to predict who will be impacted. Some kids are able to roll with it and there are others who can't."

Justin Patchin, co-director of the Cyberbullying Research Center, said his first advice to teens who receive a sext message is this: "You should delete it and not tell anybody. If it's doesn't get disseminated and distributed, it's ended."

He said he's received flak for suggesting on the center's website that kids don't always need to go to adults when sexting involves a friend (or girlfriend or boyfriend), but he still believes, "If you tell adults, you're throwing that person under a bus." Once people in authority, such as teachers and principals, are made aware of sexting, legal reporting requirements come into play.

"Adults, it seems, are forced to respond to sexting in extreme ways -- ways that have long-term, irreversible consequences," he posted in February. "Until we can develop reasonable responses that do not potentially foreclose on the futures of all involved, we are wise to advise that students do not contact adults, unless the situation is appearing to get out of control. And I think teens know when it is out of control."

Patchin doesn't discount that sexting can have serious ramifications. "You can look at high-profile examples, of people with severe psychological problems," he said, referring to two publicized cases of young girls committing suicide where sexting was a factor.

In his center's dealings with sexting, he said, "We've talked with frustrated, embarrassed, upset kids."

Merritt cautioned against overreacting about the findings and said she would like to see more data, for instance, on how sexting relates to teens' gender orientation.

Kessler Schneider's group does intend to do more studies in that area. For now, she said, the Boston findings should "draw attention to the link between sexting and mental health, which should be addressed by anti-bullying and health-promotion initiatives."

Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The Pew Research Center has more about teens and sexting.