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Peer-reviewedCC BY 4.0European Child & Adolescent Psychiatry

How adolescent depressive symptoms are associated with premature mortality: Behavioral and socioeconomic pathways across the life course

  • NaKyung Nam1,2
  • Hyewon Son3
  • Jinho Kim1,2,4
4 affiliations
  1. 1Department of Health Policy and Management, Korea University, Room 367, B-dong Hana-Science Building 145 Anam-ro, Seongbuk-gu, Seoul, Republic of Korea
  2. 2Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
  3. 3Department of Sociology, The University of Texas at Austin, Austin, TX USA
  4. 4Center for Demography of Health and Aging, University of Wisconsin- Madison, Madison, WI USA
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Abstract

Premature mortality in young adulthood has become a growing public health concern in the United States, yet it remains unclear whether vulnerability to early death originates as early as adolescence. Although depressive symptoms are highly prevalent during adolescence and linked to long-term health and socioeconomic disadvantages, their prospective association with premature mortality remains poorly understood. This study examined whether depressive symptoms experienced during adolescence predict premature mortality in young adulthood and whether health behaviors and socioeconomic status in early adulthood help explain this association. Data were drawn from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health, along with the Mortality Outcomes Surveillance System established in Wave V (N = 14,320). Cox proportional hazards models estimated the association between adolescent depressive symptoms and premature mortality, and cause-specific Cox proportional hazards models evaluated deaths due to disease, suicide, and external causes. Mediation analyses tested health behaviors and socioeconomic factors as mechanisms. Higher adolescent depressive symptoms were associated with increased risk of all-cause premature mortality in young adulthood. Cause-specific models showed that this association was concentrated in deaths due to external causes, with no significant associations for disease-related deaths or suicide. Cigarette smoking, marijuana use, lower educational attainment, and reduced employment in early adulthood accounted for part of the association for all-cause mortality. For external-cause mortality, however, health behaviors—specifically cigarette smoking and marijuana use—emerged as the prominent mediating pathways. Findings suggest that adolescent depressive symptoms may be associated with an increased vulnerability to premature mortality, in part through behavioral and socioeconomic pathways that emerge in early adulthood. Strengthening early mental health identification and support could reduce long-term disparities in survival.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03103-6.

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Cite

BibTeXRIS
BibTeX
@article{nam2026adolescent,
  title = {{How adolescent depressive symptoms are associated with premature mortality: Behavioral and socioeconomic pathways across the life course}},
  author = {NaKyung Nam and Hyewon Son and Jinho Kim},
  journal = {European Child \& Adolescent Psychiatry},
  year = {2026},
  month = jun,
  doi = {10.1007/s00787-026-03103-6},
  url = {https://doi.org/10.1007/s00787-026-03103-6},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - How adolescent depressive symptoms are associated with premature mortality: Behavioral and socioeconomic pathways across the life course
AU  - NaKyung Nam
AU  - Hyewon Son
AU  - Jinho Kim
PY  - 2026
DA  - 2026/06/25
JO  - European Child & Adolescent Psychiatry
DO  - 10.1007/s00787-026-03103-6
UR  - https://doi.org/10.1007/s00787-026-03103-6
AB  - Premature mortality in young adulthood has become a growing public health concern in the United States, yet it remains unclear whether vulnerability to early death originates as early as adolescence. Although depressive symptoms are highly prevalent during adolescence and linked to long-term health and socioeconomic disadvantages, their prospective association with premature mortality remains poorly understood. This study examined whether depressive symptoms experienced during adolescence predict premature mortality in young adulthood and whether health behaviors and socioeconomic status in early adulthood help explain this association. Data were drawn from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health, along with the Mortality Outcomes Surveillance System established in Wave V (N = 14,320). Cox proportional hazards models estimated the association between adolescent depressive symptoms and premature mortality, and cause-specific Cox proportional hazards models evaluated deaths due to disease, suicide, and external causes. Mediation analyses tested health behaviors and socioeconomic factors as mechanisms. Higher adolescent depressive symptoms were associated with increased risk of all-cause premature mortality in young adulthood. Cause-specific models showed that this association was concentrated in deaths due to external causes, with no significant associations for disease-related deaths or suicide. Cigarette smoking, marijuana use, lower educational attainment, and reduced employment in early adulthood accounted for part of the association for all-cause mortality. For external-cause mortality, however, health behaviors—specifically cigarette smoking and marijuana use—emerged as the prominent mediating pathways. Findings suggest that adolescent depressive symptoms may be associated with an increased vulnerability to premature mortality, in part through behavioral and socioeconomic pathways that emerge in early adulthood. Strengthening early mental health identification and support could reduce long-term disparities in survival.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03103-6.
SN  - 1018-8827
SN  - 1435-165X
ER  -