Mental Health
Persistence of psychological distress from adolescence through mid-life in the United States: results from Monitoring the Future Katherine Keyes* Katherine Keyes Victoria Joseph Justin Jager Mark Olfson Megan Patrick
Background: Depression, loneliness and other psychological distress symptoms are common in the US. While symptoms are known to be highly prevalent, data from outside the US suggest that prospective assessments generate substantially higher estimates of cumulative lifetime risk than retrospective assessments; such data have not been produced for the US. Here we use national data with repeated assessment of psychological distress to provide lifetime cumulative risk estimates for the US.
Methods: Monitoring the Future includes 6,993 individuals followed from age 18 (in 1976-1978) to age 60 (in 2018-2020), with ~4 assessments (range 1-12). Psychological distress included three subscales: loneliness (2 items), self-derogation (4 items), and low self-esteem (4 items); a total score was dichotomized based on 75th percentile for each subscale. We estimated the cumulative risk of 1+ period with high psychological distress among those with 2+ follow-ups, and prospective prediction from age 18 to 60 using logistic regression.
Results: Among those followed to 60 with 2+ follow-ups, 63.6% had at least 1 period of high psychological distress (males: 61.5%; females: 65.7%). A total of 39.9% had 1 period; 16.0% had 2 periods; and 7.7% had 3+ periods of high psychological distress. Most risk accumulation occurred during early adulthood; 52.4% had a period of high psychological distress by age 24. Those with high loneliness at age 18 had 2.42 times the risk of high loneliness at age 60 (95% confidence interval 2.01-2.90); those with low self-esteem at age 18 had 4.27 times the risk of low self-esteem at age 60 (95% confidence interval 3.57-5.09).
Conclusion: By age 60, most US adults will experience at least 1 period of high psychological distress, and the majority of risk accumulates early in adulthood. Adolescent distress prospectively predicts later life distress, thus intervention and prevention efforts in adolescence are critical for addressing late life mental health problems.