Adolescent pregnancy and depressive symptoms in adulthood: A population-based longitudinal analysis examining...

Adolescent pregnancy has well-documented socioeconomic consequences, yet its long-term associations with adult mental health remain underexplored. This study examines associations between adolescent pregnancy outcomes (live birth, miscarriage, abortion) and adult depressive symptoms, exploring substance use and socioeconomic attainment as potential pathways.

Prospective longitudinal cohort study using a nationally representative sample of US women (n = 6163) followed from adolescence into adulthood.

Using four waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we estimated lagged dependent variable regression models with school fixed effects to address baseline differences and unobserved school-level confounding. Cigarette smoking, binge drinking, educational attainment, and personal earnings were tested as mediators via delta-method mediation analysis.

Adolescent miscarriage (β = 0.645, 95% CI: 0.106, 1.183) and live birth (β = 0.365, 95% CI: 0.104, 0.627) were associated with elevated adult depressive symptoms in fully adjusted models, corresponding to approximately 25% and 14% of the outcome standard deviation, respectively. The association for abortion was not statistically significant. Educational attainment and cigarette smoking emerged as statistically significant mediators. Joint indirect effects accounted for 0.091 (95% CI: 0.023, 0.160), 0.099 (95% CI: 0.032, 0.166), and 0.126 (95% CI: 0.082, 0.169) for miscarriage, abortion, and live birth, respectively, corresponding to roughly 14%, 30%, and 35% of the total effect.

Adolescent pregnancy is associated with elevated adult depressive symptoms, particularly for miscarriage and live birth. Part of these associations was accounted for by educational disruption and increased substance use. Public health efforts should prioritize prevention of social disadvantage, early identification of at-risk adolescents, and integrated reproductive and mental health services for young women who experience adolescent pregnancy.