Developmental trajectories in adolescent mental health: does social status matter?

Abstract Background Adolescence is a sensitive period for poor mental health, with long-term consequences. Socioeconomic status (SES) is known to be associated with mental health, but the life-course pattern is unknown. This study examines four different SES patterns in mental health from adolescence into adulthood (ages 15-32). Methods Individuals born in 1989 were followed from 2004 to 2021, with surveys conducted at ages 15, 18, 21, 28, and 32, supplemented by register data. Descriptive statistics of depressive symptoms, medication use, and mental disorders were calculated for SES groups (low, middle, high) across four SES measures: Subjective social status (SSS) in school and in society, household income, and parental educational level. Group-Based Trajectory Modelling identified depressive symptoms trajectories and logistic regressions were used to analyze relative odds ratios (RORs) of membership in each trajectory group on individual characteristics. Results Across all SES measures, individuals with low SES showed higher mean depressive symptoms, greater medication use, and higher cumulative incidence of mental disorders between ages 15 and 32. Four depressive symptoms trajectories were identified: low stable, moderate stable, decreasing, and increasing. Being female, receiving medication or a mental disorder diagnosis, having low SSS in school, parents not living together, higher school pressure, being bullied, and lacking support from teachers, classmates, or parents resulted in higher RORs of membership to other trajectory groups compared to the low stable, while having high SSS in society resulted in lower RORs. Conclusions Individuals with low SES had more negative mental health outcomes than those with middle or high SES from age 15 to 32. Social support, other mental health outcomes, and being female increased the odds of membership to trajectory groups with more depressive symptoms compared to the low stable trajectory. Key messages • Preventive initiatives for poor mental health should focus on adolescents with low SES, especially subjective social status is strongly associated with poor mental health outcomes. • Increased social support in adolescence might prevent increasing depressive symptoms.