A Longitudinal Study of Adolescent Mental Health and Quality of Life as Predictors of College Physical Health, Mental Health, and Gluten-Free Diet Adherence in Celiac Disease

<b>Background/Objectives:</b> To determine whether adolescent (T1) mental health, quality of life, and adjustment to celiac disease (CeD) are associated with college-age (T2) perceived physical and mental health and gluten-free diet (GFD) adherence. <b>Methods:</b> In 2015, adolescents with CeD (<i>n</i> = 101, T1) completed standardized surveys assessing mental health (CSI-4), quality of life (PedsQL), and adjustment to CeD (CDDUX). Five years later, participants ≥18 years self-reported GFD adherence and physical and mental health perception in college (<i>n</i> = 59, T2). Patients who were current or recent college students that provided complete data at both time points were analyzed (<i>n</i> = 43) using Kendall's tau to test: concurrent associations among T2 perceived physical/mental health and GFD adherence; and prospective associations between T1 measures and T2 perceived outcomes. <b>Results:</b> Higher T1 CSI-4 and PedsQL scores were negatively correlated with T2 perceived physical health (<i>τ</i> = -0.31, <i>p</i> = 0.02 and <i>τ</i> = -0.28, <i>p</i> = 0.04, respectively). There was trending association between T1 PedsQL and T2 mental health perception (<i>τ</i> = -0.23, <i>p</i> = 0.06). T2 physical and mental health perception were positively correlated (<i>τ</i> = 0.41, <i>p</i> = 0.001). No significant associations emerged between T1 measures and T2 GFD adherence, nor between T2 health perception and GFD adherence, although T2 physical health perception positively trended with GFD adherence (<i>p</i> = 0.78). <b>Conclusions:</b> Adolescents with CeD reporting more depressive symptoms or lower quality of life feel less physically and mentally healthy when in college. In college, feeling physically healthy aligns with feeling mentally healthy, although neither clearly predicts GFD adherence. Early mental health screening in adolescents with CeD may support transitions to independent dietary management.