Adolescent Mental Health Problems and Adult Human Capital: Findings From the South African Birth to Twenty Plus Cohort at 28 Years of Age

PURPOSE: We investigated associations between adolescent internalizing and externalizing problems and adult human capital in a non-Western setting. Little is known about adolescent mental health problems and adult outcomes in low- and middle-income countries, many of which are characterized by high levels of adversities. METHODS: Data came from the Birth to Twenty Plus cohort, started in Soweto, Johannesburg, South Africa, in 1990. We estimated associations of internalizing and externalizing problems at the age of 14 years with self-reported educational, employment, welfare receipt, psychosocial (psychological distress, criminality, substance use), interpersonal (social isolation, intimate partner violence, partnership status), and HIV outcomes at the age of 28 years. RESULTS: Adolescents with high internalizing problems were less likely to have completed secondary school or be formally employed and more likely to report psychological distress. Those with high levels of externalizing problems were more likely to report adulthood criminal activity and substance use. We found significant associations between internalizing and externalizing problems and intimate partner violence. There was no association between adolescent mental health problems and welfare receipt, HIV, social isolation, or partnership status. Men were more likely to report incomplete secondary education, no formal employment, criminality and substance use, social isolation, and no serious relationship, whereas women were more likely to experience psychological distress and be in receipt of welfare. CONCLUSIONS: Adolescent mental health problems are associated with long-term negative adult functioning under varying socioeconomic conditions. Interventions to recognize and address youth mental health problems in low- and middle-income countries are needed to avert serious adverse adult and societal consequences.