Association of Positive Family Relationships With Mental Health Trajectories From Adolescence to Midlife

Importance: National longitudinal studies that examine the linkages between early family experiences and sex-specific development of depression across the life course are lacking despite the urgent need for interventions in family settings to prevent adult depression. Objective: To examine whether positive adolescent family relationships are associated with reduced depressive symptoms among women and men as they enter midlife. Design, Setting, and Participants: This study analyzed data from the National Longitudinal Study of Adolescent to Adult Health, which used a multistage, stratified school-based design to select a prospective cohort of 20 745 adolescents in grades 7 to 12 from January 3, 1994, to December 26, 1995 (wave 1). Respondents were followed up during 4 additional waves from April 14 to September 9, 1996 (wave 2); April 2, 2001, to May 9, 2002 (wave 3); April 3, 2007, to February 1, 2009 (wave 4); and March 3, 2016, to May 8, 2017 (sample 1, wave 5), when the cohort was aged 32 to 42 years. The study sample of 8952 male adolescents and 9233 female adolescents that were analyzed was a US national representation of all population subgroups by sex, race/ethnicity, socioeconomic status, and geography. Exposures: Adolescent family cohesion and low parent-child conflict. Main Outcomes and Measures: Levels of depressive symptoms (Center for Epidemiologic Studies-Depression Scale CES-D) from ages 12 to 42 years were used to estimate propensity score-weighted growth curve models to assess sex differences in trajectories of depression by levels of positive adolescent family relationships. Results: A total of 18 185 individuals (mean SD age at wave 1, 15.42 0.12 years; 9233 50.8% female) participated in the study. Females and males who experienced positive adolescent family relationships had significantly lower levels of depressive symptoms from early adolescence to midlife than did those who experienced less positive adolescent family relationships. For example, depressive symptoms were lower among those with high levels of family cohesion compared with those with low cohesion between 12 (1.26 lower CES-D score; 95% CI, 1.10-1.42) and 40 (0.78 lower CES-D score; 95% CI, 0.50-1.06) years of age among females and between 12 (0.72 lower CES-D score; 95% CI, 0.57-0.86) and 37 (0.21 lower CES-D score; 95% CI, 0.00-0.41) years of age among males. The reduction in depressive symptoms associated with positive adolescent family relationships was greater for females than males during the adolescent and early adulthood years (ie, early 20s) (eg, low-high cohesion difference in mean CES-D score, -1.26 95% CI, -1.42 to -1.10 for females and -0.72 95% CI, -0.86 to -0.57 for males at 12 years of age; low-high cohesion difference in mean CES-D score, -0.61 95% CI, -0.69 to -0.53 for females and -0.40 95% CI, -0.48 to -0.31 for males at 20 years of age), after which females and males benefited equally from positive adolescent relationships throughout young adulthood to midlife. Conclusions and Relevance: The findings suggest that positive adolescent family relationships are associated with better mental health among females and males from early adolescence to midlife. Interventions in early family life to foster healthy mental development throughout the life course appear to be important.