Early Adult Health Research Articles

The long-term effects of cash transfer programmes on young adults' mental health: A quasi-experimental study of Colombia, Mexico and South Africa.

Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico and South Africa (N= 14 431) we applied logistic regression models with country- and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood (OR = 0.96, 95% CIs: 0.93 to 0.98). We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03), and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population level depressive symptoms during early adulthood.

Depression in childhood to early adulthood and respiratory health in early adulthood.

Both depression and respiratory disease are common today in young populations. However, little is known about the relationship between them. This study aims to explore the association between depression in childhood to early adulthood and respiratory health outcomes in early adulthood, and the potential underlying mechanisms. A prospective study was conducted based on the Swedish BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi [Children, Allergy, Milieu, Stockholm, Epidemiology]) birth cohort (n = 4089). We identified clinically diagnosed depression through the dispensation of antidepressants, using national register data confirmed by self-reported diagnosis. At the 24-year follow-up, respiratory health was assessed via questionnaires and clinical evaluation. Metabolic and inflammatory profiles were analysed to explore potential mechanisms. Among the 2994 participants who provided study data, 403 (13.5%) had depression at any time point from around age 10 to 25 years. Depression was associated with higher risks of any chronic bronchitis symptoms (odds ratio = 1.58, 95% CI 1.21-2.06) and respiratory symptoms (odds ratio = 1.41, 95% CI 1.11-1.80) in early adulthood, independent of body mass index (BMI) and smoking status. Compared to individuals without depression, those with depression had a higher fat mass index (FMI (β = 0.48, 95% CI 0.22-0.74)) and increased blood levels of fibroblast growth factor 21 and Interleukin-6 in early adulthood. These markers together with FMI were found to partly mediate the association between depression and respiratory symptoms (total mediation proportion: 19.8 and 15.4%, respectively, P < 0.01). Depression in childhood to early adulthood was associated with an increased risk of respiratory ill-health in early adulthood, independently of smoking. Metabolic and inflammatory dysregulations may underlie this link.

The Impact Of Physical Activity In Adolescence On Cardiovascular Health In Early Adulthood

The Impact Of Physical Activity In Adolescence On Cardiovascular Health In Early Adulthood

Does maternal education moderate the relationship between adolescent cannabis use and mental health in early adulthood?

Socioeconomic disadvantage has been associated with cannabis use and poor mental health. It is therefore hypothesised that lower maternal education, a proxy for socioeconomic disadvantage, may increase the risk of cannabis-related mental health and substance use consequences. A total of 5099 participants from the Avon Longitudinal Study of Parents and Children reported cannabis use via questionnaires at 16 or 18. Logistic regression was used to examine the relationship between any and regular (weekly or more) adolescent cannabis use with depression, anxiety, psychotic experiences, and problematic cannabis use at age 24. Maternal education was included as an effect modifier. Missing data were addressed through multiple imputation using chained equations. In total, 36.5% of participants reported adolescent cannabis use and, of these, 14% reported regular use. Adolescent cannabis use was associated with an increased likelihood of anxiety and problematic cannabis use; however, there was little evidence of moderation by maternal education. Regular cannabis use was associated with an increased likelihood of problematic cannabis use, with little evidence of moderation by maternal education. There was weak evidence that the association between regular cannabis use and depression (interaction p-value = 0.024) and anxiety (interaction p-value = 0.056) was stronger in people with high maternal education. Adolescent cannabis use is associated with increased risk of anxiety and cannabis use disorder, but there was insufficient evidence that childhood socioeconomic position (proxied by maternal education) modifies this relationship. Improved public health messages for all adolescents about these risks may be warranted.

Bullying victimisation in childhood and mental health in early adulthood: comparison of prospective and retrospective reports

The association between childhood bullying victimisation and mental health problems in adulthood has been consistently reported in the literature. Previous studies used both retrospective and prospective reports to measure bullying victimisation. However, there could be biases in both reports. We aimed to assess agreement between prospective and retrospective reports of childhood bullying victimisation, to compare their associations with mental health in early adulthood, and to examine the associations of consistent prospectively and retrospectively reported bullying victimisation with adult mental health. Data were from the prospective Bavarian Longitudinal Study of neonatal at-risk children and term-born controls recruited at birth. 489 participants were followed from birth to age 26 (mean [SD]: 26.4 [0.8] years). Adult mental health was assessed using both the Achenbach Young Adult Self-Report (YSR) and standardised diagnostic interviews. Childhood bullying victimisation was prospectively reported by participants and parents at age 13 and retrospectively self-reported at age 26. We showed that the agreement between retrospective and prospective self-reports of bullying victimisation was fair (Kappa 0.30) with only slight agreement (Kappa 0.18) when compared with prospective parent-reports. Both prospectively and retrospectively self-reported bullying victimisation was associated with poor mental health. Retrospective reports tended to produce stronger associations. Participants who reported being bullied both retrospectively and prospectively had a particularly elevated risk for mental health problems. In conclusion, prospective and retrospective reports capture partly different individuals with exposure to bullying victimisation. Exposure to bullying victimisation, whether it was retrospectively or prospectively self-reported, was associated with an increased risk for mental health problems.

Youth Incarceration in Adult Facilities and Mental Health in Early Adulthood

PurposeTo examine the relationship between youth incarceration in adult correctional facilities and mental health in early adulthood. MethodsWe analyzed nationally representative data from 1997 through 2019 (N = 8,961) using the National Longitudinal Survey of Youth 1997. An ordinary least squares regression model using inverse probability weights was used to assess the influence of youth incarceration in an adult facility on average mental health scores from age 18 to 37. ResultsRespondents incarcerated in an adult facility as a youth had poorer average mental health than those not held in adult prisons or jails over the course of the study period. Those incarcerated for longer in adult facilities also exhibited more mental health symptoms. DiscussionYoung people incarcerated in adult correctional facilities experience poorer long-term mental health related to depression and anxiety in early adulthood.

Maternal experienced bereavement and offspring mental health in early adulthood: the role of modifiable parental factors.

It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. We analysed data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety-related disorders were self-reported at 18 years old using the Clinical Interview Schedule-Revised (CIS-R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. Maternal experienced bereavement was not associated with depression or anxiety-related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed.

Dampak Quarterlife Crisis terhadap Kesehatan Mental pada Dewasa Muda

Quarter Life Crisis is a person entering adulthood who constantly questions the future, is confused when facing problems, and thinks a lot about the past to see whether his current life is in accordance with the life he dreams of. This crisis often occurs in their 20s and often occurs in people who are in the transition period from education to the next career level, which is usually called early adulthood. Research also shows that the Quarter-life Crisis tends to make it difficult to find life goals and things. This has an impact on mental health such as anxiety, depression and decreased psychological well-being. The method used is a literature study by examining relevant journal articles with keywords. The purpose of this article is to determine the impact of the quarter life crisis on the mental health of early adults. Based on the results Research shows that there is a negative impact of the quarter life crisis on mental health in early adulthood.

Pre-analysis protocol for an observational study on the effects of adolescent sports participation on health in early adulthood

Abstract: We will study the impact of adolescent sports participation on early-adulthood health using longitudinal data from the National Study of Youth and Religion. We focus on two primary outcomes measured at ages 23–28 — self-rated health and total score on the PHQ9 Patient Depression Questionnaire — and control for several potential confounders related to demographics and family socioeconomic status. Comparing outcomes between sports participants and matched non-sports participants with similar confounders is straightforward. Unfortunately, an analysis based on such a broad exposure cannot probe the possibility that participation in certain types of sports (e.g., collision sports like football or soccer) may have larger effects on health than others. In this study, we introduce a hierarchy of exposure definitions, ranging from broad (participation in any after-school organized activity) to narrow (e.g., participation in limited-contact sports). We will perform separate matched observational studies, one for each definition, to estimate the health effects of several levels of sports participation. In order to conduct these studies while maintaining a fixed family-wise error rate, we deployed an ordered testing approach that exploits the logical relationships between exposure definitions. Our study will also consider several secondary outcomes including body mass index, life satisfaction, and problematic drinking behavior.

Menstrual Cycle Irregularity in Adolescence Is Associated With Cardiometabolic Health in Early Adulthood.

Background Menstrual cycle irregularities are associated with cardiovascular and cardiometabolic disease. We tested associations between age at menarche and cycle irregularity in adolescence and cardiometabolic health in early adulthood in a subsample from the Pittsburgh Girls Study. Methods and Results Data from annual interviews were used to assess age at menarche and cycle irregularity (ie, greater or less than every 27-29 days) at age 15 years. At ages 22 to 25 years, cardiometabolic health was measured in a subsample of the Pittsburgh Girls Study (n=352; 68.2% Black), including blood pressure, waist circumference, and fasting serum insulin, glucose, and lipids. T tests were used for continuous data and odds ratios for dichotomous data to compare differences in cardiometabolic health as a function of onset and regularity of menses. Early menarche (ie, before age 11 years; n=52) was associated with waist circumference (P=0.043). Participants reporting irregular cycles (n=50) in adolescence had significantly higher levels of insulin, glucose, and triglycerides, and higher systolic and diastolic blood pressure (P values range from 0.035 to 0.005) and were more likely to have clinical indicators of cardiometabolic predisease in early adulthood compared with women who reported regular cycles (odds ratios ranged from 1.89 to 2.56). Conclusions Increasing rates and earlier onset of cardiovascular and metabolic disease among women, especially among Black women, highlights the need for identifying early and reliable risk indices. Menstrual cycle irregularity may serve this purpose and help elucidate the role of women's reproductive health in protecting and conferring risk for later cardiovascular and cardiometabolic diseases.

Physical Activity During Adolescence and Mental Health in Early Adulthood: Findings From the 1993 Pelotas Birth Cohort Study.

Low prevalence of physical activity (PA) and a high prevalence of mental health problems are common among youth. The aim of this study was to evaluate the association between PA during adolescence and depression and anxiety disorders in young adulthood. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed. Leisure-time PA and total PA (leisure plus commuting) were evaluated at 11, 15, and 18years using self-reported data. PA was evaluated at each age separately and during adolescence, considering the number of times participants reached PA recommendations. Depression and anxiety were assessed through Mini International Neuropsychiatric Interview at 22years. Crude and adjusted association analyses were performed using Poisson regression with robust error variance, providing prevalence ratios and 95% confidence intervals. Three thousand two hundred and forty-seven participants were included in the study. In the adjusted analyses, active participants in leisure-time PA (≥300min/wk) and total PA at 11years were less likely to be depressed at age 22 (prevalence ratios: 0.54; 95% confidence interval, 0.33-0.89; prevalence ratios: 0.63; 95% confidence interval, 0.41-0.97). For leisure-time PA, the more PA recommendations were met during adolescence, the lower the prevalence of depression. There was no association when PA variables were evaluated separately at 15 and 18years and between PA and anxiety after controlling for potential confounders. Early adolescence appears to be a sensitive period for PA benefits on depression in early adulthood. The more timepoints reaching PA recommendations during adolescence, the lower the risk of depression. On the other hand, PA during adolescence was not associated with anxiety in young adults.

Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health)

BackgroundAir pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have examined associations of long-term air pollution exposure with markers of cardiovascular and metabolic health in young adults. ObjectivesBy combining health data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) with air pollution data from the Fused Air Quality Surface using Downscaling (FAQSD) archive, we: (1) calculated multi-year estimates of exposure to ozone (O3) and particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) for Add Health participants; and (2) estimated associations between air pollution exposures and multiple markers of cardiometabolic health. MethodsAdd Health is a nationally representative longitudinal cohort study of over 20,000 adolescents aged 12–19 in the United States (US) in 1994–95 (Wave I). Participants have been followed through adolescence and into adulthood with five in-home interviews. Estimated daily concentrations of O3 and PM2.5 at census tracts were obtained from the FAQSD archive and used to generate tract-level annual averages of O3 and PM2.5 concentrations. We estimated associations between average O3 and PM2.5 exposures from 2002 to 2007 and markers of cardiometabolic health measured at Wave IV (2008–09), including hypertension, hyperlipidemia, body mass index (BMI), diabetes, C-reactive protein, and metabolic syndrome. ResultsThe final sample size was 11,259 individual participants. The average age of participants at Wave IV was 28.4 years (range: 24–34 years). In models adjusting for age, race/ethnicity, and sex, long-term O3 exposure (2002–07) was associated with elevated odds of hypertension, with an odds ratio (OR) of 1.015 (95% confidence interval [CI]: 1.011, 1.029); obesity (1.022 [1.004, 1.040]); diabetes (1.032 [1.009,1.054]); and metabolic syndrome (1.028 [1.014, 1.041]); PM2.5 exposure (2002–07) was associated with elevated odds of hypertension (1.022 [1.001, 1.045]). ConclusionFindings suggest that long-term ambient air pollution exposure, particularly O3 exposure, is associated with cardiometabolic health in early adulthood.

Adolescent Cannabis Misuse Scale: Longitudinal Associations with Substance Use, Mental Health, and Social Determinants of Health in Early Adulthood

Background Some patterns of cannabis use may presage risk for long-term negative effects. We examined associations between a novel adolescent cannabis misuse scale and early-adult life course outcomes. Methods We performed a secondary data analysis of a cohort of Los Angeles, CA high school students from grade 9 through age 21. Participants reported baseline individual demographic and family characteristics at grade 9, adolescent cannabis misuse (8-items) and alcohol misuse (12-items) at grade 10, and outcomes at age 21. We used multivariable regression to model the associations of cannabis misuse scale score with problem substance use (defined as any of: 30-day illegal drug use, 30-day use of another’s prescription to get high, hazardous drinking) and several secondary outcomes (behavioral, mental health, academic, social determinants of health), adjusting for covariates. Parallel analyses were conducted for alcohol misuse. Results The 1,148 participants (86% retention) were 47% male, 90% Latinx, 87% US born, and 40% native English speakers. Approximately 11.4% and 15.9% of participants reported at least one item on the cannabis and alcohol misuse scales, respectively. At age 21, approximately 6.7% of participants reported problem substance use, which was associated with both Cannabis and Alcohol Misuse Scales (OR 1.31, 95%CI[1.16, 1.49] and OR 1.33, 95%CI[1.18, 1.49], respectively). Both scales were similarly associated with outcomes in all four categories. Conclusions The Adolescent Cannabis Misuse Scale is a promising tool for identifying early patterns of substance use that predict future negative outcomes and enabling early intervention at a critical period in youth development.

Networks of Adversity in Childhood and Adolescence and Their Relationship to Adult Mental Health

Adverse experiences before the age of eighteen are common and include diverse events ranging from sexual abuse to parental divorce. These stressful experiences have been linked to physical and mental health issues. Previous research has focused mainly on childhood adversity, such as experiences in the family environment. Little consideration has been given to adversities that may be particularly harmful in adolescence. To understand adolescents’ adverse experiences, this project used data from the Avon Longitudinal Study of Parents and Children (ALSPAC, total N = 14,901, N ≈ 1,200 − 10,000 per measure). We modelled interrelations of adversities in childhood (1–11 years) and adolescence (11–23 years) and examined adversity clusters using network analysis. We found two similar clusters in the childhood and adolescence networks: (1) direct abuse and (2) adverse family factors. We identified a third cluster of (3) educational and social adversities for adolescence. For both age groups, emotional abuse in the family environment was closely linked to mental health in early adulthood and most adversities were linked with depression in early adulthood. In adolescence, housing and academic issues and abuse by a romantic partner were particularly central to the network of adversities. Thus, we found commonalities and differences in the relevance of adverse experiences at different developmental stages. These findings highlight the need to develop age-dependent frameworks for adversity research and policymaking.

Abuse in childhood and cardiometabolic health in early adulthood: evidence from the Avon longitudinal study of parents and children

Abuse in childhood and cardiometabolic health in early adulthood: evidence from the Avon longitudinal study of parents and children

Association between school dropouts, early marriages, childbearing, and mental health in early adulthood of women: Evidence from a cohort study in Bihar, India

School dropouts, early marriages, and low age at childbearing are issues still prevalent in Indian states like Bihar, which may be responsible for poor mental health among young adults. The present study examined the effect of life-course events such as school dropouts, early marriages, and early childbearing on mental health status at later ages (23–28 years). Using data from the Understanding the Lives of Adolescents and Young Adults consisting of a 2360 adolescent (ages 15 – 19) girl cohort interviewed in 2007 and re-interviewed at ages 23 – 28 in 2016 from the state of Bihar, India, we applied ordinal logistic regression models in analyzing factors associated with mental health status. Women who never attended school, or dropped out from school, and who got married before age 19 showed a poorer mental health status in their young adulthood (22 – 28 years) compared to their respective counterparts who attended a school and who got married at age 19 or older. As compared to women who had a child before age 19, those who did not have any child, or who had children after 20 years of age were more likely to have poor mental health. Working women, high self-efficacy of women, and women who have decision-making power showed better mental health outcomes as compared to their respective counterparts. To enhance psychological well-being of young women, the study recommends continue education and delaying marriage as the programmatic keys with attention to improving young women’s autonomy and gender role attitudes and reducing societal pressure for bearing first child soon after marriage.

Narcissistic Personality, Social Media and Mental Health in Early Adulthood

The purpose of this study was to examine the relationship between social media, narcissism, and the mental health of young adults. It was hypothesized that there is likely to be a relationship between narcissism, social media usage, and mental health in early adulthood. A correlation research design was used to collect data (online) from (N= 160) university students (male =31; female=129) with the age range of 18-25 years (M=19.58, SD=5.27). The sample was recruited by using a convenient sampling technique from different private sectors universities. Social Media Addiction Scale (SMAS-SF), Patient Health Questionnaire (PHQ), and 16 items pair of narcissism were used to collect data. Patient Health Questionnaire introduced by Robert, Janet, and William. Pearson product-moment correlation analysis showed that mental health is positively correlated with social media whereas narcissism is negatively correlated with mental health. Implications show that seminar is very important for awareness about mental health and excessive social media usage. Results show that using hours of social media is significantly predicts mental health. Virtual problems, virtual communication, virtual information social media significantly correlated with mental health. Moreover, there are no gender differences in social media and mental health. So our hypothesis is proved. Our results contradicted the results of previous research which showed a relationship between Narcissism, Social Media, and their impact on mental health.

Examining Economic Risks in Adolescents’ Families, Neighborhoods, and Schools: Implications for Mental and Behavioral Health in Early Adulthood

PurposeThis study assessed long-term links among adolescent family, neighborhood, and school economic contexts and mental and behavioral health in early adulthood, irrespective of adult economic contexts. MethodsData were drawn from Add Health, following 10,180 participants from adolescence through early adulthood in the United States. Early adults self-reported on their depressive symptoms, perceived psychological stress, and alcohol use disorder. Income at family and school levels was drawn from youth and parent report; neighborhood income was derived from US Census Data. Multilevel models assessed associations between income in adolescence and early adult outcomes 13 years later while accounting for adolescent outcomes and income in early adulthood. Links with depressive symptoms and stress were assessed utilizing ordinary least squares regression; alcohol use disorder was assessed using ordered logistic regression. Nonlinearities in income effects were assessed with quadratic income variables in adolescence and early adulthood. ResultsFamily income emerged as the most consistent predictor of depressive symptoms (p < .01) and stress (p < .01), showing negative curvilinear associations. In contrast, exposure to higher income schools (p < .01) and neighborhoods (p < .01) during adolescence was associated with heightened risks for alcohol use disorder in early adulthood. These links emerged over and above concurrent negative connections between early adult family and neighborhood economic contexts and depressive symptoms and stress. DiscussionFindings call attention to persistent health-related risks across the income spectrum—not only at the lower end—and also highlight the long-term importance of broader economic contexts beyond the family context.

Abuse in Childhood and Cardiometabolic Health in Early Adulthood: Evidence From the Avon Longitudinal Study of Parents and Children.

BackgroundAlthough childhood abuse has been consistently associated with cardiovascular disease in later adulthood, its associations with cardiometabolic health in younger adults are poorly understood. We assessed associations between childhood physical, sexual, and psychological abuse and cardiometabolic outcomes at 18 and 25 years.Methods and ResultsWe used data on 3223 participants of the ALSPAC (Avon Longitudinal Study of Parents and Children). Exposure to childhood abuse was self‐reported retrospectively at 22 years. We used linear regression to assess the associations between childhood abuse and cardiometabolic outcomes at 18 and 25 years. At 18 years, physical (β 1.35 kg/m2; 95% CI, 0.66–2.05), sexual (β 0.57 kg/m2; 95% CI 0.04–1.11), and psychological (β 0.47 kg/m2; 95% CI 0.01–0.92) abuse were associated with higher body mass index. Physical abuse was also associated with lower high‐density lipoprotein cholesterol (β −0.07 mmol/L; 95% CI, −0.13 to −0.01) and higher C‐reactive protein (31%; 95% CI, 1%–69%), and sexual abuse was associated with higher heart rate (β 1.92 bpm; 95% CI 0.26–3.58). At age 25, all 3 types of abuse were additionally associated with higher insulin, and sexual abuse was associated with lower cholesterol (−0.14 mmol/L; 95% CI, −0.26 to −0.01). The age at which abuse occurred (<11or 11–17 years) had little influence on the associations, and when sex differences were evident, associations were stronger in men.ConclusionsChildhood abuse is associated with negative cardiometabolic outcomes even by young adulthood. Further follow‐up will determine whether associations strengthen across the life course and whether sex differences persist, which is essential for targeting effective screening programs and early interventions in those who suffered abuse in childhood.

Associations between game use and mental health in early adulthood: A nationwide study in Korea

Background: The number of digital game users is increasing, and so is attention to digital gaming's effects on mental health. We aimed to reveal if risky (game addiction) and usual game use (non-risky) are associated with mental health in early adulthood. Methods: Using data from the nationwide cross-sectional Korean Epidemic Catchment Area study for psychiatric disorders, 415 participants aged 18–30 years were divided into “non-game,” “usual game,” and “risky game” user groups based on the previous month's game use and cut-off value of game overuse screening questionnaire. Multiple linear and logistic regressions revealed the association between game use groups, perceived mental health, and lifetime prevalence of clinical mental disorders including suicidal ideation. Results: Among the 415 participants, 167 were non-game users, 175, usual game users, and 73, risky game users. Risky game users self-reported decreased satisfaction and happiness, and a significantly higher lifetime prevalence of major depressive disorder, alcohol dependence, and suicidal ideation. Usual game users were significantly associated with higher lifetime prevalence of alcohol dependence and suicidal ideation. Self-reported happiness partially mediated between game use and lifetime suicidal ideation in risky, but not usual game users. Limitations: This study is a cross-sectional observational study which was not possible to define the temporal relationship. Conclusions: Both risky and usual game use are associated with mental health problems in early adulthood, indicating the need for careful mental health screening on not only risky game users but also usual game users.