Depression or anxiety in adolescence is linked with a 20% greater likelihood of having a heart attack mid-life, according to research released today at ESC Congress 2020.

In a warning to parents, study author Dr. Cecilia Bergh of Örebro University in Sweden, said: "Be vigilant and look for signs of stress, depression or anxiety that is beyond the normal teenage angst: seek help if there seems to be a persistent problem (telephone helplines may be particularly helpful during the COVID-19 pandemic). If a healthy lifestyle is encouraged as early as possible in childhood and adolescence it is more likely to persist into adulthood and improve long-term health."

There are indications that mental well-being is declining in young people. This study investigated whether conditions like depression in adolescence (age 18 or 19) are associated with a higher risk of cardiovascular disease in adulthood. The researchers also examined the possible role of stress resilience (ability to cope with stress in everyday life) in helping to explain any associations.

The study included 238,013 men born between 1952 and 1956 who underwent extensive examinations in late adolescence (as part of their assessment for compulsory military service) and were then followed into middle age (up to the age of 58 years). The assessments at the age of 18 or 19 years included medical, psychiatric, and physical examinations by physicians and psychologists.

Stress resilience was measured by an interview with a psychologist and a questionnaire, and based on familial, medical, social, behavioural and personality characteristics.

A total of 34,503 men were diagnosed with a non-psychotic mental disorder (such as depression or anxiety) at conscription. Follow-up for cardiovascular disease was through hospital medical records.

The study found that a mental disorder in adolescence was associated with the risk of having a myocardial infarction (heart attack) by middle age. Compared to men without a mental illness in adolescence, the risk of myocardial infarction was 20% higher among men with a diagnosis - even after taking into account other characteristics in adolescence such as blood pressure, body mass index, general health, and parental socioeconomic status.

The association between mental illness and heart attack was partly - but not completely - explained by poorer stress resilience and lower physical ?tness in teenagers with a mental illness. "We already knew that men who were physically fit in adolescence seem less likely to maintain fitness in later years if they have low stress resilience," said Dr. Bergh. "Our previous research has also shown that low stress resilience is also coupled with a greater tendency towards addictive behaviour, signalled by higher risks of smoking, alcohol consumption and other drug use."

Dr. Bergh said: "Better fitness in adolescence is likely to help protect against later heart disease, particularly if people stay fit as they age. Physical activity may also alleviate some of the negative consequences of stress. This is relevant to all adolescents, but those with poorer wellbeing could benefit from additional support to encourage exercise and to develop strategies to deal with stress."