Importance: Depression and anxiety are common mood disorders that show higher prevalence in adults with joint hypermobility, a consequence of a constitutional variant of connective tissue structure. In adolescents, an association between mood disorder and hypermobility may enhance the potential understanding of risk factors for emotional disorder and provide opportunities for early intervention approaches. Objective: To test the hypothesis that joint hypermobility, a consequence of constitutional variant of connective tissue, is associated with common mental illness in adolescents. Design: This was a longitudinal prospective study. Setting: The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective ongoing general population birth cohort study based in Avon County, England. Participants: The original data set comprised 6105 individuals from the cohort with data available on joint hypermobility at age 14 years; a sub-sample (n=3803) had later psychiatric assessments. Measurement of Exposure: Joint hypermobility was measured by physical examination at age 14 and 18 years, using the Beighton Scale Main Outcome and Measures: Participants were assessed at age 18 years. ICD 10 diagnoses of Depression and Anxiety were obtained using the Clinical Interview Schedule-Revised (CIS R) and levels of anxiety quantified using the Anxiety Sensitivity Index (ASI) Results: Presence of generalized joint hypermobility (GJH) at age 14 years predicted depression at 18 years in males (Odds Ratio (OR) 2.10; 95%CI, 1.17 - 3.76) but not females. After accounting for missing data it was determined that this relationship was mediated by heart rate, a potential measure of physiological arousal. Symptomatic hypermobility ((GJH plus chronic widespread pain (CWP)) at age 18 years was further associated with the presence of anxiety disorder (OR 3.13; 95% CI 1.52 - 6.46) and level of anxiety (Beta = 0.056, t(3315)=3.27), depressive disorder (adjusted OR 3.52; 95%CI, 1.67 - 7.40) and degree of psychiatric symptomatology (Beta 0.096, t(2064)=4.38) Conclusions and relevance: Generalized joint hypermobility and symptomatic hypermobility are associated with common mental disorders in adolescence. Consideration of hypermobility may provide important opportunities for intervention to mitigate psychiatric disorder.

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