Mental health risk factors in adolescence were examined as predictors of mental distress in early adulthood. A cohort of 709 Finnish adolescents was studied in 1990 (mean age 16.8) and in 1995. Trait anxiety, defence styles, life events, self-esteem and somatic symptoms were evaluated as predictors of high scores in the General Health Questionnaire in adulthood. Females (36%) were more likely to be distressed than males (23%). High trait anxiety and somatic symptom scores among adolescent females, and high immature defence style scores among males predicted mental distress. Males with low trait anxiety in adolescence had less distress. The results indicate trait anxiety as an important predictor of mental distress. Gender differences in other predictors suggest gender differences in coping.