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Background: Adolescents with early psychiatric hospitalization are likely to be at a significant risk for long-term difficulties., Objective: To examine early adulthood outcomes of psychiatrically hospitalized adolescents., Design: Inception cohort recruited from 1978 to 1981 and observed until 2002., Setting: Northeastern United States., Participants: Adolescents (aged 12-15 years) from 2 matched cohorts were recruited and assessed repeatedly across 20 years: 70 psychiatrically hospitalized youths and 76 public high school students., Main Outcome Measures: Death, emotional distress, high school completion, and educational attainment., Results: Psychiatrically hospitalized youths were significantly more likely to die and to report higher levels of emotional distress. Hospitalized youths were significantly less likely to graduate from high school and complete college and graduate school., Conclusions: The association between psychiatric symptoms sufficient to result in psychiatric hospitalization during adolescence and later mortality, emotional distress, high school completion, and educational attainment is striking. Further study is needed to identify and understand linkages between adolescent psychiatric impairment and decrements in adult functioning, particularly the processes that may underlie these linkages. Increasing school completion and educational attainment among hospitalized youths may minimize decrements in adult adaptation.