Background: Previous investigations into the impact of birth complications and social environment have generally followed their subjects only at young ages. Aims: To assess the long- range impact of socio-economic status (SES) and birth risks on the development of emotional and nervous conditions through adulthood. Method: The Johns Hopkins Pathways Study interviewed 1824 subjects born between 1960 and 1965. The median household income of the children at age 7-8 years was used to divide the cohort into high and low income categories. Differences in life time prevalence of emotional and nervous conditions through adulthood between the two income groups were identified. Results: Children in the lower income group were 1.86 times more likely to report an emotional or nervous condition as adults. Boys in the lower income group at age 7-8 years were 3.2 times more likely to do so. The risks of difficult birth for adult mental disturbance were accentuated in the low-income group. Conclusions: Children who experience birth complications are at increased risk of developing adult mental disturbances; this increase is mitigated by higher SES. Declaration of interest: This study was supported by National Institute of Mental Health Grants MH 14592 and MH 53188, the Robert Wood Johnson Foundation, the William T. Grant Foundation and the Johns Hopkins Population Center.