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Psychopathology in young adults born at extremely low birth weight

Published online by Cambridge University Press:  07 December 2010

M. H. Boyle*
Affiliation:
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada Offord Centre for Child Studies, McMaster Children's Hospital, Hamilton, Ontario, Canada
V. Miskovic
Affiliation:
McMaster Integrative Neuroscience Discovery, & Study (MiNDS), McMaster University, Hamilton, Ontario, Canada
R. Van Lieshout
Affiliation:
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada Offord Centre for Child Studies, McMaster Children's Hospital, Hamilton, Ontario, Canada
L. Duncan
Affiliation:
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada Offord Centre for Child Studies, McMaster Children's Hospital, Hamilton, Ontario, Canada
L. A. Schmidt
Affiliation:
Offord Centre for Child Studies, McMaster Children's Hospital, Hamilton, Ontario, Canada McMaster Integrative Neuroscience Discovery, & Study (MiNDS), McMaster University, Hamilton, Ontario, Canada Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
L. Hoult
Affiliation:
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
N. Paneth
Affiliation:
Departments of Epidemiology and Human Development, Michigan State University, East Lansing, Michigan, USA
S. Saigal
Affiliation:
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
*
*Address for correspondence: M. H. Boyle, Ph.D., Department of Psychiatry and Behavioural Neurosciences, McMaster University and Offord Center for Child Studies, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. (Email: [email protected])

Abstract

Background

Little is known about the long-term mental health of extremely low birth weight (ELBW) (<1000 g) survivors. We test whether young adults aged 22 to 26 years born at ELBW differ from normal birth weight (NBW) controls in self-reported levels of psychopathology.

Method

Participants included 142 ELBW survivors (86% response) born between 1977 and 1982 to residents of central-west Ontario, Canada and 133 NBW control subjects (92% response). The Young Adult Self-Report measure was used to create five DSM-IV oriented scales aggregated to form internalizing (depressive problems, anxiety problems, avoidant personality problems) and externalizing (attention deficit-hyperactivity disorder problems and antisocial personality problems) scales.

Results

After adjusting for family background characteristics, mean scores for ELBW survivors were 3.02 [95% confidence interval (CI) 0.78–5.26] points higher for internalizing problems and no different, i.e. 0.00 (95% CI −1.17 to 1.17), for externalizing problems. There was a sex×group statistical interaction such that being male muted the risk for externalizing problems among those born at ELBW: −2.11 (95% CI −4.21 to −0.01). Stratifying ELBW adults as born small for gestational age (SGA) versus appropriate weight for gestational age (AGA) revealed a significant gradient of risk for levels of internalizing problems that was largest for SGA, i.e. 4.75 (95% CI 1.24–8.26), and next largest for AGA, 2.49 (95% CI 0.11–4.87), compared with NBW controls.

Conclusions

Depression, anxiety and avoidant personality problems (internalizing problems) are elevated in young adulthood among ELBW survivors. This effect is relatively small overall but noticeably larger among ELBW survivors born SGA.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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References

Aarnoudse-Moens, CSH, Weisglas-Kuperus, N, van Goudoever, JB, Oosterlaan, J (2009). Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 124, 717728.CrossRefGoogle ScholarPubMed
Achenbach, TM (1997). Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. University of Vermont, Department of Psychiatry: Burlington, VT.Google Scholar
Achenbach, TM, Bernstein, A, Dumenci, L (2005). DSM-oriented scales and statistically based syndromes for ages 18 to 59: linking taxonomic paradigms to facilitate multitaxonomic approaches. Journal of Personality Assessment 84, 4963.CrossRefGoogle ScholarPubMed
Achenbach, TM, McConaughy, SH, Howell, CT (1987). Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychological Bulletin 101, 213232.CrossRefGoogle ScholarPubMed
Alati, R, Lawlor, DA, Mamun, AA, Williams, GM, Najman, JM, O'Callaghan, M, Bor, W (2007). Is there a fetal origin of depression? Evidence from the Mater University Study of Pregnancy and its outcomes. American Journal of Epidemiology 165, 575582.CrossRefGoogle Scholar
Anderson, P, Doyle, LW (2003). Victorian Infant Collaborative Study Group. Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. Journal of the American Medical Association 289, 32643272.CrossRefGoogle ScholarPubMed
Anderson, PJ, Doyle, LW (2008). Cognitive and educational deficits in children born extremely preterm. Seminars in Perinatology 32, 5158.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barker, DJP (2006). Adult consequences of fetal growth restriction. Clinical Obstetrics and Gynecology 49, 270283.CrossRefGoogle ScholarPubMed
Barkley, RA, Murphy, KR (1998). Attention-Deficit Hyperactivity Disorder: A Clinical Workbook, 2nd edn. Guilford Press: New York.CrossRefGoogle Scholar
Barnes, LLB, Harp, D, Jung, WS (2002). Reliability generalization of scores on the Spielberger State-Trait Anxiety Inventory. Educational and Psychological Measurement 62, 603618.CrossRefGoogle Scholar
Bhutta, AT, Cleves, MA, Casey, PH, Cradock, MM, Anand, KJS (2002). Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. Journal of the American Medical Association 288, 728737.CrossRefGoogle ScholarPubMed
Botting, N, Powls, A, Cooke, RWI, Marlow, N (1997). Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birthweight children at 12 years. Journal of Child Psychology and Psychiatry 38, 931941.CrossRefGoogle Scholar
Boyle, MH, Offord, DR, Racine, YA, Fleming, JE, Szatmari, P, Sanford, MN (1993). Evaluation of the revised Ontario Child Health Study Scales. Journal of Child Psychology and Psychiatry 34, 189213.CrossRefGoogle ScholarPubMed
Byles, J, Byrne, C, Boyle, MH, Offord, DR (1988). Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device. Family Process 27, 97–104.CrossRefGoogle ScholarPubMed
Cadman, DT, Boyle, MH, Offord, DR, Szatmari, P, Rae-Grant, NI, Crawford, JW, Byles, J (1986). Chronic illness and functional limitations in Ontario children: findings of the Ontario Child Health Study. Canadian Medical Association Journal 135, 761767.Google ScholarPubMed
Cadman, DT, Boyle, MH, Szatmari, P, Offord, DR (1987). Chronic illness, disability and mental health: findings of the Ontario Child Health Study. Pediatrics 79, 805813.CrossRefGoogle ScholarPubMed
Cohen, J (1992). A power primer. Psychological Bulletin 112, 155159.CrossRefGoogle ScholarPubMed
Conrad, AL, Richman, L, Lindgren, S, Nopoulos, P (2010). Biological and environmental predictors of behavioural sequelae in children born preterm. Pediatrics 125, e83e89.CrossRefGoogle ScholarPubMed
Cooke, RWI (2004). Health, lifestyle, and quality of life for young adults born very preterm. Archives of Disease in Childhood 89, 201206.CrossRefGoogle ScholarPubMed
Copeland, W, Shanahan, L, Costello, EJ, Angold, A (2009). Configurations of common psychosocial risk factors. Journal of Child Psychology and Psychiatry 50, 451459.CrossRefGoogle ScholarPubMed
Costello, EJ, Worthman, C, Erkanli, A, Angold, A (2007). Prediction from low birth weight to female adolescent depression: a test of competing hypotheses. Archives of General Psychiatry 64, 338344.CrossRefGoogle ScholarPubMed
Dahl, LB, Kaaresen, PI, Tunby, J, Handegård, BH, Kvernmo, S, Rønning, JA (2006). Emotional, behavioural, social and academic outcomes in adolescents born with very low birth weight. Pediatrics 118, e449e459.CrossRefGoogle ScholarPubMed
Davidson, RJ (2000). Affective style, psychopathology, and resilience: brain mechanisms and plasticity. American Psychologist 55, 11961214.CrossRefGoogle ScholarPubMed
Delobel-Ayoub, M, Kaminski, M, Marret, S, Burguet, A, Marchand, L, N'Guyen, S, Matis, J, Thiriez, G, Fresson, J, Arnaud, C, Poher, M, Larroque, B (2006). Behavioral outcome at 3 years of age in very preterm infants: the EPIPAGE study. Pediatrics 117, 19962005.CrossRefGoogle ScholarPubMed
De Los Reyes, A, Kazdin, AE (2005). Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychological Bulletin 131, 483509.CrossRefGoogle ScholarPubMed
Epstein, NB, Baldwin, LM, Bishop, DS (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy 9, 171180.CrossRefGoogle Scholar
Farooqi, A, Hägglöf, B, Sedin, G, Gothefors, L, Serenius, F (2007). Mental health and social competencies of 10- to 12-year-old children born at 23 to 25 weeks of gestation in the 1990s: a Swedish national prospective follow-up study. Pediatrics 120, 118133.CrossRefGoogle ScholarPubMed
Gardner, F, Johnson, A, Yudkin, P, Bowler, U, Hockley, C, Mutch, L, Wariyar, U (2004). Extremely Low Gestational Age Steering Group. Behavioral and emotional adjustment of teenagers in mainstream school who were born before 29 weeks' gestation. Pediatrics 114, 676682.CrossRefGoogle ScholarPubMed
Georgiades, K, Boyle, MH, Jenkins, JM, Sanford, M, Lipman, E (2008). A multilevel analysis of whole family functioning using the McMaster Family Assessment Device. Journal of Family Psychology 22, 344354.CrossRefGoogle ScholarPubMed
Grunau, RE, Whitfield, MF, Fay, TB (2004). Psychosocial and academic characteristics of extremely low birth weight (<or =800 g) adolescents who are free of major impairment compared with term-born control subjects. Pediatrics 114, e725e732.CrossRefGoogle ScholarPubMed
Gutbrod, T, Wolke, D, Soehne, B, Ohrt, B, Reigel, K (2000). Effects of gestation and birth weight on growth and development of very low birthweight small for gestational age infants: a matched group comparison. Archives of Disease in Childhood, Fetal and Neonatal Edition 82, F208F214.CrossRefGoogle ScholarPubMed
Hack, M (2009). Adult outcomes of preterm children. Journal of Developmental and Behavioral Pediatrics 30, 460470.CrossRefGoogle ScholarPubMed
Hack, M, Taylor, HG, Schluchter, M, Andreias, L, Drotar, D, Klein, N (2009). Behavioral outcomes of extremely low birth weight children at age 8 years. Journal of Developmental and Behavioral Pediatrics 30, 122130.CrossRefGoogle ScholarPubMed
Hack, M, Youngstrom, EA, Cartar, L, Schluchter, M, Taylor, HG, Flannery, D, Klein, N, Borawski, E (2004). Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years. Pediatrics 114, 932940.CrossRefGoogle ScholarPubMed
Hack, M, Youngstrom, EA, Cartar, L, Schluchter, M, Taylor, HG, Flannery, D, Klein, N, Borawski, E (2005). Predictors of internalizing symptoms among very low birth weight young women. Journal of Developmental and Behavioral Pediatrics 26, 93–104.CrossRefGoogle ScholarPubMed
Hille, ET, den Ouden, AL, Saigal, S, Wolke, D, Lambert, M, Whitaker, A, Pinto-Martin, JA, Hoult, L, Meyer, R, Felman, JF, Verloove-Vanhorick, SP, Paneth, N (2001). Behavioural problems in children who weigh 1000 g or less at birth in four countries. Lancet 357, 16411643.CrossRefGoogle ScholarPubMed
Hille, ETM, Dorrepaal, C, Perenboom, R, Gravenhorst, JB, Brand, R, Verloove-Vanhorick, SP (2008). Social life-style, risk taking behaviour, and psychopathology in young adults born very preterm or with very low birthweight. Journal of Pediatrics 152, 793800.CrossRefGoogle ScholarPubMed
Horwood, JL, Mogridge, N, Darlow, BA (1998). Cognitive, educational, and behavioural outcomes to 7 to 8 years in a national very low birthweight cohort. Archives of Disease in Childhood, Fetal and Neonatal Edition 79, F12F20.CrossRefGoogle Scholar
Horwood, SP, Boyle, MH, Torrance, GW, Sinclair, JC (1982). Mortality and morbidity of 500- to 1499-gram birth weight infants live-born to residents of a defined geographic region before and after neonatal intensive care. Pediatrics 69, 613620.CrossRefGoogle ScholarPubMed
Indredavik, MS, Vik, T, Heyerdahl, S, Kulseng, S, Brubakk, AM (2005). Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires. European Child and Adolescent Psychiatry 14, 226236.CrossRefGoogle ScholarPubMed
Indredavik, MS, Vik, T, Heyerdahl, S, Kulseng, S, Fayers, P, Brubakk, AM (2004). Psychiatric symptoms and disorders in adolescents with low birth weight. Archives of Disease in Childhood, Fetal and Neonatal Edition 89, F445F450.CrossRefGoogle ScholarPubMed
Johnson, A, Bowler, U, Yudkin, P, Hockley, C, Wariyar, U, Gardner, F, Mutch, L (2003). Health and school performance of teenagers born before 29 weeks gestation. Archives of Disease in Childhood, Fetal and Neonatal Edition 88, F190F198.CrossRefGoogle ScholarPubMed
Johnson, S, Hollis, C, Kochhar, P, Hennessy, E, Wolke, D, Marlow, N (2010). Psychiatric disorders in extremely preterm children: Longitudinal Finding at age 11 years in the EPICure study. Journal of the American Academy of Child and Adolescent Psychiatry 49, 453463.Google ScholarPubMed
Kooij, JJS, Boonstra, AM, Swinkels, SHN, Bekker, EM, de Noord, I, Buitelaar, JK (2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders 11, 445458.CrossRefGoogle Scholar
Korkman, M, Liikanen, A, Fellman, V (1996). Neuropsychological consequences of very low birth weight and asphyxia at term: follow-up until school age. Journal of Clinical and Experimental Neuropsychology 18, 220233.CrossRefGoogle ScholarPubMed
Kramer, MS, Platt, RW, Wen, SW, Joseph, KS, Allen, A, Abrahamowicz, M, Blondel, B, Breat, G (2001). A new and improved population-based Canadian reference for birth weight for generational age. Pediatrics 108, e35.CrossRefGoogle Scholar
Levy-Shiff, R, Einat, G, Har-Even, D, Mogilner, M, Mogilner, S, Lerman, M, Krikler, R (1994). Emotional and behavioral adjustment in children born prematurely. Journal of Clinical Child Psychology 23, 323333.CrossRefGoogle Scholar
Lindström, K, Lindblad, F, Hjern, A (2009). Psychiatric morbidity in adolescents and young adults born preterm: a Swedish national cohort study. Pediatrics 123, e47e53.CrossRefGoogle Scholar
Lynch, CD, Zhang, J (2007). The research implications of the selection of a gestational age estimation method. Paediatric and Perinatal Epidemiology 21, 8696.CrossRefGoogle ScholarPubMed
Miskovic, V, Schmidt, LA, Boyle, MH, Saigal, S (2009). Regional electroencephalogram (EEG) spectral power and hemispheric coherence in young adults born at extremely low birth weight. Clinical Neurophysiology 120, 231238.CrossRefGoogle ScholarPubMed
Monfils Gustafsson, W, Josefsson, A, Ekholm Selling, K, Sydsjö, G (2009). Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort. Acta Psychiatrica Scandinavica 119, 5461.CrossRefGoogle ScholarPubMed
Moster, D, Lie, RT, Markestad, T (2008). Long-term medical and social consequences of preterm birth. New England Journal of Medicine 359, 262273.CrossRefGoogle ScholarPubMed
Msall, ME, Park, JJ (2008). The spectrum of behavioural outcomes after extreme prematurity: regulatory, attention, social and adaptive dimensions. Seminars in Perinatology 32, 4250.CrossRefGoogle ScholarPubMed
Räikkönen, K, Pesonen, AK, Heinonen, K, Kajantie, E, Hovi, P, Järvenpää, AL, Eriksson, JG, Andersson, S (2008). Depression in young adults with very low birth weight: the Helsinki study of very low-birth-weight adults. Archives of General Psychiatry 65, 290296.CrossRefGoogle ScholarPubMed
Reijneveld, SA, de Kleine, MJK, van Baar, AL, Kollée, LAA, Verhaak, CM, Verhulst, FC, Verloove-Vanhorick, SP (2006). Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years. Archives of Disease in Childhood, Fetal and Neonatal Edition 91, F423F428.CrossRefGoogle ScholarPubMed
Rickards, AL, Kelly, EA, Doyle, LW, Callanan, C (2001). Cognition, academic progress, behavior and self-concept at 14 years of very low birth weight children. Journal of Developmental and Behavioral Pediatrics 22, 19.CrossRefGoogle ScholarPubMed
Rosenberg, M (1965). Society and the Adolescent Self-image. Princeton University Press: Princeton, New Jersey.CrossRefGoogle Scholar
Saigal, S, Doyle, LW (2008). An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371, 261269.CrossRefGoogle ScholarPubMed
Saigal, S, Lambert, M, Russ, C, Hoult, L (2002). Self-esteem of adolescents who were born prematurely. Pediatrics 109, 429433.CrossRefGoogle ScholarPubMed
Saigal, S, Pinelli, J, Hoult, L, Kim, MM, Boyle, M (2003). Psychopathology and social competencies of adolescents who were extremely low birth weight. Pediatrics 111, 969975.CrossRefGoogle ScholarPubMed
Saigal, S, Szatmari, P, Rosenbaum, P, Campbell, D, King, S (1991). Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study. Journal of Pediatrics 118, 751760.CrossRefGoogle Scholar
Samara, M, Marlow, N, Wolke, D (2008). Pervasive behavior problems at 6 years of age in a total-population sample of children born at ⩽25 weeks of gestation. Pediatrics 122, 562573.CrossRefGoogle Scholar
Schlotz, W, Phillips, DIW (2009). Fetal origins of mental health: evidence and mechanisms. Brain, Behavior, and Immunity 23, 905916.CrossRefGoogle ScholarPubMed
Schmidt, LA, Miskovic, V, Boyle, MH, Saigal, S (2008). Shyness and timidity in young adults who were born at extremely low birth weight. Pediatrics 122, e181e187.CrossRefGoogle ScholarPubMed
Schmidt, LA, Miskovic, V, Boyle, MH, Saigal, S (2010). Frontal electroencephalogram asymmetry, salivary cortisol and internalizing problems in young adults who were born at extremely low birth weight. Child Development 81, 183199.CrossRefGoogle ScholarPubMed
Schuerger, JM, Witt, AC (1989). The temporal stability of individually tested intelligence. Journal of Clinical Psychology 45, 294302.3.0.CO;2-N>CrossRefGoogle Scholar
Spielberger, CD, Gorsuch, RL, Lushene, PR, Vagg, PR, Jacobs, AG (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press: Palo Alto.Google Scholar
Stevenson, CJ, Blackburn, P, Pharoah, POD (1999). Longitudinal study of behaviour disorders in low birthweight infants. Archives of Disease in Childhood, Fetal and Neonatal Edition 8, F5F9.CrossRefGoogle Scholar
Stjernqvist, K, Svenningsen, NW (1999). Ten-year follow-up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement. Acta Paediatrica 88, 557562.CrossRefGoogle ScholarPubMed
Strang-Karlsson, S, Räikkönen, K, Pesonen, AK, Kajantie, E, Paavonen, EJ, Lahti, J, Hovi, P, Heinonen, K, Järvenpää, AL, Eriksson, JG, Andersson, S (2008). Very low birth weight and behavioral symptoms of attention deficit hyperactivity disorder in young adulthood: the Helsinki study of very-low-birth-weight adults. American Journal of Psychiatry 165, 13451353.CrossRefGoogle ScholarPubMed
Sykes, DH, Hoy, EA, Bill, JM, McClure, BG, Halliday, HL, Reid, MM (1997). Behavioural adjustment in school of very low birthweight children. Journal of Child Psychology and Psychiatry 38, 315325.CrossRefGoogle ScholarPubMed
Szatmari, P, Saigal, S, Rosenbaum, P, Campbell, D (1993). Psychopathology and adaptive functioning among extremely low birthweight children at eight years of age. Development and Psychopathology 5, 345357.CrossRefGoogle Scholar
Szatmari, P, Saigal, S, Rosenbaum, P, Campbell, D, King, S (1990). Psychiatric disorders at five years among children with birthweights <1000 g: a regional perspective. Developmental Medicine and Child Neurology 32, 954962.CrossRefGoogle Scholar
Taylor, HG, Hack, M, Klein, NK (1998). Attention deficits in children with <750 g birth weight. Child Neuropsychology 4, 2134.CrossRefGoogle Scholar
Taylor, HG, Klein, N, Drotar, D, Schluchter, M, Hack, M (2006). Consequences and risks of <1000-g birth weight for neuropsychological skills, achievement, and adaptive functioning. Journal of Developmental and Behavioral Pediatrics 27, 459469.CrossRefGoogle ScholarPubMed
Taylor, HG, Klein, N, Hack, M (2000). School-age consequences of birth weight less than 750 g: a review and update. Developmental Neuropsychology 17, 289321.CrossRefGoogle Scholar
Walshe, M, Rifkin, L, Rooney, M, Healy, E, Nosarti, C, Wyatt, J, Stahl, D, Murray, RM, Allin, M (2008). Psychiatric disorder in young adults born very preterm: role of family history. European Psychiatry 23, 527531.CrossRefGoogle ScholarPubMed
Ware, JE, Sherbourne, CD (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473483.CrossRefGoogle ScholarPubMed
Wechsler, D (1974). The Wechsler Intelligence Scale for Children – Revised. Psychological Corp.: New York, NY.Google Scholar