Mental Health Outcomes in US Children and Adolescents Born Prematurely or with Low Birthweight

“The evidence presented here suggests that premature birth and LBW [low birthweight] are significant risk factors for mental health problems among children and adolescents,” write the authors of an article published in Depression Research and Treatment. Despite marked improvements in survival rates, preterm and LBW infants remain vulnerable to many physical and mental health problems, including respiratory distress syndrome; asthma and lung disease; cerebral palsy; visual, hearing, and cognitive impairments; and a range of behavioral and developmental disorders. While physical health problems among premature and LBW children are well documented, behavioral and mental health problems among them are less well studied.

The study described in this article examined (1) the prevalence of overall and specific mental health outcomes among U.S. children by prematurity and LBW before and after controlling for household socioeconomic status (SES) and sociodemographic characteristics; (2) whether mental health outcomes associated with prematurity and LBW vary by child’s sex and age; (3) whether social factors are significant predictors of mental problems in both preterm/LBW and general child populations; and (4) the extent to which neurodevelopmental conditions such as autism/autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and developmental delay might account for the relationship between perinatal conditions and common emotional/behavioral disorders of depression, anxiety, and conduct problems.

Data for the present study came from the 2011-2012 National Survey of Children’s Health (NSCH). The purpose of the NSCH was to provide national and state-specific prevalence estimates for a variety of children’s health and well-being indicators. The sample size for the present analysis was 85,535 children ages 2-17. Ten mental health outcomes were studied: behavioral/emotional problem, serious behavioral/emotional problem, depression, anxiety, opposition defiant or conduct disorder, ASD, attention deficit disorder (ADD)/ADHD, developmental delay, learning disability, and intellectual disability/mental retardation.

The authors found that

  • The prevalence of mental health problems was 22.9 percent among children born prematurely, 28.7 percent among very-low-birthweight (VLBW) children, and 18.9 percent among moderately low-birthweight (MLBW) children, all significantly higher than the prevalence for term/normal-birthweight children (less than15 percent) or for the general child population (15.5 percent).
  • Compared to those born full term, children born prematurely had 61 percent higher adjusted odds of serious emotional/behavioral problems, 33 percent higher odds of depression, 58 percent higher odds of anxiety, 2.3 times higher odds of autism/ASD, 2.9 times higher odds of development delay, and 2.7 times higher odds of intellectual disability than term children.
  • VLBW children had 3.2 times higher odds of autism/ASD, 1.7 times higher odds of ADD/ADHD, 5.4 times higher odds of development delay, and 4.4 times higher odds of intellectual disability than normal-birthweight children.
  • SES, race/ethnicity, and household structure were significant predictors of mental health problems in the general population as well as among premature/LBW and term/normal-birth-weight children.
  • The increased risks of mental health problems associated with prematurity were accounted for by neurodevelopmental conditions.

The authors conclude that “increased mental health surveillance and screening are recommended for children born prematurely and/or with LBW, providing the opportunity for early diagnosis and intervention.”

Population of focus: Children

Link to resource: Mental Health Outcomes in US Children and Adolescents Born Prematurely or with Low Birthweight

Date: 2013

Journal: Depression Research and Treatment