Mental Health in Low Birth Weight Individuals Approaching Adulthood
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In developed countries, an increasing number of children have survived after preterm birth during the latest decades. These children are surviving at the borders of viability and are at increased risk for a number of adverse outcomes. Few studies have followed low birth weight populations into adulthood. In this study, three groups of children born in the Trøndelag counties of Norway in 1986-88 have been followed up from birth to twenty years of age. Two groups born with low birth weight were compared with a control group born in the same period. One of the low birth weight groups were children born with very low birth weight ≤1500 g (the VLBW-group). Participants in this group were admitted to the neonatal intensive care unit at The University Hospital in Trondheim, Norway at birth. The other low birth weight group included subjects born small for gestational age (SGA) < 10 percentile at term. The control group was born at term with normal birth weight (≥ 10 percentile). The two latter groups were recruited from a multicentre study constituting participants from Uppsala, Sweden and Bergen and Trondheim, Norway, and only the participants from Trondheim were included in this follow-up. The study is part of a larger follow-up project, Low Birth Weight in a Life-time Perspective, focusing on a variety of long term aspects of being born with low birth weight. Testing has included assessment of motor skills, vision, mental health, cognitive skills, supplemented with magnetic resonance imaging (MRI) of the brain, applying different techniques. Mental health was assessed for the first time at 14 years of age. The aim of this study was to investigate whether mental health and related aspects in young adulthood were affected by being born with low birth weight. Furthermore, we wanted to assess stability and change in psychiatric morbidity between adolescence and young adulthood. In the period of autumn 2006 to autumn 2008, the participants’ mental health was assessed by a psychiatric interview and different questionnaires on mental health, quality of life and self-esteem. In addition questionnaires were mailed to the participants’ parents. Referral to appropriate health care institutions was offered if indicated after mental health testing. Higher risk for psychiatric disorders, predominantly anxiety disorders and ADHD, was found in both low birth weight group compared with controls. A disorder was found in 33 % in the VLBW group and in 26% in the SGA group, compared with 8 % in the control group. The low birth weight participants reported more emotional and behavioural problems, lower quality of life related to mental health, and lower athletic performance (VLBW) and social acceptance (SGA) than controls. The VLBW group had high psychiatric morbidity in both adolescence and young adulthood. Problems tended to increase from adolescence to young adulthood in all three study groups; however, the increase in psychiatric morbidity was only statistically significant for the SGA group born at term. About half of the participants born with low birth weight had no mental health problems at either 14 of 20 years of age, compared with about 75 % in the control group. Better cognitive function modified the differences between the VLBW and the control group, while this effect was not found in the SGA group. In the VLBW group, screening in adolescence discriminated between persons with and without a psychiatric disorder in young adulthood. Better cognitive functioning modified the differences between the VLBW group and the controls, while the effect of IQ on differences between the SGA group and the controls was negligible. The findings in the VLBW group are in keeping with reports from other international studies. Our observations in the SGA group represent new findings; hence there is a need for replication in corresponding and larger study populations. Our results indicate that being born with low birth weight, either prematurely or at term, may serve as a risk factor for adversities in mental health and related aspects in young adult age. Continued attention both in research and in clinical settings is therefore needed for both groups of low birth weight in order to promote good mental health and well-being later in life.
SerieDoktoravhandlinger ved NTNU, 1503-8181; 2012:332
Dissertations at the Faculty of Medicine, 0805-7680; 580