Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
J Child Psychol Psychiatry. 2018 Nov;59(11):1192-1200. doi: 10.1111/jcpp.12909. Epub 2018 Apr 18.
Individuals born extremely preterm are exposed to significant perinatal stresses that are associated with an increased risk of psychopathology. However, a paucity of longitudinal studies has prevented the empirical examination of long-term, dynamic effects of perinatal adversity on mental health. Here, internalizing and externalizing problems from adolescence through adulthood were compared in individuals born at extremely low birth weight (ELBW; <1,000 g) and normal birth weight (NBW; >2,500 g).
Internalizing and externalizing data were collected over 20 years in three waves, during adolescence, young adulthood, and adulthood. Growth models were used to compare longitudinal trajectories in a geographically based sample of 151 ELBW survivors and 137 NBW control participants born between 1977 and 1982 matched for age, sex, and socioeconomic status at age 8.
After adjusting for sex, socioeconomic and immigrant status, and family functioning, ELBW survivors failed to show the normative, age-related decline in internalizing problems over time relative to their NBW peers (β = .21; p < .01). Both groups exhibited small declines in externalizing problems over the same period. Self-esteem (but not physical health, IQ, or maternal mood) partially mediated the association between ELBW status and internalizing problems.
Extremely low birth weight survivors experienced a blunting of the expected improvement in depression and anxiety from adolescence to adulthood. These findings suggest that altered physiological regulatory systems supporting emotional and cognitive processing may contribute to the maintenance of internalizing problems in this population.
极早产儿在围产期会经历多种应激，这与精神病理学风险增加有关。然而，由于缺乏纵向研究，无法对围产期逆境对心理健康的长期、动态影响进行实证检验。本研究比较了极低出生体重（ELBW；<1,000g）和正常出生体重（NBW；>2,500g）个体从青春期到成年期的内化和外化问题。
在三个时间点（青春期、青年期和成年期）收集了内化和外化数据，共 20 年。使用增长模型比较了 1977 年至 1982 年间出生的、基于地理的 151 名 ELBW 幸存者和 137 名 NBW 对照参与者的纵向轨迹，这些参与者在 8 岁时按年龄、性别和社会经济地位进行了匹配。
在调整性别、社会经济和移民状况以及家庭功能后，ELBW 幸存者在与 NBW 同龄人相比时，未能表现出随着年龄增长而内化问题的正常下降趋势（β=0.21；p<.01）。两组在同一时期的外化问题都略有下降。自尊（而不是身体健康、智商或母亲情绪）部分中介了 ELBW 状态与内化问题之间的关联。
极低出生体重幸存者经历了从青春期到成年期抑郁和焦虑预期改善的钝化。这些发现表明，支持情感和认知处理的改变的生理调节系统可能导致该人群内化问题的持续存在。
