School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
J Dev Behav Pediatr. 2021;42(2):154-162. doi: 10.1097/DBP.0000000000000898.
Preterm birth is associated with a high prevalence of psychiatric disorders including internalizing problems. However, there is a lack of consensus on the risk for depression and on specific diagnostic profiles. This meta-analysis investigates the independent pooled odds of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition anxiety and depressive disorders in children between 3 and 19 years of age born preterm compared with their term-born peers.
PubMed/MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature electronic databases were searched (last updated in September 2019) using population ("child"), exposure ("preterm birth"), and outcome ("anxiety") terms for English peer-reviewed publications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed with the risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was estimated using fixed-effects models.
Eleven independent studies met the inclusion criteria. The pooled sample comprised 1294 preterm and 1274 term-born children with anxiety outcomes and 777 preterm and 784 term-born children with depressive outcomes between 3 and 19 years of age. Children born preterm had significantly greater odds for anxiety (OR: 2.17; 95% CI, 1.43-3.29), generalized anxiety (OR: 2.20; 95% CI, 1.26-3.84), and specific phobia (OR: 1.93; 95% CI, 1.05-3.52) relative to their term-born peers. There were no significant between-group differences for reported depressive disorders.
Preterm birth is associated with a higher prevalence of anxiety, but not depressive disorders, from 3 to 19 years of age, suggesting distinct etiological pathways in this high-risk population. The findings support variation in the rates of specific anxiety diagnoses, indicating the need to extend neurodevelopmental surveillance to encompass a holistic emotional screening approach.
早产与包括内化问题在内的精神障碍高发有关。然而，对于抑郁风险和特定诊断特征，尚未达成共识。本荟萃分析调查了在 3 至 19 岁早产儿与足月出生同龄人相比，患有第四版《精神障碍诊断与统计手册》焦虑和抑郁障碍的独立汇总优势比。
使用人群（“儿童”）、暴露（“早产”）和结局（“焦虑”）术语，在 PubMed/MEDLINE、PsycINFO 和 Cumulative Index to Nursing and Allied Health Literature 电子数据库中搜索英文同行评审出版物（最后一次更新时间为 2019 年 9 月）。采用纽卡斯尔-渥太华质量评估量表评估偏倚风险，遵循系统评价和荟萃分析报告的首选项目。使用固定效应模型估计汇总优势比（OR）及其 95%置信区间（CI）。
11 项独立研究符合纳入标准。汇总样本包括 1294 名患有焦虑症的早产儿和 1274 名足月出生的儿童，以及 777 名患有抑郁症的早产儿和 784 名足月出生的儿童，年龄在 3 至 19 岁之间。与足月出生的同龄人相比，早产儿发生焦虑症（OR：2.17；95%CI，1.43-3.29）、广泛性焦虑症（OR：2.20；95%CI，1.26-3.84）和特定恐惧症（OR：1.93；95%CI，1.05-3.52）的优势明显更高。两组间报告的抑郁症无显著差异。
从 3 岁到 19 岁，早产与焦虑症的发病率较高相关，但与抑郁症无关，这表明高危人群中存在不同的病因途径。研究结果支持特定焦虑症诊断率的差异，表明需要扩展神经发育监测，包括全面的情感筛查方法。
