Compared with adults who had a normal birth weight, extremely low-birth-weight survivors had similar numbers of risk factors for depression and anxiety but were more likely to have increased depression and anxiety scores in the presence of risk factors, according to the results of a study published in the Journal of Child Psychology and Psychiatry.

To determine whether extremely low birth weight is associated with the presence of and response to traditional risk factors for anxiety and depression in adulthood, 142 extremely low-birth-weight (<1000 g) survivors and 133 matched normal birth weight controls were evaluated longitudinally until age 22 to 26. Participants were evaluated for the presence of risk factors (family dysfunction, educational attainment of head of household, parent home ownership, etc), the presence of resiliency factors (number of close friends, competency in sports, etc), and depression and anxiety internalizing scores on the Young Adult Self-Report.

No difference in the prevalence of individual or overall risk factors was reported based on birth weight status (P >.05). Extremely low-birth-weight survivors did have a lower prevalence of resiliency factors compared with normal birth weight controls (mean difference 0.85; P <.05).

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Overall, risk (P <.0001) and resiliency factors (P =.02) were correlated with internalizing scores at age 22 to 26. In participants with extremely low-birth-weight, each risk factor was associated with a 2-point increase in internalizing scores and increased clinically significant internalizing symptoms compared with normal birth weight controls (OR 2.47, 95% CI 1.63-3.76).

Resiliency factors did not have a significant impact on internalizing scores in participants with extremely low birth weight, whereas an inverse relationship was present in participants with a normal birth weight.

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“Individuals exposed to severe perinatal adversity [extremely low birth weight] were found to not only be more sensitive to traditional risk factors for depression and anxiety in adulthood, but did not appear to experience the benefit typically associated with exposure to common resiliency factors,” the researchers wrote.

“Intervention strategies aimed at preventing or reducing exposure to traditional childhood risk factors for psychopathology may reduce the burden of mental illness in adult survivors of prematurity.”


Van Lieshout RJ, Boyle MH, Favotto L, et al. Impact of extremely low-birth-weight status on risk and resilience for depression and anxiety in adulthood [published online October 2, 2017]. J Child Psychol Psychiatry. doi:10.1111/jcpp.12826