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Internalizing symptoms in very low birth weight preschoolers: Symptom level and risk factors from four rating
Nadine Helle1, Claus Barkmann1, Stephan Ehrhardt2
1Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W29, 20246 Hamburg, Germany.
Insights
Infants with very low birth weight (VLBW) may show more internalizing symptoms, but parental distress is a key predictor. Early identification of parental psychological distress is crucial for child emotional development.
Area of Science:
- Developmental Psychology
- Pediatrics
- Child Psychiatry
Background:
- Increasing rates of very low birth weight (VLBW) infants present risks for emotional development, specifically internalizing symptoms.
- Existing research on VLBW children's internalizing symptoms is limited, often relying solely on maternal reports.
- Preschool-aged children's emotional well-being requires multi-informant assessment for a comprehensive understanding.
Purpose of the Study:
- To investigate internalizing symptoms in preschool-aged children with VLBW compared to term-born peers.
- To examine predictors of internalizing symptoms from multiple perspectives: mother, father, teacher, and child.
- To analyze the influence of parental psychological distress and socioeconomic status on children's internalizing symptoms.
Main Methods:
- Longitudinal HaFEn cohort study in Hamburg, Germany.
- Inclusion of 104 VLBW and 79 term preschoolers.
- Multilevel modeling to assess predictors of internalizing symptoms from four informant perspectives.
Main Results:
- Parents perceived significantly higher internalizing symptoms in VLBW children compared to term peers.
- Teacher and child self-reports did not show significant group differences in internalizing symptoms.
- Maternal postpartum distress and paternal postpartum/current distress predicted offspring internalizing symptoms (mother/father perspectives); socioeconomic status predicted symptoms (teacher perspective).
Conclusions:
- Parental psychological distress is a significant factor influencing children's internalizing symptoms, as perceived by parents.
- Early identification and support for parental postpartum distress are vital for mitigating potential long-term emotional and developmental impacts on children.
- Multi-informant assessments are crucial for a nuanced understanding of internalizing symptoms in VLBW children.
Background:
Preterm births rates of infants with very low birth weight (VLBW < 1500 g) are increasing. Prematurity poses several risks for emotional child development, e.g., internalizing symptoms. Our understanding of this condition in young children is limited, for at preschool age, symptoms have mostly been assessed from the mother's perspective only.
Methods:
As part of the longitudinal HaFEn cohort-study in Hamburg, Germany, we measured the level of internalizing symptoms in VLBW and term preschoolers as well as predictors from four informants' perspectives: mother, father, teacher, and child. A multilevel model was constructed to examine predictors of internalizing symptoms. n = 104 VLBW and n = 79 term children were included.
Results:
From both their parents' perspective, children with VLBW had a significantly higher level of internalizing symptoms. From the teacher's and child's own perspectives, there were no significant mean group differences. In the multilevel analyses, the results were different regarding the four perspectives. VLBW did not predict internalizing symptoms. From mother's perspective, her own postpartum psychological distress, and from father's perspective, his postpartum and current psychological distress predicted a higher level of internalizing symptoms in their offspring. From teacher's perspective, socio-economic status predicted internalizing symptoms.
Limitations:
The sample size was relatively small. Exclusion criteria and drop out of families could have created some selection bias.
Conclusions:
Our findings point to the importance of early identification of parental postpartum psychological distress given the potential for later internalizing symptoms in their children or the perception of their offspring as vulnerable and symptomatic, which may also impact the child's development.
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