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Anxiety and Depressive Disorders in Children Born Preterm: A Meta-Analysis
Grace C Fitzallen1,2, Yashna K Sagar2, H Gerry Taylor3,4
1School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
Insights
Children born preterm have increased odds for anxiety disorders, including generalized anxiety and specific phobias, compared to term-born peers. However, no significant differences in depressive disorders were found between the groups.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Public Health
Background:
- Preterm birth is linked to a higher incidence of psychiatric conditions in children.
- Existing research shows variability in understanding the specific risks for depression and anxiety disorders in this population.
Purpose of the Study:
- To conduct a meta-analysis investigating the pooled odds of anxiety and depressive disorders in children aged 3–19 years born preterm versus term-born.
- To clarify the diagnostic profiles and independent risks associated with preterm birth for these disorders.
Main Methods:
- A systematic literature search was performed on PubMed/MEDLINE, PsycINFO, and CINAHL databases up to September 2019.
- Eleven studies were included, with pooled odds ratios (OR) calculated using fixed-effects models following PRISMA guidelines.
- Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale.
Main Results:
- Children born preterm showed significantly higher odds for anxiety disorders (OR: 2.17), generalized anxiety (OR: 2.20), and specific phobia (OR: 1.93) compared to term-born controls.
- The analysis included data from 1294 preterm and 1274 term-born children for anxiety outcomes, and 777 preterm and 784 term-born children for depressive outcomes.
- No statistically significant differences in the odds of depressive disorders were observed between preterm and term-born children.
Conclusions:
- Preterm birth is associated with an elevated risk of anxiety disorders, but not depressive disorders, in children and adolescents aged 3–19.
- These findings suggest potentially distinct etiological pathways for anxiety and depression in individuals born preterm.
- The results highlight the need for comprehensive emotional screening and neurodevelopmental surveillance in this high-risk group.
Objective:
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.
Method:
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.
Results:
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.
Conclusion:
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.
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