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Relative Age and Psychotropic Drug Use in Preterm and Term-Born Children and Young Adults
Christine Strand Bachmann1,2, Kari Risnes2,3, Johan Håkon Bjørngaard1,4
1Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Preterm infants are more vulnerable to mental health issues related to being younger in their school class. This relative age effect on psychostimulant prescription persists into young adulthood for preterm individuals.
Area of Science:
- Developmental Psychology
- Pediatric Mental Health
- Public Health
Background:
- Relative age within school cohorts is associated with educational and mental health disadvantages.
- Preterm birth may increase vulnerability to these relative age effects.
Purpose of the Study:
- To investigate the impact of relative age on mental health outcomes in preterm infants.
- To determine if preterm infants are more susceptible to relative age effects on mental health compared to term-born infants.
Main Methods:
- Utilized Norwegian registry data for individuals born between 1989 and 1998.
- Compared prescription rates for psychostimulants and other psychiatric medications from age 10 to 23.
- Analyzed data based on birth month (relative age) and gestational age (preterm vs. term).
Main Results:
- Preterm infants born in November/December had higher odds of psychostimulant prescription compared to those born in January/February.
- This relative age effect on psychostimulant prescription persisted into young adulthood (ages 20-23) for preterm individuals.
- Term-born individuals also showed a relative age effect, but it diminished by young adulthood.
Conclusions:
- Relative immaturity poses long-term mental health risks for preterm individuals.
- Preterm individuals require careful monitoring and support from healthcare and educational systems.
- Early identification and intervention are crucial for mitigating long-term mental health challenges in preterm populations.
Background And Objectives:
Being among the youngest within a school class is linked to disadvantages in various educational and mental health domains. This study aimed to investigate whether preterm born infants are particularly vulnerable to relative age effects on mental health, not previously studied.
Methods:
We used registry data on all Norwegians born between 1989 and 1998 to compare prescription status for psychostimulants, antidepressants, hypnotics, anxiolytics, and antipsychotics per year from age 10 to 23 years (2004-2016) between exposure groups with different time of birth in the year (relative age) and different gestational age (preterm versus term).
Results:
Of 488 470 individuals, 29 657 (6,1%) were born preterm. For term born in November/December, the adjusted odds ratio (aORs) for psychostimulant prescription compared with peers born in January/February was 1.80 (95% confidence interval [CI], 1.69-1.91) at ages 10 to 14 years, and 1.17 (95% CI, 1.08-1.27) at ages 20 to 23 years. Within preterm born, the corresponding results were 1.39 (95% CI, 1.13-1.69) and 1.34 (95% CI, 1,00-1.78) at ages 10 through 14 and 20 through 23 years, respectively.
Conclusions:
Being relatively young within the school group was associated with increased psychostimulant prescription in the preterm as well as the term population. In contrast to term peers, the relative age effect for psychostimulant prescription seemed to persist to young adulthood for the preterm population. The results suggest that preterm individuals are vulnerable to long-term effects of relative immaturity and that they require careful consideration from both health care professionals and the school system.
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