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Behavioural and emotional problems in moderately preterm children with low socioeconomic status: a population-based study

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Abstract

Moderately preterm (MP) birth is associated with higher rates of behavioural and emotional problems. To determine the extent to which low socioeconomic status (SES) contributes to these higher rates, we assessed independent and joint effects of MP birth and low SES, overall and by gender. Dutch preventive child health care centres provided a population-based sample of 915 MP children (32–36 weeks gestation) and 543 term-born children, born in 2002/2003. In multivariable logistic regression analyses, we determined the risk of behavioural and emotional problems per standard deviation (SD) decrease in gestational age and SES, using standardized measures for both. We also assessed three SES categories, being low (1SD or more below mean of standardized SES), intermediate (mean ± 1SD), and high (greater than mean + 1SD). The Child Behavior Checklist for 1.5–5 years was used to assess behavioural (externalizing), emotional (internalizing), and total problems at age 4 years. MP children with low SES had significantly higher total problem scores than those with high SES (11.3 vs. 5.1 %, respectively). Each SD decrease in SES was associated with a 42 % higher odds of elevated total problem scores (OR 1.42, 95 % CI 1.14–1.77). No joint effects were found, meaning that lower gestational age independently added to the risk of behaviour problems (OR 1.24, 95 % CI 1.00–1.56). Effects of MP birth and low SES were more pronounced in girls. In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems. The combination of risk factors identifies children who could benefit greatly from early intervention.

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Acknowledgments

This study is part of the LOLLIPOP cohort study on the development, growth, and health of children born preterm (controlled-trials.com ISRCTN 80622320) and is supported by the research foundation of Beatrix Children’s Hospital, the Cornelia Foundation for the Handicapped Child, the A. Bulk-Child Health Care Research Fund, the Dutch Brain Foundation, and unrestricted research grants from FrieslandCampina, Friso Infant Nutrition, Abbott, and Pfizer Europe. M.R. Potijk was supported by a Junior Scientific Master Class grant of the University of Groningen. We thank the three child health care doctors, E.M.J. Ten vergert, MD, B.M. Van der Hulst, MD, and M.J. Broer van Dijk, MD, for coordinating the field work, and Dr. T. Brantsma—van Wulfften Palthe for correcting the English manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Prior to inclusion, written informed consent was obtained from the parents of all study participants.

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Authors and Affiliations

  1. Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Marieke R. Potijk, Andrea F. de Winter & Sijmen A. Reijneveld

  2. Division of Neonatology, Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Arend F. Bos & Jorien M. Kerstjens

Authors
  1. Marieke R. Potijk
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  2. Andrea F. de Winter
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  3. Arend F. Bos
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  4. Jorien M. Kerstjens
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  5. Sijmen A. Reijneveld
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Corresponding author

Correspondence to Marieke R. Potijk.

Additional information

The study was approved by the review board of the University Medical Center Groningen.

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Potijk, M.R., de Winter, A.F., Bos, A.F. et al. Behavioural and emotional problems in moderately preterm children with low socioeconomic status: a population-based study. Eur Child Adolesc Psychiatry 24, 787–795 (2015). https://doi.org/10.1007/s00787-014-0623-y

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  • DOI: https://doi.org/10.1007/s00787-014-0623-y

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