European Child & Adolescent Psychiatry

, Volume 21, Issue 10, pp 583–589 | Cite as

Mental health at 5 years among children born extremely preterm: a national population-based study

  • Silje Katrine Elgen
  • Katrine Tyborg Leversen
  • Jacob Holter Grundt
  • Jørgen Hurum
  • Anne Berit Sundby
  • Irene Bircow Elgen
  • Trond Markestad
Original Contribution


The objective of this study was to compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between functional abilities and mental health within the preterm group. In a national Norwegian cohort with gestational age 22–27 weeks or birthweight 500–999 g, mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Of 361 eligible preterm children, parents completed SDQ for 255 (71 %). 97 (38 %) had TDS90 compared to 116 (11 %) of the reference group (OR 5.1; 95 % CI 3.7–7.1). For the preterms, the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR 8.0; 95 % CI 3.2–19, and mild NDD 43/102 [adjusted OR 2.2 (1.2–4.1)]. For preterms with no NDD, TDS90 was more common than for the reference group (27/116 vs. 116/1,089, OR 2.5; 95 % CI 1.6–4.1). Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other functional impairments.


Extremely premature infant Extremely low birthweight SDQ Mental health Follow-up 


  1. 1.
    Marlow N et al (2005) Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352(1):9–19PubMedCrossRefGoogle Scholar
  2. 2.
    Larroque B et al (2008) Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 371(9615):813–820PubMedCrossRefGoogle Scholar
  3. 3.
    Gardner F et al (2004) Behavioral and emotional adjustment of teenagers in mainstream school who were born before 29 weeks’ gestation. Pediatrics 114(3):676–682PubMedCrossRefGoogle Scholar
  4. 4.
    Delobel-Ayoub M et al (2009) Behavioral problems and cognitive performance at 5 years of age after very preterm birth: the EPIPAGE Study. Pediatrics 123(6):1485–1492PubMedCrossRefGoogle Scholar
  5. 5.
    Elgen I, Sommerfelt K, Markestad T (2002) Population based, controlled study of behavioural problems and psychiatric disorders in low birthweight children at 11 years of age. Arch Dis Child Fetal Neonatal Ed 87(2):F128–F132PubMedCrossRefGoogle Scholar
  6. 6.
    Indredavik MS et al (2004) Psychiatric symptoms and disorders in adolescents with low birth weight. Arch Dis Child Fetal Neonatal Ed 89(5):F445–F450PubMedCrossRefGoogle Scholar
  7. 7.
    Delobel-Ayoub M et al (2006) Behavioral outcome at 3 years of age in very preterm infants: the EPIPAGE study. Pediatrics 117(6):1996–2005PubMedCrossRefGoogle Scholar
  8. 8.
    Samara M, Marlow N, Wolke D (2008) Pervasive behavior problems at 6 years of age in a total-population sample of children born at </= 25 weeks of gestation. Pediatrics 122(3):562–573PubMedCrossRefGoogle Scholar
  9. 9.
    Hysing M et al (2009) Emotional and behavioural problems in subgroups of children with chronic illness: results from a large-scale population study. Child Care Health Dev 35(4):527–533PubMedCrossRefGoogle Scholar
  10. 10.
    Goodman R (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40(5):791–799PubMedCrossRefGoogle Scholar
  11. 11.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345PubMedCrossRefGoogle Scholar
  12. 12.
    Goodman R et al (2000) Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 177:534–539PubMedCrossRefGoogle Scholar
  13. 13.
    Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 9(2):129–134PubMedCrossRefGoogle Scholar
  14. 14.
    Hysing M et al (2007) Chronic physical illness and mental health in children. Results from a large-scale population study. J Child Psychol Psychiatry 48(8):785–792PubMedCrossRefGoogle Scholar
  15. 15.
    Markestad T et al (2005) Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 115(5):1289–1298PubMedCrossRefGoogle Scholar
  16. 16.
    Westby Wold SH et al (2009) Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study. Arch Dis Child Fetal Neonatal Ed 94(5):F363–F367PubMedCrossRefGoogle Scholar
  17. 17.
    Leversen KT et al (2011) Prediction of neurodevelopmental and sensory outcome at 5 years in Norwegian children born extremely preterm. Pediatrics 127(3):e630–e638PubMedCrossRefGoogle Scholar
  18. 18.
    Wechsler D (1999) Wechsler preschool and primary scale of intelligence-revised (Swedish edition). Psykologförlaget AB, StockholmGoogle Scholar
  19. 19.
    Henderson S, Sugden D (1996) The Movement Assessment Battery for Children [Swedish edition]. Psykologförlaget AB, StockholmGoogle Scholar
  20. 20.
    Palisano R et al (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39(4):214–223PubMedCrossRefGoogle Scholar
  21. 21.
    Strengths & Difficulties Questionnaires homepage. Accessed 10 Jan 2012 12/09/09
  22. 22.
    Brøndbo PH et al (2011) The Strengths and Difficulties Questionnaire as a screening instrument for Norwegian child and adolescent mental health services, application of UK scoring algorithms. Child Adolesc Psychiatry Mental Health 5:32CrossRefGoogle Scholar
  23. 23.
    Goodman A, Goodman R (2011) Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. J Child Psychol Psychiatry 52(1):100–108PubMedCrossRefGoogle Scholar
  24. 24.
    Kesler SR, Reiss AL, Vohr B et al (2008) Brain volume reductions within multiple cognitive systems in male preterm children at age twelve. Pediatrics 152(4):513–520CrossRefGoogle Scholar
  25. 25.
    Reiss AL, Kesler SR, Vohr B et al (2004) Sex differences in cerebral volumes of 8-year-olds born preterm. Pediatrics 145(2):242–249CrossRefGoogle Scholar
  26. 26.
    Gray RF, Indurkhya A, McCormick MC (2004) Prevalence, stability, and predictors of clinically significant behavior problems in low birth weight children at 3, 5, and 8 years of age. Pediatrics 114(3):736–743PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Silje Katrine Elgen
    • 1
  • Katrine Tyborg Leversen
    • 1
    • 3
  • Jacob Holter Grundt
    • 2
  • Jørgen Hurum
    • 2
  • Anne Berit Sundby
    • 2
  • Irene Bircow Elgen
    • 1
    • 4
  • Trond Markestad
    • 1
    • 2
    • 3
  1. 1.Department of Clinical MedicineUniversity of BergenBergenNorway
  2. 2.Department of PediatricsHospital Innlandet TrustLillehammerNorway
  3. 3.Department of PediatricsHaukeland University HospitalBergenNorway
  4. 4.Department of Child and Adolescent PsychiatryHaukeland University HospitalBergenNorway

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