Extremely preterm births linked to increased risk of psychiatric disorders

Premature births and a family history lead to an increased risk of developing a psychiatric disorder by the age of 15, many also suffering from 2 or 3 disorders, mainly anxiety, attention deficit hyperactivity disorder (ADHD) and major depression.

A team, led by Jean A. Frazier, MD, Eunice Kennedy Shriver Center at the University of Massachusetts School of Medicine, assessed the prevalence, co-occurrence, sex differences, and functional correlates from the Diagnostic and Statistical Manual of Disorders Mental Health, Fifth Edition (DSM-5) Psychiatric Disorders in Extremely Premature Adolescents 15 Years of Age.

The trial

In the Extremely Low Gestational Age Newborns (ELGAN) trial, researchers looked at children born less than 28 weeks gestation to the age of 15. The team identified 670 children who responded to the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), the Youth Self Report, a scale for the inability to participate in social roles and cognitive tests.

Investigators also asked parents to complete a family psychiatric history questionnaire.

Overall, anxiety, ADHD, and major depression emerged as the most prevalent psychiatric disorders. The results also show that women met the criteria for anxiety than men.

The link with psychiatric disorders

However, 66% of participants did not meet criteria for a psychiatric disorder, while 15% met criteria for 1, 9% met criteria for 2 and 8% met criteria for at least 3 psychiatric disorders.

Participants with 2 or more psychiatric disorders were more likely to have repeated a grade in school, as well as to have an Individualized Education Program (IEP) and to have a lower nonverbal IQ than participants without psychiatric disorders.

In addition, people with a psychiatric disorder were more likely to use psychotropic drugs, to have greater cognitive and functional impairment, and to have single mothers, affiliated with public health insurance and not. not having completed high school.

Using questionnaires intended for parents, investigators learned that a positive family history of psychiatric disorders was more common in adolescents with 3 or more psychiatric disorders.

“Among adolescents born extremely premature, anxiety, major depression, and ADHD were the most common psychiatric disorders at age 15,” the authors wrote. “Adolescents with> 1 psychiatric disorder were at increased risk for multiple functional and participatory challenges. “

Prediction of psychiatric disorders

For some psychiatric disorders, changes in genetic copy number (CNV) can help predict risk, while for others it is a more narrow prediction.

Recently, a team led by Xabier Calle Sanchez, MS, Institute of Biological Psychiatry, Mental Health Services, University Hospital Copenhagen, produced an unbiased, population-based estimate of prevalence, disease risks and trajectories, genetic copy fertility and mortality. number of variants involved in neuropsychiatric disorders.

Overall, copy number variants were largely associated with an increased risk of ASD and ADHD. However, the risk estimates for schizophrenia for most genetic copy number variants were lower than previously reported.

For 1q21.1 deletion, there was a significant risk found for MDD (HR, 5.8; 95% CI, 1.5 to 22.2) and a gender-specific risk of bipolar disorder (HR, 17 ; 95% CI 1.5 to 189.3 for men alone).

While 1q21.1 and 15q13.3 were associated with increased risks for most diagnoses, the 17p12 deletion consistently resulted in a lower risk of psychiatric disorders (HR, 0.4-0.8). However, none of the estimates differed significantly from the general population.

After performing a trajectory analysis, the researchers found that while the diagnostic risk profiles differed from loci to loci, they were similar for deletions and duplications within each locus and in stratified analyzes. by sex suggest that the pathogenicity of many genetic copy number variants may be modulated by gender.

The study, “Psychiatric Outcomes, Function, and Participation in Extremely Low Gestational Newborns at Age 15,” has been published online in the Journal of the American Academy of Child and Adolescent Psychiatry.