Psychological Medicine

Original Articles

Psychopathology in young adults born at extremely low birth weight

M. H. Boylea1a2 c1, V. Miskovica3, R. Van Lieshouta1a2, L. Duncana1a2, L. A. Schmidta2a3a4, L. Houlta5, N. Panetha6 and S. Saigala5

a1 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

a2 Offord Centre for Child Studies, McMaster Children's Hospital, Hamilton, Ontario, Canada

a3 McMaster Integrative Neuroscience Discovery, & Study (MiNDS), McMaster University, Hamilton, Ontario, Canada

a4 Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada

a5 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

a6 Departments of Epidemiology and Human Development, Michigan State University, East Lansing, Michigan, USA


Background Little is known about the long-term mental health of extremely low birth weight (ELBW) (<1000 g) survivors. We test whether young adults aged 22 to 26 years born at ELBW differ from normal birth weight (NBW) controls in self-reported levels of psychopathology.

Method Participants included 142 ELBW survivors (86% response) born between 1977 and 1982 to residents of central-west Ontario, Canada and 133 NBW control subjects (92% response). The Young Adult Self-Report measure was used to create five DSM-IV oriented scales aggregated to form internalizing (depressive problems, anxiety problems, avoidant personality problems) and externalizing (attention deficit-hyperactivity disorder problems and antisocial personality problems) scales.

Results After adjusting for family background characteristics, mean scores for ELBW survivors were 3.02 [95% confidence interval (CI) 0.78–5.26] points higher for internalizing problems and no different, i.e. 0.00 (95% CI −1.17 to 1.17), for externalizing problems. There was a sex×group statistical interaction such that being male muted the risk for externalizing problems among those born at ELBW: −2.11 (95% CI −4.21 to −0.01). Stratifying ELBW adults as born small for gestational age (SGA) versus appropriate weight for gestational age (AGA) revealed a significant gradient of risk for levels of internalizing problems that was largest for SGA, i.e. 4.75 (95% CI 1.24–8.26), and next largest for AGA, 2.49 (95% CI 0.11–4.87), compared with NBW controls.

Conclusions Depression, anxiety and avoidant personality problems (internalizing problems) are elevated in young adulthood among ELBW survivors. This effect is relatively small overall but noticeably larger among ELBW survivors born SGA.

(Received May 20 2010)

(Revised October 01 2010)

(Accepted October 01 2010)

(Online publication December 07 2010)


c1 Address for correspondence: M. H. Boyle, Ph.D., Department of Psychiatry and Behavioural Neurosciences, McMaster University and Offord Center for Child Studies, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. (Email:

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