Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review

Burden of mental, behavioral, and neurodevelopmental disorders in the Finnish most preterm children: a national register study

Etiologies and the whole picture in childhood mental, behavioral, and neurodevelopmental disorders related to gestational age are unclear. This study included all Finnish children (N = 341,632) born between January 1, 2001, and December 31, 2006, whose data including their mothers (N = 241,284) were collected from national registers. Children with unclear gestational age (GA) (N = 1245), severe congenital malformations (N = 11,746), and moderate/severe/undefined cognitive impairment (N = 1140), and those who died during the perinatal period (N = 599) were excluded. The main outcome was the prevalence of mental and behavioral disorders (International Classification of Disorders) at 0 - 12 years of age in association with GA, adjusted for gender and prenatal variables. Out of all included (N = 326,902) children 16.6% (N = 54,270) were diagnosed to have any mental health disorder at 0 - 12 years. Adjusted Odd Ratio (OR) were for any disorder in preterm (< 37 weeks) 1.37 [1.28 - 1.46] and 4.03 [3.08 - 5.26] in extreme preterm (≤ 28 weeks) versus term born children, p < 0.05. The lower the GA at birth, the higher the risk for multiple disorders and earlier onset of disorder, p < 0.05. Adjusted ORs were for male/female 1.94 [1.90 - 1.99], maternal mental health disorder (yes/not) 1.99 [1.92 - 2.07], and smoking during pregnancy (yes/not) 1.58 [1.54 - 1.62], and these risks were more common in preterm versus term born children (p < 0.05). Extreme early birth was a strong risk factor per se for any or multiple and early shown mental health disorders. Other risk factors for mental health accumulated to preterm children.

The Relationship Between Early Term Birth and the Risk of Later Childhood Mental Disorders Within a Pregnancy Cohort

This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.

Longitudinal studies of child mental disorders in the general population: A systematic review of study characteristics

Introduction

Longitudinal studies of child mental disorders in the general population (herein study) investigate trends in prevalence, incidence, risk/protective factors, and sequelae for disorders. They are time and resource intensive but offer life-course perspectives and examination of causal mechanisms. Comprehensive syntheses of the methods of existing studies will provide an understanding of studies conducted to date, inventory studies, and inform the planning of new longitudinal studies.

Methods

A systematic review of the research literature in MEDLINE, EMBASE, and PsycINFO was conducted in December 2022 for longitudinal studies of child mental disorders in the general population. Records were grouped by study and assessed for eligibility. Data were extracted from one of four sources: a record reporting study methodology, a record documenting child mental disorder prevalence, study websites, or user guides. Narrative and tabular syntheses of the scope and design features of studies were generated.

Results

There were 18,133 unique records for 487 studies-159 of these were eligible for inclusion. Studies occurred from 1934 to 2019 worldwide, with data collection across 1 to 68 time points, with 70% of studies ongoing. Baseline sample sizes ranged from n = 151 to 64,136. Studies were most frequently conducted in the United States and at the city/town level. Internalizing disorders and disruptive, impulse control, and conduct disorders were the most frequently assessed mental disorders. Of studies reporting methods of disorder assessment, almost all used measurement scales. Individual, familial and environmental risk and protective factors and sequelae were examined.

Conclusions

These results summarize characteristics of existing longitudinal studies of child mental disorders in the general population, provide an understanding of studies conducted to date, encourage comprehensive and consistent reporting of study methodology to facilitate meta-analytic syntheses of longitudinal evidence, and offer recommendations and suggestions for the design of future studies. Registration DOI: 10.17605/OSF.IO/73HSW.

Conditions of Birth and Early Childhood Developmental Risk for Mental Disorders

Distinct classes of children in the general population are at increased odds of later mental illness and other adverse outcomes according to patterns of early childhood developmental vulnerability. If certain risk factors known at the time of birth are reliably associated with membership in early childhood risk classes, then preventative interventions could be initiated in the earliest years of life. Associations between 14 factors known at the time of birth and membership in early childhood risk classes were examined in 66,464 children. Risk class membership was associated with maternal mental illness, parental criminal charges and being male; distinct patterns of association were shown for some conditions, for example, prenatal child protection notification was uniquely associated with misconduct risk'. These findings suggest that risk factors known at the time of birth could assist in very early detection of children who may benefit from early intervention in the first 2000 days.

Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study

BACKGROUND

Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications.

METHODS

A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight.

RESULTS

The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45 days after childbirth.

CONCLUSIONS

Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.

Burden and risk factors of anxiety disorders among Arabic pediatric population: A systematic review

<b>Aim:</b> In the general population, where 6 to 20% of individuals experience anxiety disorders, children also experience a higher burden of anxiety. We undertook a systematic review In order to examine and summarize the results from studies that estimated the prevalence of anxiety and/or its associated risk factors in the pediatric populations of Arab nations, primarily the gulf countries.<br /> <b>Methods:</b> Any study that focused on the pediatric population and completed in Arab nations to determine the incidence of anxiety and/or its risk factors among children under the age of 18. The review had 13 articles were included.<br /> <b>Results:</b> The results of the systematic review found that there was a wide variation in the prevalence of anxiety among children. At least 30.2% of the children were found to suffer from anxiety and the prevalence could go up to 60% in some countries with a higher prevalence among girls than boys. Associated factors of anxiety were diverse including exposure to environmental tobacco smoke, parenting style, living with parents suffering from mental disorders, school type, and being female.<br /> <b>Conclusion:</b> The findings of the review demonstrate the higher prevalence of anxiety among children as almost at least one-third of children suffer from anxiety in the Gulf countries. The program managers and the respective government of these Arab countries need to devise some strategies and interventions that not only focus on the children but also their environment.

COVID-19-Related Anxiety Symptoms among Quarantined Adolescents and Its Impact on Sleep Pattern Changes and Somatic Symptoms

Background: Home-quarantine due to COVID-19 may have negative psychological effects on vulnerable sub-groups such as children and adolescents. We aimed to explore the prevalence of anxiety among adolescents who were in home-quarantine and its impact on onset of sleep disturbance and somatic symptoms, and on the level of agreement between adolescent and parent perceptions. Methods: Five hundred adolescents (ages 10–17) and 500 parents participated in the study. Adolescents filled out PROMIS Anxiety, PROMIS Sleep Disturbance, and PHQ-15 Physical-Symptom forms, while their parents completed proxy questionnaires containing the same domains. Results: 38% of the adolescents reported experiencing anxiety during home-quarantine period, 29% suffered from sleep disturbance, and 48% reported somatic symptoms. Addition of one day in home-quarantine was significantly associated with sleep disturbance (OR = 3.78, 95%CI: 1.09–8.45) and somatic symptoms (OR = 1.80, 95%CI: 1.01–3.08); female gender was associated with increased risk for somatic symptoms (OR = 2.15, 95%CI: 1.07–4.55); poor agreement in levels of anxiety, sleep disturbance and somatic symptoms was found between adolescent and parent reports (ICCs of 0.197–0.262). Discussion: Total isolation from household members during home-quarantine may cause anxiety, sleep disturbance, and somatization among adolescents. Achieving the appropriate balance between infection control and mitigation of the potential adverse psychological effect of home-quarantine among children and adolescents should be immediate priorities for policymakers.

Preterm birth and the risk of chronic disease multimorbidity in adolescence and early adulthood: A population-based cohort study

BACKGROUND

People who were born prematurely have high risks of many individual diseases and conditions in the early part of the life course. However, our knowledge of the burden of multiple diseases (multimorbidity) among prematurely born individuals is limited. We aimed to investigate the risk and patterns of chronic disease multimorbidity in adolescence and early adulthood among individuals born across the spectrum of gestational ages, comparing preterm and full-term born individuals.

METHODS AND FINDINGS

We used individual-level data from linked nationwide registers to examine the associations of gestational age at birth with specialised healthcare records of ≥2 chronic diseases (multimorbidity) in adolescence (age 10-17 years) and early adulthood (age 18-30 years). Our study population comprised 951,116 individuals (50.2% females) born alive in Finland between 1st January 1987 and 31st December 2006, inclusive. All individuals were followed from age 10 years to the onset of multimorbidity, emigration, death, or 31 December 2016 (up to age 30 years). We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for multimorbidity using flexible parametric survival models. During 6,417,903 person-years at risk (median follow-up: 7.9 years), 11,919 individuals (1.3%) had multimorbidity in adolescence (18.6 per 10,000 person-years). During 3,967,419 person-years at risk (median follow-up: 6.2 years), 15,664 individuals (1.7%) had multimorbidity in early adulthood (39.5 per 10,000 person-years). Adjusted HRs for adolescent multimorbidity, comparing preterm to full-term born individuals, were 1.29 (95% CI: 1.22 to 1.36) and 1.26 (95% CI: 1.18 to 1.35) in females and males, respectively. The associations of preterm birth with early adult multimorbidity were less marked, with the adjusted HRs indicating 1.18-fold risk in females (95% CI: 1.12 to 1.24) and 1.10-fold risk in males (95% CI: 1.04 to 1.17). We observed a consistent dose-response relationship between earlier gestational age at birth and increasing risks of both multimorbidity outcomes. Compared to full-term born males, those born at 37-38 weeks (early term) had a 1.06-fold risk of multimorbidity in adolescence (95% CI: 0.98 to 1.14) and this risk increased in a graded manner up to 6.85-fold (95% CI: 5.39 to 8.71) in those born at 23-27 weeks (extremely premature), independently of covariates. Among females, the same risks ranged from 1.16-fold (95% CI: 1.09 to 1.23) among those born at 37-38 weeks to 5.65-fold (95% CI: 4.45 to 7.18) among those born at 23-27 weeks. The corresponding risks of early adult multimorbidity were similar in direction but less marked in magnitude, with little difference in risks between males and females born at 36-37 weeks but up to 3-fold risks observed among those born at 23-27 weeks.

CONCLUSIONS

Our findings indicate that an earlier gestational age at birth is associated with increased risks of chronic disease multimorbidity in the early part of the life course. There are currently no clinical guidelines for follow-up of prematurely born individuals beyond childhood, but these observations suggest that information on gestational age would be a useful characteristic to include in a medical history when assessing the risk of multiple chronic diseases in adolescent and young adult patients.

Individual, Prenatal, Perinatal, and Family Factors for Anxiety Symptoms Among Preschool Children

Anxiety is one of the most common psychological disorders among children. Few studies have investigated the prevalence and comprehensive factors for anxiety among preschool children in China. This study aimed to assess the prevalence of anxiety and explore influential factors at multiple levels including individual, prenatal and perinatal, and family factors, associated with anxiety symptoms among preschool children. The multisite cross-sectional study was conducted in Anhui Province and included 3,636 preschool children aged 3-6 years. Anxiety symptoms of children were assessed using the Chinese version of the Spence Preschool Anxiety Scale. Logistic regression analyses were performed to explore associations between factors at multiple levels and significant anxiety symptoms, and the model was validated internally using 10-fold cross-validation. Among the participants, 9.1% of children had significant anxiety symptoms. Girls reported more significant anxiety symptoms. Children's poor dietary habits, sleep disturbances, autistic tendencies, and left-behind experience; maternal poor prenatal emotional symptoms; and more caregivers' anxiety symptoms were significantly associated with anxiety symptoms among children. The result of 10-fold cross-validation indicated that the mean area under the curve, sensitivity, specificity, and accuracy were 0.78, 70.45%, 78.18%, and 71.15%, respectively. These factors were slightly different among different subtypes of anxiety symptoms. The results of this study suggested that anxiety symptoms in preschool children were prevalent, particularly in girls. Understanding early-life risk factors for anxiety is crucial, and efficient prevention and intervention strategies should be implemented in early childhood even pregnancy.