Children and youth born prematurely are prescribed drugs to treat mental illness more often

Prescription of psychotropic drugs (used to treat ADHD, depression, sleep disorders, anxiety and psychotic illness) are higher among children, adolescents and young adults born preterm than their peers born full term.

This difference applies throughout adolescence and into early adulthood, in particular for the most preterm individuals. However, moderate to late preterm individuals also receive this kind of prescriptions to a larger extent than full term peers. Accordingly, preterm individuals are in need of preventive and health-promoting measures, especially during adolescence, which is a period predictive for later mental health and life changes.

Twofold increased risk of prescriptions

In our study recently published in JAMA Network Open, data from the Medical Birth Registry of Norway, the Norwegian Prescription Database and Statistics Norway were used to study psychotropic drug use among 500,000 Norwegian children/ adolescents/ young adults born from 1989 to 1998.

We found that those who were born preterm were prescribed more of all types of psychotropic drugs. The most premature had a twofold increased risk of getting one (or more) prescription(s) of such a drug from 10 to 23 years, compared with peers born to term.

Difference in medication to boys and girls

Following the trends of psychotropic drug prescription from 10 to 23 years, we found that prescription increased with age for most drugs, both for the group born to term, and for the groups born preterm. Antidepressants were particularly increasing among girls into young adult years.

As many as five percent of girls born to term and twelve percent of the most preterm girls got an antidepressant prescription at age 23. Boys were more likely to be prescribed drugs for ADHD; about ten percent of the most preterm boys received such a prescription the year the turned ten, compared to about three percent of boys born to term.

Compared to siblings

To investigate the cause of differences in psychotropic drug prescription among the groups, we compared the participants to their siblings. Our findings indicate that physiological changes in brain development can explain the increased prescription to the most preterm group, while factors like environmental conditions and genetics are likely to explain increased prescription for the later preterm groups.

Guidelines from the Norwegian Directorate of Health state that all preterm children are to be followed until five years age; the most preterm (i.e. with birth weight under 1000/1500 grams or born before 28 weeks of gestation) in the specialist health service, and later preterm children in the first line. After five years of age, follow-up takes place if necessary.

Need for more systematic follow-up

Our findings show that children, adolescents, and young adults born preterm have an increased mental health vulnerability. Adolescence is a period where many mental health difficulties emerge, and trajectories established during adolescence are predictive for later mental health and life changes.

There is need for more systematic follow-up, with health-promoting and preventive measures for the preterm population, also after starting school where mental health is particularly important. Therefore, the knowledge from this study can be important for the health services to plan and carry out follow-up of preterm children and adolescents.