Improving mental health outcomes in children born preterm

Multiple modifiable factors, if improved, have potential to improve mental health outcomes in preterm-born children, according to new research published in The Journal of Child Psychology and Psychiatry from researchers at the University of Warwick. Children born preterm, at less than 37 weeks’ gestation, have an increased risk of mental health problems, which have historically not improved in past decades, wrote authors Sabrina Twilhaar, the study’s lead author and assistant professor, Department of Psychology, Warwick; and Dieter Wolke, the study’s co-author and professor of Psychology at the University of Warwick.¹

The researchers analyzed data from over 1500 children born prematurely from the German Bavarian Longitudinal Study (BLS) and the United Kingdom’s Millennium Cohort Study (MCS). The researchers aimed to take a broad-viewed approach to social factors that could potentially help children born preterm succeed after leaving the hospital. Through analysis, family and social actors were linked to improved mental health outcomes in this population. The study aimed to:

• Determine the degree of mental health resilience in preterm-born children
• Identify modifiable factors at the individual, parent–child, family, peer group, and neighborhood levels associated with resilience
• Explore the differential effects of factors based on sex and contextual adversity

“Roughly half of preterm-born children go on to have positive mental health outcomes, while others face difficulties,” said Twilhaar in a press release from the University of Warwick. “Finding these factors that predict positive outcomes [emphasizes] that mental health resilience isn’t just down to luck … it’s partly shaped by the environments that children grow up in, and we now have a clearer idea of where to put our focus to help more children thrive.”²

The current study featured data from 574 preterm-born children from the BLS born in Germany and 985 children from the MCS born in the United Kingdom, assessed prospectively at 7 or 8 years og age. Resilience was defined as better-than-expected mental health outcomes, using a residuals approach. There were 5 potential promotive factors used:

• Individual: self-regulation, perceived competence, cognition
• Parent-child relationships
• Family: home improvement, inter-parental relationship, social support, sibling relationships
• Peers: Bullying, friendships
• Neighborhood characteristics

“Associations between promotive factors and resilience were tested using regression-based methods, with sex and contextual adversity (adverse life events, psychosocial stress, socioeconomic deprivation) as moderators and mediators,” wrote the researchers.

Across both study cohorts, the following factors were associated with resilience:

• Individual: Regulatory abilities, cognition
• Parent-child: The mother-child relationship
• Family: Authoritative and structured climate, inter-parental relationship
• Peers: Bullying

In the MCS at the individual level, independence and self-regulation, emotional dysregulation, and naming vocabulary abilities were associated with resilience, as were conflict between mother and child, maternal attachment, and emotonal and verbal responsivity, with responsivity only observed in boys.

Overall and across cohorts, factors explained 30 to 41% of the variance in resilience, with effects similar across sex and contextual adversity. Promotive factors were less prevalent in boys.

“What’s striking is that these are all things we can alter with interventions,” said Wolke. “Supporting parenting, improving interparental relationships, and tackling bullying could make a real difference for the mental health of preterm-born children.”²

With a shift of focus, stated the researchers, to resilience, roadmaps exist for targeted prevention and intervention “with a dual focus on enhancing protective/promotive factors while mitigating risks,” they concluded. “The emphasis on resilience rather than deficits has the added benefit of reducing the risk of stigmatisation among at-risk groups. Moving forward, a comprehensive approach recognising the interplay of multisystem factors is essential for improving mental health outcomes in preterm-born children.”¹

References:

1. Twilhaar, E.S. and Wolke, D. Fostering positive mental health outcomes in vulnerable children: Pathways to resilience after preterm birth. J Child Psychol Psychiatr. doi:10.1111/jcpp.70002
2. Protecting childhood mental health after preterm birth: key factors identified. University of Warwick. Press release. July 16, 2025. Accessed July 16, 2025. https://www.eurekalert.org/news-releases/1091277