Growing Up After a Very Early Birth: What Twenty Years of Follow-Up Says About Anxiety and Low Mood

An Australian study that interviewed the same young people at ages 7, 13 and 20 finds their emotional health tracked closely with that of friends born at full term

Parents whose baby arrives many weeks early often carry a question that reaches far beyond the neonatal unit: will my child grow up to be happy? A long-running Australian study has now followed the same group of young people from early childhood into their twenties, asking carefully and repeatedly about anxiety and low mood. Its central message is a reassuring one — the emotional path of those born very early looked much like the path of their friends born at full term — and it points to family circumstances in the first years of life, rather than to anything that happened in intensive care, as the clearest early signal.

Why this question has been so hard to answer

The study behind this article, a twenty-year follow-up run from Melbourne, Australia, was designed to fill one specific gap in what was known [1]. To see why that gap mattered, it helps to know what came before it.

Babies born very early — before 30 weeks of pregnancy, or weighing less than about 1,250 grams — now survive in large numbers, and attention has rightly shifted from whether they live to how their lives go. For a long time, research suggested that people born very early carried a somewhat higher risk of anxiety and depression. A large 2011 review that pooled many studies found higher rates of psychiatric diagnoses in children, teenagers and young adults born preterm compared with those born at term [2], and a later analysis that combined the raw data from adult studies around the world estimated that adults born very early were roughly twice as likely to meet criteria for an anxiety disorder [3].

That sounds definitive, but there was a hidden problem. Almost all of these conclusions came from snapshots — one group of children studied at age 8, a different group of adults studied at 25, another group somewhere in between. Nobody had followed the same people, with the same kind of careful diagnostic interview, from childhood all the way to adulthood. Without that, it was impossible to know when difficulties appeared, whether they lasted, or whether they faded. Researchers in Melbourne had already described the mental health of their group at age 7 [4] and again at 13 [5], but the adult picture was missing. Elsewhere, a well-known German study had found that rates of anxiety and low mood in people born very early jumped sharply between childhood and age 26 — but it jumped in the comparison group too [6]. The trajectory, in other words, was a puzzle with the last piece missing.

What the researchers did

The study is called the Victorian Infant Brain Study, or VIBeS [1]. Between 2001 and 2003, researchers at the Royal Women's Hospital in Melbourne, Australia, enrolled 224 babies born very early. They also recruited a comparison group of 77 children born at full term, so that the two groups could be followed side by side through the same years and the same events. Families returned for assessments at the Royal Children's Hospital in Melbourne at ages 2, 5, 7, 13 and 20 years. The people doing the assessments did not know which children had been born early, which helps keep the results honest.

Mental health was measured with structured interviews — carefully scripted conversations that follow standard diagnostic criteria, rather than tick-box questionnaires. At ages 7 and 13, parents were interviewed about their child. At age 20, the young adults answered for themselves. The researchers grouped the results into anxiety disorders (conditions such as generalised anxiety, phobias and panic), mood disorders (conditions such as depression), and a combined category they called emotional disorder, meaning either one.

They also measured something they called family social risk when the children were 2 years old. This was a simple score built from six pieces of everyday information: who was in the family, how old the mother was, how much education the main caregiver had, whether the main earner was employed and in what kind of work, and what language was spoken at home [7]. Families were then divided into lower and higher social risk. This is not a judgement about parenting; it is a rough measure of how much financial and practical pressure a family is living under.

In total, 260 young people — 191 born very early and 69 born at term — completed at least one interview. The very early group had been born at an average of 27.2 weeks of pregnancy and weighed on average 966 grams at birth. Six in ten came from higher-social-risk families, compared with three in ten of the term-born group.

What they found

The first finding is that anxiety and low mood became much more common as everyone grew up — in both groups.

At age 7, anxiety disorders were found in about 9 in 100 children born very early and about 8 in 100 children born at term [1]. At age 13, the two groups drifted apart: about 15 in 100 of the very early group compared with about 8 in 100 of the term group. This was the widest gap the study found anywhere. By age 20, the gap had closed and the numbers had risen sharply in both groups — about 21 in 100 among those born very early and about 26 in 100 among those born at term.

Depression and other mood disorders were rare in childhood and became much more common later. At age 7, fewer than 1 in 100 of the very early group had one. By 20, that had risen to about 11 in 100, compared with about 8 in 100 in the term group. Putting anxiety and mood together, roughly a quarter of the young adults born very early, and slightly under a third of those born at term, met criteria for one of these conditions at age 20.

It is worth pausing on what that means. These are not small numbers, but they are not specific to preterm birth either. Mental health problems affect roughly 10 to 20 in every 100 children and adolescents worldwide [8], and pooled international research puts the figure in a similar range [9]. Anxiety and depression are common in young adulthood generally. What this study suggests is that a very early birth did not add much on top of that.

The second finding is about who, among those born very early, was more likely to struggle. Of the 191 young people born very early, 58 — about 3 in 10 — received a diagnosis of anxiety or a mood disorder at some point across the three assessments. The single factor that stood out was family social risk measured back at age 2: children from higher-social-risk families had roughly two and a half times the odds of a diagnosis later on. Being female, being small for gestational age at birth, and having had a serious brain bleed as a newborn each nudged the odds upward, but not clearly enough to be certain. Strikingly, the medical details that dominate a neonatal unit stay — how early the baby was born, how long they needed oxygen, how long the hospital admission lasted, what the brain scan showed at term — showed essentially no relationship with mental health years later.

What this means for families

If your child was born very early, the most useful takeaway is that their emotional future is not written in the neonatal chart. The medical severity of a preterm course — the weeks on a ventilator, the scan results, the length of stay — did not predict who developed anxiety or depression in this study. What did matter was the pressure a family was under in the early years, and that is something that support, services and community can change. Research in this same group has shown that a warm and stimulating home can buffer children born very early even when medical and social risks are present [10], and studies elsewhere have found that many children born extremely early do well emotionally despite a difficult start [11].

It also means that follow-up should not stop when a child starts school. The rise in anxiety happened around age 13, and depression appeared mainly between 13 and 20 — both long after most neonatal follow-up clinics have said goodbye. If you notice persistent worry, withdrawal, changes in sleep or a loss of interest in things your child used to enjoy, that is worth raising with your family doctor or paediatrician, regardless of how the neonatal course went. These are treatable conditions, and they are common enough that asking about them should feel ordinary rather than alarming.

A few honest limits are worth knowing. The comparison group was small — only 49 term-born young adults were interviewed at 20 — so the comparison between groups is less precise than the numbers alone suggest. Some families stopped taking part over the twenty years, and those who left were more often the ones under greater social pressure, which is exactly the group the study identified as most vulnerable. And the age-20 interviews began during Melbourne's COVID-19 lockdowns, a period when distress rose among young adults everywhere. All of these could shift the picture somewhat.

What researchers are working on next

The broader field is increasingly framing very preterm birth as something whose long-term effects are shaped as much by the world a child grows into as by what happened at birth [12], and reviews of adult outcomes have repeatedly found that results depend heavily on how and when mental health is measured [13]. Long-standing follow-up studies of very low birthweight adults have reached varying conclusions [14], which is one reason a single well-followed cohort like this one is valuable.

The next steps are clear enough. Researchers want larger groups followed the same way, so that small but real differences cannot hide inside wide margins of error. They want to understand what family social risk is actually standing in for — money, time, stress, access to services — so that support can be aimed at the right thing. And they want to test whether offering families extra support early genuinely improves mental health twenty years later, rather than assuming it does. For families reading this today, the practical message is simpler: an early birth does not set an emotional destiny, and the things that seem to matter most are the things that can be supported.

References

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