A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood.
A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood.
复制标题
早产儿从学前到成年的行为轨迹差异易感性测试。
DOI：
10.1002/nur.22275
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发表时间：
2023
影响因子：
2
通讯作者：
Sullivan,MaryC
中科院分区：
文献类型：
--
作者：
Kelly,MichelleM;Arcoleo,Kimberly;D'Agata,AmyL;Sullivan,MaryC
早产使儿童倾向于内化和外化的行为，这些行为可能会持续到青春期，导致成人的心理健康状况。社会和照料环境，特别是对早产的脆弱婴儿，影响长期结果，但机制尚不清楚。照顾早产儿的医疗团队很难预测谁将受到风险的影响最大，谁将受益最大，以及干预的最佳时机。差异易感性理论通过假设个人可能更容易或更不容易受到环境影响，为传统的只考虑风险的评估和理论提供了另一种选择。对早产儿和足月儿的样本从出生到23岁进行了跟踪调查。对对照组进行内化和外化行为的混合模型重复测量分析(N= 214；观察 = 1070)。环境背景被索引为近端保护(低、中、高)和医疗风险(低、中、高)。对性别、种族、社会经济地位和认知的个人特征协变量进行了建模。内化行为的轨迹随着时间的推移有很大的变化。早期的近端保护环境对行为有持续的积极影响。有部分人支持差异易感性理论，认为早熟作为一种延展性特征，能够吸收环境的积极和消极影响，比那些没有延展性的人更强烈。目前的分析表明，学龄前近端环境对早产儿在年轻成年期的内化和外化行为具有持久的影响。了解这些细微差别可能有助于医疗保健专业人员促进和选择支持儿童和家庭的干预措施的时机。目前的手稿反映了对纵向数据的持续分析。测试差异易感性理论不需要患者或公众对分析的贡献。作者在根据结果实施实践或政策变化时，会征求患者或公众的意见。
Preterm birth predisposes children to internalizing and externalizing behaviors that may persist into adolescence resulting in adult mental health conditions. Social and caregiving contexts, particularly for vulnerable infants born preterm, influence long‐term outcomes, but mechanisms are not clearly understood. Healthcare teams caring for those born preterm face difficulty predicting who will be most affected by risk, who will most benefit, and the optimal timing of intervention. Differential susceptibility theory offers an alternative to the traditional risk‐only assessments and theories by positing that individuals may be more, or less, susceptible to environmental influences. A sample of preterm‐ and term‐born infants were followed from birth to 23 years of age. Mixed model repeated measures analyses of internalizing and externalizing behaviors were utilized for the comparison groups (N= 214; observations = 1070). Environmental contexts were indexed as proximal protection (low, moderate, high) and medical risk (low, moderate, high). Personal characteristic covariates of sex, race, socioeconomic status, and cognition were modeled. Internalizing behavior trajectories varied significantly over time. Early proximal protective environments conferred a sustained positive influence on behaviors. There is partial support for differential susceptibility theory suggesting that prematurity, as a malleability characteristic enables absorption of both the positive and negative influences of the environment, with greater intensity that those without malleability. The current analyses suggest lasting effects of the preschool age proximal environment on internalizing and externalizing behaviors in young adulthood for those born preterm. Understanding these nuances may aid healthcare professionals in the promotion and timing of interventions to support the child and family. The current manuscript reflects ongoing analyses of longitudinal data. No patient or public contribution to the analyses were required for testing the differential susceptibility theory. The authors would solicit patient or public contribution when implementing practice or policy changes based on the results.