Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology

Abstract

Very preterm birth (VPT; < 32 weeks of gestation) has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset. Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity. However, the etiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies. Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological, and psychosocial factors.

Keywords: brain; pain; parenting; preterm; socio-emotional; stress.

Figure 1

Structural alterations in the social brain found in preterm individuals. This is a graphic representation of a summary of the studies reviewed in Table 3. Colored areas highlight brain regions involved in processing socio-emotional stimuli that have been shown to display structural alterations in very preterm samples.

Figure 2

Adapted from Healy et al. (2013) an integrative model showing biological and environmental factors underlying the association between very preterm birth, socio-emotional vulnerabilities, and psychopathology. According to the model, VPT birth (caused by a combination of genetic factors, obstetric events, and other variables) leads to brain alterations in both socio-emotional and cognitive networks. These alterations might underlie socio-emotional vulnerabilities in childhood (possibly due to both deficits in social competence or to more general impaired cognitive functions). Painful procedures and stress experienced during the neonatal period may also impact the development of subplate neurons and preoligodendrocytes, resulting in alterations in brain microstructure. Parenting and parental mental health may mediate the effect of these early adverse events and act either as protective or exacerbating risk factors. Children and adolescents at socio-emotional risk may then be exposed to experiences of social exclusion and social victimization (social defeat and chronic social stress), which have been associated with dopamine sensitization in mesolimbic areas and increased stress-induced striatal dopamine release. We propose that dopamine dysfunction may mediate the association between socio-emotional vulnerabilities and psychopathology and contribute to increased risk of developing psychiatric morbidity in adulthood. In this model we have included a direct reciprocal link between impaired cognitive functions and psychopathology bypassing an intermediate emotional vulnerability stage.