Regulatory problems and developmental psychopathology within the first 2 years of living-a nested in cohort population-based study.

BACKGROUND

Infancy regulatory problems (RP) of sleep, feeding and eating, and excessive crying are thought to play a key role in the development of psychopathology in childhood, but knowledge of the early trajectories is limited.

OBJECTIVE

To explore RP at ages 8-11 months and the associations with mental health problems at 1½ years, and assess the influences of maternal mental health problems and relationship problems.

METHODS

RP was explored in a nested in-cohort sample (N = 416) drawn from a community-based cohort (N = 2,973). Cohort children were examined by community health nurses, using a mental health screening, which included seven items of RP. Follow-up at 1½ years included diagnostic assessment according to the International Classification of Diseases, ICD-10, and the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood: Revised edition, DC:0-3R. Data analyses included logistic regression models and analyses of the mediation effect of maternal mental health and relationship problems.

RESULTS

RP of sleep were associated with a 2-fold increased risk of child mental disorder specifically sleep disorders, adjusted odds ratio (OR) 9.3 [95% confidence interval (CI): 2.0-42.9], disorders of behavior and emotions, adjusted OR 2.9 (95% CI: 1.0-8.4), and DC:0-3R regulatory disorders, adjusted OR 2.7 (95% CI: 1.0-7.5). Children with RP of feeding and eating showed an increased risk of overall mental disorder, adjusted OR 1.4 (95% CI: 0.7-2.4), and specifically, feeding and eating disorders, adjusted OR 6.0 (95% CI: 1.6-21.7), disorders of behavior and emotions, adjusted OR 2.2 (95% CI: 0.9-5.8), as well as DC:0-3R regulatory disorders, adjusted OR 1.6 (1.0-7.5). RP of emotional regulation were associated with increased risk of any mental disorder, adjusted OR 1.5 (1.0-2.4), and specifically behavioral and emotional disorders, adjusted OR 2.2 (95% CI: 0.9-5.9) and DC:0-3R relationship disorders, adjusted OR 1.8 (95% CI: 0.9-3.8). The mediation effect of maternal mental health problems and relationship problems ranged between 0% and 48%.

CONCLUSION

RP at ages 8-11 months is associated with increased risk of ICD-10 and DC:0-3R disorders at 1½ years. Study findings highlight a group of vulnerable infants in need of preventive intervention to break the early trajectories of psychopathology.