Background: Children born preterm (<37 weeks' gestation) are at increased risk of mental health problems, and their mental health outcomes have not improved in the past decades. This study aims to (1) determine the degree of mental health resilience in preterm-born children; (2) identify modifiable factors at individual, parent-child, family, peer group, and neighbourhood levels associated with resilience; (3) explore differential effects of factors based on sex and contextual adversity.
Methods: Preterm-born children from the Bavarian Longitudinal Study (BLS; n = 574) born in Germany (1985-1986) and Millennium Cohort Study (MCS; n = 985) born in the UK (2000-2002) were assessed prospectively at 7 (MCS) or 8 (BLS) years. Resilience was defined as better-than-expected mental health outcomes, using a residuals approach. Potential promotive factors included (1) individual: self-regulation, perceived competence, cognition; (2) parent-child relationships; (3) family: home environment, interparental relationship, social support, sibling relationships; (4) peers: bullying, friendships; and (5) neighbourhood 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.
Results: The following factors were consistently (in both cohorts) associated with resilience: (1) individual: regulatory abilities, cognition; (2) parent-child: mother-child relationship; (3) family: authoritative and structured climate, interparental relationship; (4) peers: bullying. Regulatory abilities showed independent effect in both cohorts. Collectively, factors explained 30%-41% of the variance in resilience. Effects were similar across sex and contextual adversity, but promotive factors were less prevalent in boys and adverse contexts. Particularly in the UK, promotive resources were scarce amidst contextual adversity, which explained the lower resilience of children living in adversity.
Conclusions: This study identified modifiable factors such as child self-regulation, interparental relationships, and bullying that - if improved - have a high potential for improving mental health outcomes in preterm-born children.
Keywords: Resilience; adversity; longitudinal studies; mental health; preterm birth; protective factors; sex differences.
© 2025 The Author(s). Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.