Melbourne School of Psychological Sciences - Theses
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ItemThe SENSE study (Sleep and Education: learning New Skills Early): postintervention effects of a randomised controlled trial of a cognitive-behavioural and mindfulness-based group sleep improvement intervention among at-risk adolescents( 2016)Objective: There is growing recognition that many adolescents obtain insufficient and/or poor quality sleep. Sleep problems are also a major risk factor for the emergence of mental health problems in adolescence. However, few studies have examined disturbed sleep as a potential mechanism in the treatment and prevention of mental health problems among adolescents. Adolescent sleep problems can be treated using a range of approaches. School-based sleep education programs, which are typically delivered to whole school classes, have been shown to have little impact on sleep behaviour or mental health. Cognitive-behavioural and mindfulness-based sleep programs, which are typically delivered to at-risk or already symptomatic adolescents, have been shown to be more effective in improving sleep and emotional distress, but studies evaluating their effectiveness have been limited in several ways, including small sample sizes and inadequate/lack of control groups. We conducted a systematic review and meta-analysis examining the efficacy of cognitive-behavioural sleep interventions among adolescents. Searches of PubMed, PsycINFO, CENTRAL, EMBASE, and MEDLINE were performed from inception to 1 May 2016. Eight trials were selected (n=234, mean age=15.24 years; female=63.18%). Main outcomes were subjective (sleep diary/questionnaire) and objective (actigraphy) total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). There was a small number of randomised controlled trials (RCTs; n=3), and a high risk of bias across the RCTs; therefore within sleep condition meta-analyses were examined. At post-intervention, subjective TST improved by 29.47 minutes (95% CI = 17.18, 41.75), SOL by 21.44 minutes (95% CI = -30.78, -12.11), SE by 5.34% (95% CI = 2.64, 8.04), and WASO by a medium effect size (d = 0.59 [95% CI = 0.36, 0.82). Objective SOL improved by 16.15 minutes (95% CI = -26.13, -6.17), and SE by 2.82% (95% CI = 0.58, 5.07). Global sleep quality, daytime sleepiness, depression, and anxiety also improved. Gains were generally maintained over time. Our meta-analysis provides preliminary evidence that cognitive-behavioural sleep interventions are an effective treatment for adolescent sleep problems, producing clinically meaningful responses within active treatment conditions. Their efficacy is maintained over time, and results in significant alleviation of sleep problems and improvement in functional outcomes. However, further large-scale, high-quality RCTs are needed to confirm these findings. The aim of this thesis was to investigate the post-intervention effects of a cognitive-behavioural/mindfulness-based group sleep intervention on sleep, mental health, and cognitive style among at-risk adolescents. The study went beyond simply measuring treatment outcomes to also evaluate mechanisms of change. Based on the behavioural, cognitive, hyperarousal, and transdiagnostic models of insomnia, a number of specific mediators were hypothesised to account for therapeutic change in cognitive-behavioural and mindfulness-based sleep interventions for adolescents, including earlier bedtimes, more consistent bedtimes, increased sleep hygiene awareness, and decreased dysfunctional beliefs and attitudes about sleep, worry, rumination, pre-sleep arousal, anxiety, and depression. Method: A RCT was conducted across Victorian secondary schools in Melbourne, Australia. Adolescents (aged 12-17 years) were recruited using a two-stage procedure, consisting of an in-school screening (n=1491) followed by a diagnostic interview for those meeting screening criteria (n=218), to identify students with high levels of anxiety and sleeping difficulties, but without past or current major depressive disorder (n=144). Eligible participants were randomised into either a sleep improvement intervention (‘Sleep SENSE’) or an active control ‘study skills’ intervention (‘Study SENSE’). One hundred twenty three participants began the interventions (Female=60%; Mean Age=14.48, SD=0.95), with 60 in the sleep condition and 63 in the control condition. All participants were required to complete a battery of mood, sleep and cognitive style questionnaires, seven-days of wrist actigraphy (an objective measurement of sleep), and sleep diary entry at pre-and-post intervention. Results: The sleep intervention condition was associated with significantly greater improvements in subjective sleep (global sleep quality, sleep onset latency, daytime sleepiness), objective sleep onset latency, anxiety, pre-sleep arousal, and sleep knowledge compared with the control intervention condition, with small-medium effect sizes. Parallel multiple mediation models showed that there were bidirectional relationships between improvements in subjective sleep quality and pre-sleep arousal/global anxiety. Conclusion: The SENSE study is an efficacy trial of a selective group-based sleep intervention for the treatment and prevention of sleep and mental health problems among at-risk adolescents experiencing both sleep and anxiety disturbance. The study provides evidence, using a methodologically rigorous design, including an active control comparison condition, that a multi-component group sleep intervention that includes cognitive-behavioural and mindfulness-based therapies, can improve wakefulness in bed variables, daytime dysfunction, anxiety, pre-sleep arousal, and sleep knowledge among at-risk adolescents. The results also provide evidence that pre-sleep arousal and anxiety are particularly important for adolescents’ perceived sleep quality, and should be key targets for new treatments of adolescent sleep problems. Public Health Significance: Given the high prevalence of adolescent sleep and internalising problems, the implications of an effective adolescent sleep intervention for clinical practice and public policy are potentially significant. However, changing sleep behaviour, especially objective measures of sleep, in this age group, has been challenging. This thesis shows that the Sleep-SENSE program can improve objective and subjective indices of sleep, as well as anxiety symptoms, when compared to an active control intervention. The results also showed that reductions in pre-sleep hyperarousal represent a key psychophysiological mechanism for therapeutic improvements in subjective sleep problems among anxious adolescents, and that cognitive behavioural and mindfulness-based sleep interventions should be directed towards adolescents with vulnerability for hyperarousal. Sleep SENSE is one of the only interventions demonstrated to be efficacious in improving sleep and mental health amongst vulnerable adolescents. Furthermore, the program is likely to be cost-effective - it involves a simple screening process and a group intervention format - and could be disseminated to a wide range of clinical and non-clinical settings in primary care, mental health, adolescent health and sleep medicine, and may assist in the treatment and prevention of adolescent sleep and mental health problems. The intervention also lends itself to flexible modes of delivery (e.g., non-specialist practitioners, group settings, individual settings, school-based, internet and other e-health modes of delivery), further enhancing its translational potential.
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ItemInvestigating anxiety and depression in adults with low intellectual ability( 2016)Adults with low ability have been routinely excluded from general population research that supports cognitive behavioural therapy for anxiety and depression. Even studies using samples of adults with ability below average exclude potential participants with profound and severe intellectual disability, without testing task-specific capacity. Consequently, little is known about the viability of cognitive models of anxiety and depression amongst adults with low ability. The present study addresses this through four main lines of enquiry: inclusion of all abilities through screening and validity procedures; prevalence of signs and symptoms of anxiety and depression as well as the impact of life stressors on these; cognitions and their specificity for anxiety and depression; and the impact of anxiety and ability on attentional responses to emotional stimuli. A sample of 70 adults from each level of low ability, unselected for signs or symptoms of anxiety and depression, was recruited from community-based disability support services. Participants were screened for general (receptive language) and task-specific abilities, interviewed for symptoms of anxiety and depression and disorder related cognitions then administered a visual-probe task with emotional face stimuli. Informants provided data on signs of mental ill-health, stressful life events and adaptive behaviour. Task-specific validity procedures governed data included for analysis. The inclusionary approach meant participants from all ability levels below average were included. Task-specific screening measures were superior to receptive language in predicting validity on research tasks, especially for participants with severe and profound intellectual disability. Dimensional measurements meant ability variables could be covaried or controlled in most analyses. Mean levels of signs and symptoms were lower than those in available reference studies, as were the rates of clinical level cases. General ability was positively correlated with signs of anxiety and depression but was not related to symptoms. Similarly, the number of life events was correlated with all scales on the measure of signs but not with symptoms of anxiety or depression. The lack of concordance highlights the gap between what informants see and what respondents think and feel. Learning a person’s subjective interpretation of events can help understand their emotions and behaviour. Depressive cognitions uniquely predicted significant variance in symptoms of depression but only ability, rather than anxious cognitions, predicted anxiety symptoms. Cognitive content-specificity for depression bolsters support for the use of cognitive behaviour therapy but further research into the relationship between ability and anxiety is required. The lack of directional bias in selective attention to emotional faces in any of the anxiety or ability groups means cognitive-motivational theory was not supported but future studies should address methodological issues. Attentional control theory was supported but the slowing of emotional face processing caused by high anxiety, but not depression needs replication. Trials of attentional training may be justified to reduce anxiety. Further research into cognitive models of anxiety and depression is urgently needed and future studies should ask theoretical as well as clinical questions.
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ItemAssessing the relationship between executive function, coping, stress, depression, anxiety and quality of life in multiple sclerosis( 2014)Background: Compared to healthy controls, people with multiple sclerosis (PwMS) use fewer adaptive and more maladaptive coping strategies when managing stressors and they experience higher rates of depression, anxiety and adjustment disorders. In addition, PwMS experience a high prevalence of cognitive impairment, including executive dysfunction, which has been linked to depression and anxiety. Aims: The current study examined the relationship between executive function, coping strategy use and psychosocial adjustment outcomes including stress, depression, anxiety and quality of life (QoL) in PwMS. The research assessed i) the ability of coping strategies and executive function to predict maladaptive and adaptive adjustment outcomes, and ii) the relationship between executive function and coping and whether there is a moderating and mediating relationship of different coping strategies between executive function and psychosocial adjustment in PwMS. Methods: Participants (N=107) with relapsing remitting or secondary progressive multiple sclerosis were administered tasks of executive function and completed self-report measures of stress, depression, anxiety, QoL and coping. Results: Consistent with expectations, stress, depression, anxiety and QoL were predicted by adaptive and maladaptive coping styles. Similarly, coping strategies, total coping and an adaptive coping index were predicted by tasks of executive function. Lower scores on tasks of executive function best predicted higher use of maladaptive strategies, but also adaptive strategies, while higher scores were limited in their ability to predict adaptive coping strategies. Tasks of executive function that most often predicted coping strategies included tasks of working memory, cognitive flexibility, information processing and attention. However, contrary to expectations, there was limited support for a relationship between tasks of executive function and psychosocial adjustment outcomes. An indirect relationship was found between executive function performance and adjustment through individual maladaptive coping strategies and adaptive coping strategies, as well as for an index of adaptive coping. Higher executive function performance was related to better adjustment via lower venting and behavioral disengagement, as well as higher scores on the adaptive coping index, whereas lower executive function performance was related to better adjustment via higher growth and acceptance. In general, better executive function and psychosocial adjustment was associated with minimal use of adaptive coping strategies, or greater use of maladaptive coping strategies. Conclusion: Executive function and psychosocial adjustment is mediated and moderated by coping strategies used by PwMS. Well-preserved executive function provides relative protection from poorer adjustment in the presence of high maladaptive or low adaptive coping. PwMS who perform poorly on tasks of executive function benefit from using less cognitively demanding coping strategies to enhance adjustment outcomes and this area that would benefit from further research to underpin effective intervention strategies. Findings from this study will assist with development of patient resources and patient management aimed at enhancing adaptive psychosocial adjustment in PwMS.
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ItemParental psychological distress following very preterm birth: impact on infant social-emotional development and parent-child interaction( 2014)It is known that there are high rates of psychological distress in parents of very preterm infants, but previous researchers examining parental mental health after preterm birth have usually assessed mental health at one point in time. As such, little is known about the evolution of parental distress, particularly during the inpatient period in the Neonatal Intensive Care Unit (NICU). Parental distress can negatively impact parent-child relationships, which can then affect longer term child social-emotional development. Furthermore, children born very preterm have higher rates of early social-emotional difficulties, and are more likely to experience suboptimal parent-child interaction. These problems are likely to be compounded by parental mental health difficulties. Understanding these issues in the first year of life is vital to guide appropriate intervention, both for the wellbeing of mothers and fathers during this difficult period, and for the optimal development of their very preterm infants. This study aimed to describe the trajectory of psychological distress (depression, anxiety and post-traumatic stress symptoms) in mothers and fathers of very preterm infants at several key time points from birth to 12 months corrected age. It also investigated how this distress influenced parent-child interaction and the infant’s social-emotional development at 12 months corrected age. Finally, it examined whether parent-child interaction explained the relationship between maternal psychological distress during the first 12 months and infant social-emotional development at 12 months corrected age. Participants included 96 mothers and 86 fathers of 127 infants (99 families including 26 sets of twins and one set of triplets) born prior to 30 weeks gestational age and admitted to the Royal Women’s Hospital NICU in Melbourne, Australia. A subset of families of 55 infants were followed up at 12 months corrected age. Mothers and fathers completed measures assessing depression (The Centre for Epidemiological Studies Depression Scale) and anxiety (The Hospital Anxiety and Depression Scale) fortnightly from birth until the infant reached term equivalent age, and at three, six and 12 months corrected age. In addition, parents completed the Post-traumatic Stress Disorder Checklist Specific Version at term equivalent age and 12 months corrected age to assess post-traumatic stress symptoms. At 12 months corrected age the mothers and infants participated in the Emotional Availability Scales, an observational task assessing parent-child interaction, and mothers completed the Infant-Toddler Social and Emotional Assessment to assess infant social-emotional development. Overall, results showed that symptoms of depression, anxiety and post-traumatic stress were initially high for both mothers and fathers, and reduced in severity over time between the birth of their infant and 12 months corrected age. However, rates of clinically significant symptoms of depression remained above levels that would be expected in the general population at 12 months corrected age. Psychological distress in parents at various time points was predictive of certain infant social-emotional development and parent-child interaction outcomes. When these associations were examined more closely, it was found that the relationships between maternal mental health predictors and infant social-emotional development could not be explained by the influence of parent-child interaction. The findings of this study represent a substantial advance in the understanding of parental mental health following very preterm birth, especially in fathers. Additionally, the results may help identify the optimal timing of assessment and intervention to improve mothers’ and fathers’ wellbeing, and thus their infants’ development.
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ItemTuning in to teens: examining the efficacy of an emotion-focused parenting intervention in reducing pre-adolescents’ internalising difficulties( 2014)The transition from childhood to adolescence coincides with an increase in anxiety, a peak in somatic complaints, and a post-pubertal rise in depression by mid-adolescence, particularly for girls. For those affected, internalising difficulties result in considerable stress and impairment for the young person even if symptoms do not reach criteria for clinical diagnosis. Up to 50% of all adult psychological disorders have their onset during adolescence, highlighting the importance of identifying methods of prevention that are evidence-based. Emotional competence has been found to be an important protective factor for healthy social, emotional, and behavioural functioning. Both adolescents and adults with internalising difficulties show deficits in aspects of emotional competence. Research in child development suggests that parents’ emotional competence and emotion socialisation practices are related to children’s emotional functioning, including child internalising difficulties. This research has not yet been translated into intervention or prevention programs targeting parents of adolescents. The current study examined the efficacy of the Tuning in to Teens parenting program in improving emotion socialisation practices in parents of pre-adolescents and in measuring the impact on youth internalising difficulties. Grounded in emotion socialisation theory, this program teaches parents skills in responding to emotions in ways that enhance emotional competence in the young person, while also improving parent-youth communication and connectedness. A group-randomised control design was used where participants were recruited from schools and randomised into intervention and control conditions. Data were collected from 225 parents and 224 youth during the young person’s final year of elementary school (6th grade) and again, 10 months later in their first year of secondary school (7th grade). The thesis includes three studies. Study 1 reports the results of multilevel analyses, which showed participation in Tuning in to Teens resulted in significant improvements in parental emotion socialisation and reductions in youth internalising difficulties for the intervention condition. Study 2 examined moderators and mediators of program outcome. Results showed greater program effects for intervention subgroups with high pre-intervention difficulties. Parental education, income, parental internalising difficulties, parental difficulties in emotion awareness and regulation, and attendance rate did not moderate program effects. Mediation analyses supported emotion socialisation theory and showed parents who participated in the Tuning in to Teens parenting program reported improvements in emotion socialisation, which in turn was related to reductions in youth internalising difficulties. Study 3 investigated the relationship between parent emotion socialisation and youth somatic complaints. The study extended the literature on somatic complaints by being the first to consider parents’ emotional competence and emotion socialisation practices as predictors of youth somatic complaints alongside parents’ own somatic complaints. Results indicated that changes in parents’ awareness and regulation of emotion and emotion socialisation practices resulted in reduced youth somatic complaints. These findings have important implications for current aetiological models of somatic complaints and provide support for using an emotion-focused approach to enhance current treatment models of youth somatic complaints. A significant contribution of this thesis is that it presents the first randomised control trial evaluation of a parenting program that utilises research linking parents’ emotion socialisation with young people’s mental health, applying it in practice with a sample of parents of pre-adolescents. The research findings provide support for emotion socialisation theory and for using an emotion focused parenting program to prevent internalising difficulties in early adolescence.
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ItemOlder parent-child relationships and their associations with older people’s psychological wellbeing: a comparison of Australian-born people and Chinese immigrants( 2014)Parent-child relationships are one of the most fundamental types of family relationships. Against the background of population ageing in Australia and many other Western countries, the present study explored the nature of these relationships in later life and their associations with older people’s psychological wellbeing. Alongside population ageing, Australian populations are becoming culturally diverse. To enhance our understanding of cultural diversity in these issues, the study focused the differences between older Australian-born people and older Chinese immigrants. Older Chinese immigrants were included in the present study because there are some unique features in the nature of parent-child relationships in this group, such as the concept of filial piety. A convenience sample of 122 participants were recruited in the present study, comprising 60 Australian-born people and 62 Chinese immigrants. These participants were interviewed using a standardized interview schedule. Three groups of measures were used, assessing socio-demographic factors, the nature of parent-child relationships, and psychological wellbeing. The solidarity–conflict model and the concept of ambivalence were used to operationalize the nature of parent-child relationships, and four indicators (i.e., depression, anxiety, loneliness, and quality of life) were used to present a broad picture of older people’s psychological wellbeing. Most participants reported relatively high levels of solidarity in their relationships with adult children. Specifically, the majority lived close to, had frequent contact with, and were involved in some kind of exchange relationships with their children. Most participants felt close to their children, believed that their children’s opinions and values were relatively similar to their own, and had some kind of filial expectations. However, conflict and ambivalence were common, albeit, of low intensity, in participants’ relationships with adult children. The study further found that these relationship dimensions were significantly associated with the four wellbeing indicators and that most of these associations persisted when socio-demographic variables were considered. There were both similarities and differences in the nature of older parent-child relationships between Australian-born people and Chinese immigrants. For example, participants from both groups preferred to live independently and to receive help from professional aged care services than from their children. However, older Chinese immigrants were more likely to live with children and reported higher levels of ideal filial expectations. There were also stronger associations between depressive symptoms and the nature of older parent-child relationships among Chinese participants. These findings highlight the complexity of parent-child relationships in contemporary multicultural Australian society and suggest that using a comprehensive model, such as the solidarity-conflict model, helps to present a more complete picture of these relationships. They also provide evidence for the importance of these relationships to older people’s psychological wellbeing. Finally, these findings have important implications for policy development and service planning and provision for older people, in particular, those for older Chinese immigrants.
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ItemSleep, mood, and cognitive vulnerability in adolescents: a naturalistic study over restricted and extended sleep opportunities( 2013)Introduction: It is well established that for adolescents, school days are associated with sleep restriction, and that insufficient sleep has been linked to mood disturbances. This longitudinal study assessed sleep, mood, and life stress over the school term and vacation periods with restricted and extended sleep opportunities. The relationships between objective and subjective sleep, as well as between sleep and mood were examined. A cognitive model was proposed and tested to assess whether sleep-specific (i.e., dysfunctional beliefs and attitudes about sleep) and global (i.e., dysfunctional attitudes) cognitive vulnerabilities played a role in these relationships. Methods: One-hundred and forty-six adolescents (47.3% male) aged 16.2+/-1.0 years (M+/-SD) from the general community wore an actigraph continuously for four weeks: the last week of a school term (Time-E), the following two-week vacation (Time-V), and the first week of the next term (Time-S). Social demographic information, chronotype, and cognitive vulnerabilities were assessed at Time-E. Subjective sleep, symptoms of depression, anxiety, and life stress were repeatedly measured at Time-E, Time-V, Time-S, and the middle of the subsequent school term. Regression analyses were used to explore the relationship between sleep and mood, and structural equation modelling was used to examine changes of variables over time, as well as the moderating roles of cognitive vulnerabilities. Results: Compared with school days, sleep during the vacation was characterized by later timing, longer duration, lower quality and greater variability. Daily changes in actigraphy- measured sleep over the vacation period showed linear delays in sleep timing throughout the vacation, while changes in time-in-bed were non-significant. The first vacation week was characterized by a linear decrease in total sleep time and sleep quality, and these changes stabilized during the second vacation week. Compared to vacations, school terms were associated with higher symptoms of depression, anxiety, and life stress. Poorer sleep quality, particularly poorer subjective perception of sleep quality, was significantly associated with higher symptoms of depression and anxiety. Sleep- specific cognitive vulnerability moderated the relationship between objective and subjective sleep onset latency during extended but not restricted sleep opportunity. After controlling for life stress, global cognitive vulnerability played different moderating roles in the relationship between subjective sleep and mood over school term and vacation periods. Higher global cognitive vulnerability was associated with a stronger relationship between subjective sleep and symptoms of anxiety (but not depression) during the school term, as well as with a stronger relationship between subjective sleep and symptoms of depression (but not anxiety) during the vacation period. Conclusion: Sleep, mood, and life stress changed markedly over the school term and vacation periods. Changes in sleep over the vacation suggested that the recovery from school- related sleep restriction was completed within two weeks’ extended sleep opportunity, and the average sleep duration over this period suggested that sleep requirements in adolescence may be less than conventionally described in the media and in the scientific literature. Cognitive vulnerabilities played important roles in the relationship between sleep and mood. Adolescents with higher cognitive vulnerability might be more emotionally vulnerable towards school-related sleep restriction. These findings have important implications for future studies, as well as practical implications for policies and interventions designed to improve adolescents’ wellbeing.
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ItemNeighbourhood disadvantage and internalising symptoms in adolescents: the mediating role of stressful life events, temperament, and maternal aggression( 2013)Purpose of the study: Disadvantaged neighbourhoods are associated with increased risk for anxiety and depression in adolescents. However the mechanisms for this relationship are not fully understood. Using a longitudinal design, I investigated whether several potential mediators, including stressful life events, maternal aggressive, dysphoric and positive behaviour, and adolescent temperament (Surgency, Negative affectivity, Effortful Control, Affiliation), could help explain the relationship between neighbourhood disadvantage and symptoms of anxiety and depression in early- to mid-adolescence. Method: A community sample of 245 adolescents and their parents participated in a range of assessments at baseline (age approximately 12-13 years old), including an observational assessment of parent-adolescent interactions, and a battery of adolescent-rated questionnaires. Neighbourhood disadvantage was assessed by combining Postal Area data collected during this first wave of assessment with a measure of disadvantage called the Socio-Economic Indexes For Areas (SEIFA) developed by the Australian Bureau of Statistics Adolescents were followed-up approximately 4 years later and completed questionnaires assessing depressive and anxious symptoms. Results: Analyses revealed that adolescents from disadvantaged neighbourhoods were more likely to report a greater number of stressful life events, and depressive and anxious symptoms. They were also more likely to score higher on temperament measures of Negative Affectivity, and lower on measures of Surgency and Effortful control. Mothers from disadvantaged neighbourhoods were more likely to display aggressive and dysphoric behaviour for longer periods, and positive behaviour for shorter periods, however no differences were detected in regard to the frequency of these behaviours. Mediational analyses using a bootsrapping approach determined that stressful life events and three temperament dimensions (low Surgency, low Effortful Control, high Negative Affectivity) significantly mediated the relationship between neighbourhood disadvantage and symptoms of anxiety and depression at baseline. Stressful life events and maternal aggression significantly mediated the relationship between neighbourhood disadvantage and change in depressive and anxious symptoms from baseline to follow-up. Conclusion: The research reported in this thesis provides evidence that disadvantaged neighbourhoods differ from less disadvantaged neighbourhoods in several different ways. In addition, various factors were found to partially mediate the relationship between neighbourhood disadvantage and anxiety and depression at different periods during adolescence. Temperament appears to be important earlier in adolescence, maternal affective behaviour seems to be important during mid- to later-adolescence, while stressful life events appear to act throughout adolescence. These findings suggest that the neighbourhood environment is likely to influence adolescents both directly, and indirectly through its effects on more proximal and individual risk factors. It was concluded that prevention and intervention programs targeting a range of risk factors in adolescents from disadvantaged neigbourhoods could be particularly effective at reducing the prevalence of internalising disorders in adolescents.
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ItemMood and anxiety outcomes in adolescents born with extremely low birthweight or extremely preterm: prevalence and neuroanatomy( 2012)Preterm birth is associated with poor outcome in a range of domains, which can persist into adolescence and beyond. This may include poor mental health outcomes, and particularly, anxiety and depressive symptoms. To date, studies of mood and anxiety outcomes in preterm groups have mainly used dimensional measures of symptoms; only a handful employ clinical diagnostic instruments and these largely focus on recent symptoms. Our understanding of the prevalence of clinically diagnosable disorders is consequently limited, particularly in late adolescence and for those born since 1990. Prematurity at birth can also have a significant and longstanding impact on brain development. An extended medial network, including the hippocampus, amygdala, and medial prefrontal cortex, is implicated in emotion regulation, as well as clinical mood and anxiety disorders. Hippocampus, amygdala, and prefrontal structure may be altered in preterm samples, but potential relationships between these brain regions and emotional outcomes are yet to be explored in preterm survivors. This study aimed to address these limitations in the current literature by i) characterising mood and anxiety outcomes in adolescents born extremely low birthweight or extremely preterm (ELBW/EP), ii) characterising the structure of regions in the extended medial network, and iii) investigating the relationships between these outcomes and brain structure. A number of specific hypotheses arose from this research question. Firstly, it was expected that the ELBW/EP group would report more recent symptoms, more frequently meet diagnostic criteria for current or past disorder, and more strongly endorse personality traits associated with anxiety and depression than a normal birthweight (>2500g; NBW), full-term (>36 weeks; FT) control group. Secondly, it was expected that ELBW/EP participants may have smaller hippocampus, amygdala, and ventromedial prefrontal cortex volumes, and thinner ventromedial prefrontal cortices, than NBW participants. Finally, it was predicted that structural reductions in these regions of interest would be associated with greater mood and anxiety symptoms, and a history of clinically diagnosable disorder, in ELBW/EP and NBW participants. This study assessed 215 ELBW/EP and 157 NBW adolescents who were born in 1991 and 1992 in the state of Victoria, Australia. Participants from a prospective geographical cohort were followed up at age 18 and completed measures of mood and anxiety symptoms and disorders (including questionnaires and a structured clinical interview), as well as personality traits. Participants also underwent structural MRI scanning, and cortical and subcortical brain volumes were generated using FreeSurfer (v5.0). Unexpectedly, there was no elevation in clinically relevant recent or lifetime history of depression or anxiety in the ELBW/EP group. Although mood and anxiety disorders were more prevalent in females overall, there was no interaction between group and gender. The ELBW/EP group had disproportionately smaller bilateral hippocampus volumes and left amygdala volumes than controls, and the ventromedial prefrontal cortex was proportionately larger and thicker in the ELBW/EP group than the NBW group. Recent mood and anxiety symptoms were not well predicted by any of the neuroanatomical variables of interest. Despite this, lifetime history of a mood or anxiety disorder was associated with smaller left vmPFC volumes. Further analyses indicated this pattern was apparent in those with a history of anxiety disorder but not mood disorder. Group did not moderate these findings. Assessment of ELBW/EP adolescents’ self-reported mood and anxiety outcomes revealed an encouraging picture. Although extremely low birthweight or extreme prematurity was associated with altered structure of regions in the extended medial network, these alterations appeared to have limited relationship with outcomes. These findings contribute to the literature by examining older adolescent mood and anxiety outcomes and using high field-strength neuroimaging. The implications for preterm survivors and the relevance of brain structure to mood and anxiety outcomes in this age group are considered.