Objective To study emotional and behavioural problems, relations to friends and substance use in young adults born with very low birth weight (VLBW: ≤1500 g) compared to controls.

Design/methods A hospital-based follow-up study of 34 VLBW young adults and 35 term-born controls at 23 years of age. Data was collected using the Achenbach System of Empirically Based Assessment – Adult Self-Report (ASR) and the Beck Depression Inventory (BDI).

Results The ASR total problems score was 38.6 (21.7) in the VBLW group compared with 29.0 (18.7) in the control group (p = 0.08). The VLBW group had higher scores for anxious/depressed (p = 0.04), attention problems (p = 0.03), aggressive behaviour (p = 0.05), internalising problems (p = 0.02) and critical items (p = 0.02). BDI scores did not differ between the groups. The VLBW group reported lower mean substance use (p = 0.04), mainly due to less use of alcohol. Furthermore, they reported having fewer friends, less closeness to friends, and less time spent with friends compared with controls (p = 0.05). When excluding 11 participants with cerebral palsy and/or low intelligence quotient (<2 SD of mean in the control group), the scores for critical items, anxious/depressed and substance use were essentially the same (p-values: 0.04–0.07).

Conclusion The VLBW group reported more emotional problems than controls, and also a higher level of clinically relevant psychiatric symptoms. The findings may indicate that anxiety symptoms and a cautious lifestyle with regard to substance use are characteristics of VLBW individuals in young adulthood.