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Gebreegziabher ZA, Eristu R, Molla A. Determinants of adolescents' depression, anxiety, and somatic symptoms in Northwest Ethiopia: A non-recursive structural equation modeling. PLoS One 2024; 19:e0281571. [PMID: 38598540 PMCID: PMC11006201 DOI: 10.1371/journal.pone.0281571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/16/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION In low and middle-income countries, adolescent mental health is not only a major public health challenge but also a development concern. Depression and anxiety are the most common mental health disorders and somatic symptoms often co-exist with them. Adolescents with common mental health problems are associated with an increased risk of suicide, future unemployment, and poor quality of life. However, little is known about the mental health of adolescents in Ethiopia. Thus, this study aimed to assess the determinants of depression, anxiety, and somatic symptoms among adolescents in Northwest Ethiopia, in 2022. METHODS An institution-based cross-sectional study was conducted from June 8 to 24, 2022. Two-stage stratified random sampling was used to select 1407 adolescents in Northwest Ethiopia. Structured and standardized self-administered questionnaires were used to collect the data. Non-recursive structural equation modeling was employed to assess the direct, indirect, and total effects of predictors. Adjusted regression coefficients and corresponding 95% confidence intervals were used to interpret the strength of the association. RESULTS The prevalence of depression, anxiety, and somatic symptoms were 28.21% (95% CI: 25.8, 31%), 25.05% (95%CI: 22.8, 27.5), and 25.24(95% CI: 23, 27.6%) respectively. Alcohol use had a significant positive effect on depression [β = 0.14, 95% CI: 0.073, 0.201], anxiety [β = 0.11, 95% CI: 0.041, 0.188], and somatic symptoms [β = 0.12, 95% CI: 0.062, 0.211]. Stress had a significant positive effect on depression [β = 0.76, 95% CI: 0.642, 0.900], anxiety [β = 1.10, 95% CI: 0.955, 1.264], and somatic symptoms [β = 086, 95% C: 0.700, 1.025]. Depression had a direct positive effect on anxiety [β = 0.74, 95% CI: 0.508, 1.010]. CONCLUSION In this study, the prevalence of depression, anxiety, and somatic symptoms was moderate. Alcohol use and stress were significantly related to depression, anxiety, and somatic symptoms. The bidirectional relationship between anxiety and depression was significant. Therefore, public health interventions should focus on the bidirectional relationship between depression and anxiety, as well as on identified factors to reduce the burden of mental illness in adolescents.
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Affiliation(s)
- Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Rediet Eristu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Baranauskas M, Kupčiūnaitė I, Stukas R. Mental Health and Physical Activity of Female Higher Education Students during the COVID-19 Pandemic: A Comparative Cross-Sectional Study from Lithuania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9725. [PMID: 35955080 PMCID: PMC9367914 DOI: 10.3390/ijerph19159725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
During emerging adulthood (EA), higher education medical students undergo a higher risk of anxiety and depression compared to the general population. The aim of this comparative cross-sectional study was to compare the proportions of three mental disorders, namely anxiety, depression and somatisation in terms of their symptoms and self-reported physical activity (PA) levels across the cohorts of biomedical and non-biomedical female students as well as to assess the association between the mental health outcomes and PA use. Between September 2021 and January 2022, a total of 1231 female higher education students aged between 18 and 29 years old were recruited for the study. Severe symptoms of anxiety and depression, as well as unexplained somatic complaints, were suffered by 51.9%, 11% and 23% of female students, respectively. Non-biomedical female students, compared to medicine and health sciences students, were more vulnerable due to the increased prevalence of negative mental health outcomes. The relationship between increased sports activity as a potential trigger for mental well-being and decreased severity of depressive symptoms was identified in the cohorts of both biomedical (adjusted odd ratio (ORadj) 0.4; 95% confidence interval (CI): 0.1-1.0) and non-biomedical (ORadj 0.4; 95% CI: 0.2-0.9) female students. The current research highlights the importance of increasing sports activity by involving students in regular physical exercise of specific types for decreasing the severity of depressive symptoms in student-aged female populations.
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Affiliation(s)
- Marius Baranauskas
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania
| | - Ingrida Kupčiūnaitė
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania
| | - Rimantas Stukas
- Institute of Health Sciences, Faculty of Medicine, Department of Public Health, Vilnius University, 01513 Vilnius, Lithuania
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Alaie I, Philipson A, Ssegonja R, Hagberg L, Feldman I, Sampaio F, Möller M, Arinell H, Ramklint M, Päären A, von Knorring L, Olsson G, von Knorring AL, Bohman H, Jonsson U. Uppsala Longitudinal Adolescent Depression Study (ULADS). BMJ Open 2019; 9:e024939. [PMID: 30826765 PMCID: PMC6429885 DOI: 10.1136/bmjopen-2018-024939] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses. PARTICIPANTS The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15-year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N≥200 000). FINDINGS TO DATE The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships. FUTURE PLANS Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.
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Affiliation(s)
- Iman Alaie
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anna Philipson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Lars Hagberg
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Margareta Möller
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hans Arinell
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Gunilla Olsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anne-Liis von Knorring
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Bohman H, Låftman SB, Cleland N, Lundberg M, Päären A, Jonsson U. Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study. Child Adolesc Psychiatry Ment Health 2018; 12:42. [PMID: 30123319 PMCID: PMC6090675 DOI: 10.1186/s13034-018-0245-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/04/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders. METHODS The entire school population of 16-17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991-1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17-19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants' ages of 18 and 35 years. RESULTS Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose-response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55-4.85; 2-4 symptoms: OR = 2.77, 95% CI 1.04-7.39; ≥ 5 symptoms: OR = 5.75, 95% CI 1.98-16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p < 0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose-response relationship (p < 0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p < 0.05). CONCLUSIONS Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.
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Affiliation(s)
- Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, 75124 Uppsala, Sweden
- Department of Women’s and Children’s Health, Akademiska University Hospital, 75185 Uppsala, Sweden
- Department of Clinical Science and Education, Södersjukhuset/Karolinska Institutet, 11883 Stockholm, Sweden
| | - Sara B. Låftman
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden
| | - Neil Cleland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Mathias Lundberg
- Department of Clinical Science and Education, Södersjukhuset/Karolinska Institutet, 11883 Stockholm, Sweden
| | - Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, 75124 Uppsala, Sweden
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, 75124 Uppsala, Sweden
- Department of Women’s & Children’s Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, CAP Research Center, Gävlegatan 22B, Floor 8, 113 30 Stockholm, Sweden
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Temporomandibular Disorders among Dutch Adolescents: Prevalence and Biological, Psychological, and Social Risk Indicators. Pain Res Manag 2018; 2018:5053709. [PMID: 29849843 PMCID: PMC5932427 DOI: 10.1155/2018/5053709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
Aims To assess the prevalence rates of pain-related temporomandibular disorders (TMDs) and temporomandibular joint (TMJ) sounds in a large group of Dutch adolescents, aged between 12 and 18 years and to determine if the same biological, psychological, and social risk indicators are related to both TMD pain and TMJ sounds. Methods In this cross-sectional questionnaire survey, 4,235 questionnaires were analyzed, with an about equal gender distribution. Results The overall prevalence of pain-related TMDs was 21.6% (26.1% for girls and 17.6% for boys) and that of TMJ sounds was 15.5% (19.3% for girls and 11.7% for boys). Logistic regression analyses revealed that the following variables appeared to be the strongest predictors of TMD pain: female gender, increasing age, sleep bruxism, biting on lips and/or cheeks, stress, and feeling sad. Regarding self-reported TMJ sounds, the multiple regression model revealed that female gender, increasing age, awake bruxism, and biting on lips and/or cheeks were the strongest predictors. Conclusions TMDs are a common finding among Dutch adolescents. Except for the psychological factors that appeared to be associated with TMD pain only, pain-related TMDs and TMJ sounds shared similar biological risk indicators.
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Evans S, Djilas V, Seidman LC, Zeltzer LK, Tsao JCI. Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator? THE JOURNAL OF PAIN 2017; 18:1087-1095. [PMID: 28479208 DOI: 10.1016/j.jpain.2017.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/18/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
Sleep problems have been identified as a potential antecedent of chronic pain and pain-related disability in pediatric populations. In adult studies, affect has been implicated in these relationships. This study sought to better understand the relationships between sleep quality, negative and positive affect, and pain and functioning in children with chronic pain. Participants included 213 children and adolescents (aged 7-17 years) presenting to a tertiary pain clinic with chronic pain. Children completed questionnaires measuring sleep quality, positive and negative affect, pain intensity, and functional disability. Results indicated that 74% of children reported disordered sleeping and that poor sleep quality was significantly associated with increased pain, disability, negative affect, and decreased positive affect. Our hypotheses were partially supported, with negative affect (but not positive affect) mediating the relationship between poor sleep and increased pain; and positive as well as negative affect mediating the relationship between poor sleep and increased functional disability. There was no evidence for affect as a moderator. This study adds to the growing literature demonstrating the effect of poor sleep quality on children's pain and functioning, highlighting the need to develop further longitudinal research to confirm the causal roles of these variables. PERSPECTIVE This article examines the relationship between poor sleep quality, affect (negative as well as positive), pain, and disability in children with chronic pain. The findings have the potential to better understand the processes involved in how poor sleep may lead to increased pain and pain-related disability.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia.
| | - Vesna Djilas
- School of Psychology, Deakin University, Geelong, Australia
| | - Laura C Seidman
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Lonnie K Zeltzer
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Jennie C I Tsao
- UCLA Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at University of California, Los Angeles, California
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Bohman H, Låftman SB, Päären A, Jonsson U. Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years. BMC Psychiatry 2017; 17:117. [PMID: 28356107 PMCID: PMC5370459 DOI: 10.1186/s12888-017-1252-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/03/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Earlier research has investigated the association between parental separation and long-term health outcomes among offspring, but few studies have assessed the potentially moderating role of mental health status in adolescence. The aim of this study was to analyze whether parental separation in childhood predicts depression in adulthood and whether the pattern differs between individuals with and without earlier depression. METHODS A community-based sample of individuals with adolescent depression in 1991-93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on parental separation and conditions in childhood and adolescence was collected at baseline. The outcome was depression between the ages 19-31 years; information on depression was collected at the follow-up diagnostic interview. The statistical method used was binary logistic regression. RESULTS Our analyses showed that depressed adolescents with separated parents had an excess risk of recurrence of depression in adulthood, compared with depressed adolescents with non-separated parents. In addition, among adolescents with depression, parental separation was associated with an increased risk of a switch to bipolar disorder in adulthood. Among the matched non-depressed peers, no associations between parental separation and adult depression or bipolar disorder were found. CONCLUSIONS Parental separation may have long-lasting health consequences for vulnerable individuals who suffer from mental illness already in adolescence.
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Affiliation(s)
- Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden. .,Department of Women's and Children's Health, Akademiska sjukhuset, SE-75185, Uppsala, Sweden. .,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177, Stockholm, Sweden. .,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Sara Brolin Låftman
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-10691 Stockholm, Sweden
| | - Aivar Päären
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124 Uppsala, Sweden
| | - Ulf Jonsson
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124 Uppsala, Sweden ,0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Borres N, Nilsson N, Drake I, Sjölander S, Nilsson C, Hedlin G, Nordlund B. Parents' perceptions are that their child's health-related quality of life is more impaired when they have a wheat rather than a grass allergy. Acta Paediatr 2017; 106:478-484. [PMID: 27925295 DOI: 10.1111/apa.13688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
AIM It is unknown whether food allergies have greater impact on quality of life than respiratory allergies. This study compared health-related quality of life (HRQoL) in children allergic to wheat or grass. METHODS We surveyed 63 children with wheat allergies (median age of five) and 72 with grass allergies (median age 12), with their parents. The Child Health Questionnaires for parents (CHQ-PF28) and children (CHQ-CF87) were applied. RESULTS The parents of children in the wheat group recorded significantly lower CHQ-PF28 scores for the impact of their child's allergy on general behaviour, general health perceptions, parental impact of emotions and time and family activities, than the parents of children with grass allergies (p values ≤0.001). However, parents in the grass group recorded lower scores for the change in health item than the parents of children with wheat allergies (p = 0.020). In the grass group, children and parents reported similar scores for the different questions, but there was poorer correlation between parents and children in the wheat allergy group. CONCLUSION HRQoL was lower in children with wheat than grass allergies according to parental reports, with more consistent perceptions of HRQoL among parents and children in the grass allergy than wheat allergy group.
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Affiliation(s)
- Nora Borres
- Department of Clinical Science; Medical Faculty; University of Lund; Malmö Sweden
| | - Nora Nilsson
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Isabel Drake
- Department of Clinical Science; Medical Faculty; University of Lund; Malmö Sweden
| | | | - Caroline Nilsson
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet and Sacchska Children's Hospital; Stockholm Sweden
| | - Gunilla Hedlin
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Björn Nordlund
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
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Abstract
Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self-report and behavioral pain assessment tools appropriate for children are provided; and factors to be considered when choosing a specific one are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.
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Murberg TA, Bru E. School-Related Stress and Psychosomatic Symptoms among Norwegian Adolescents. SCHOOL PSYCHOLOGY INTERNATIONAL 2016. [DOI: 10.1177/0143034304046904] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study examines the relationships between school-related stress, gender and psychosomatic symptoms in a sample of 531 adolescents pupils in years (grades) 8, 9 and 10 (aged 13-16 years) from two compulsory schools in Norway. Results showed that 18.1 percent reported being ‘very much’ affected by at least one of the assessed psychosomatic symptoms. Girls reported significantly more psychosomatic symptoms than did boys. Tests of the dimensionality of the school-related stress that was assessed in the present study showed four main categories: (1) difficulties with peers at school; (2) worries about school achievement; (3) schoolwork pressure and (4) conflicts with parents and/or teachers. Results from multiple regression analyses showed that scores for the different stressors were significantly associated with psychosomatic symptoms. Findings suggest that frequency of psychosomatic symptoms might be related to how well or otherwise pupils adapt to the demands of school and to the interpersonal climate of the school. Gender seems to play a differentiating role here. Girls reported significantly more stress that was related to worries about school achievement, whereas boys reported significantly more stress arising from conflicts with parents and/or teachers. Finally, stress due to difficulties with peers at school was more closely correlated with psychosomatic symptoms among boys than among girls.
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Affiliation(s)
| | - Edvin Bru
- Stavanger University College, Stavanger, Norway
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Päären A, Bohman H, von Knorring L, Olsson G, von Knorring AL, Jonsson U. Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample. BMC Psychiatry 2014; 14:363. [PMID: 25539591 PMCID: PMC4299780 DOI: 10.1186/s12888-014-0363-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/11/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to outline the early risk factors for adult bipolar disorder (BPD) in adolescents with mood disorders. METHODS Adolescents (16-17 years old) with mood disorders (n = 287; 90 participants with hypomania spectrum episodes and 197 with major depressive disorder [MDD]) were identified from a community sample. Fifteen years later (at 30-33 years of age), mood episodes were assessed (n = 194). The risk of developing BPD (n = 22), compared with MDD (n = 104) or no mood episodes in adulthood (n = 68), was estimated via logistic regression. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed as potential risk factors. RESULTS Among the adolescents with mood disorders, a family history of BPD was the strongest predictor of developing BPD compared with having no mood episodes in adulthood (OR = 5.94; 95% CI = 1.11-31.73), whereas disruptive disorders significantly increased the risk of developing BPD compared with developing MDD (OR = 2.94; CI = 1.06-8.12). The risk that adolescents with MDD would develop adult BPD, versus having no mood episodes in adulthood, was elevated among those with an early disruptive disorder (OR = 3.62; CI = 1.09-12.07) or multiple somatic symptoms (OR = 6.60; CI = 1.70-25.67). Only disruptive disorders significantly predicted adult BPD among adolescents with MDD versus continued MDD in adulthood (OR = 3.59; CI = 1.17-10.97). Only a few adolescents with hypomania spectrum episodes continued to have BPD as adults, and anxiety disorders appeared to increase this risk. CONCLUSIONS Although most of the identified potential risk factors are likely general predictors of continued mood disorders, disruptive disorders emerged as specific predictors of developing adult BPD among adolescents with MDD.
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Affiliation(s)
- Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden.
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden.
| | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
| | - Gunilla Olsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden.
| | - Anne-Liis von Knorring
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden.
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Box 593, SE-75124, Uppsala, Sweden. .,Department of Neuroscience, Psychiatry, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
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12
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Genizi J, Srugo I, Kerem NC. The cross- ethnic variations in the prevalence of headache and other somatic complaints among adolescents in Northern Israel. J Headache Pain 2013; 14:21. [PMID: 23566020 PMCID: PMC3620373 DOI: 10.1186/1129-2377-14-21] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/19/2013] [Indexed: 11/26/2022] Open
Abstract
Background Headache is the most common cause for chronic or recurrent pain in childhood and adolescence. Chronic pain may have a long-term effect on adolescents. It might contribute to functional limitations, such as poor school attendance, and it may adversely affect development of healthy social relationships. The aim of our study was to examine the cross- ethnic variation in the prevalence of headache in a non- clinical sample of adolescents in Northern Israel and to learn about its association to other somatic complaints. Methods A self-administered, anonymous questionnaire was presented to 2,088 tenth grade students attending 19 high-schools in Northern Israel (all the public high schools within two districts). Participants were Jews and Arabs, the latter including Muslim, Christians, and Druze, aged 15 to 16. Parental and student consent was obtained from all participants. The study was approved by the IRB of our institution. Results All 2088 questionnaires were returned although only 2019 were usable and analyzed. Arab adolescents comprised 55% (1117) of the analyzed sample and Jews 45% (902), 56% of participants were girls. Of the Arab participants, 18.6% reported having frequent headaches (girls 25.3%, boys 9.1%, P<0.0001) much less than their Jewish peers (P<0.0001) among whom 27.9% reported having frequent headaches (girls 35.6%, boys 19% P<0.0001). Other somatic complaints such as abdominal pain, palpitations, disordered sleep and fatigue were more frequent in adolescents (Jews and Arabs, girls and boys) who suffered from headaches than in their peers who did not report having headaches (P<0.0001), the same pattern observed in the Jewish and the Arab group. Conclusions Headache is a frequent complaint among adolescents in Northern Israel. Jewish adolescents reported having headaches more frequently than their Arab peers. Those who suffered from frequent headaches also reported having significantly more other somatic complaints than adolescents without headaches. Girls had more somatic complaints then boys in the two ethnic groups.
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Affiliation(s)
- Jacob Genizi
- Pediatric Neurology Unit, Bnai Zion Medical Center, Haifa, Israel.
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13
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Bohman H, Jonsson U, Päären A, von Knorring L, Olsson G, von Knorring AL. Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC Psychiatry 2012; 12:90. [PMID: 22839681 PMCID: PMC3439696 DOI: 10.1186/1471-244x-12-90] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/17/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms. METHODS The total population of 16-17-year-olds in Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later. RESULTS Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders. CONCLUSIONS Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.
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Affiliation(s)
- Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, SE-75185, Uppsala, Sweden,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, SE-75185, Uppsala, Sweden
| | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Gunilla Olsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, SE-75185, Uppsala, Sweden
| | - Anne-Liis von Knorring
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, SE-75185, Uppsala, Sweden
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14
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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15
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Jedel E, Carlsson J, Stener-Victorin E. Health-related quality of life in child patients with temporomandibular disorder pain. Eur J Pain 2012; 11:557-63. [PMID: 16935534 DOI: 10.1016/j.ejpain.2006.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 07/12/2006] [Accepted: 07/17/2006] [Indexed: 11/29/2022]
Abstract
UNLABELLED Temporomandibular disorders (TMDs) occurs frequently in children and measuring health-related quality of life (HRQL) can complement efficacy measures, offering a complete picture of the impact of disease and treatment on overall well-being. AIM To compare HRQL, pain threshold (PT) and range of motion (ROM) in child patients with temporomandibular disorder (TMD) pain and an age and gender matched control group. METHODS The study design was a controlled cross-sectional study. Forty-two children participated in the study. Twenty-one child patients referred to a dental pediatric clinic for specialist treatment because of TMD pain and an age and gender matched control group completed the Child health questionnaire-child form 87 (CHQ-CF87). PT was measured with Pain matcher and ROM in terms of maximum unassisted mandibular opening was measured with a ruler. RESULTS The child patients with pain more than once a week had a pain duration ranging from 3 months to almost 6 years. The median for pain intensity measured with visual analogue scale (VAS) was 47 ranging from 5 to 80 and the median for behavioral rating scale (BRS) was 3 ranging from 1 to 4. Child patients with TMD pain more than once a week reported significantly lower scores in CHQ-CF87 when compared with a control group. The results for PT and ROM were non-significant. CONCLUSION CHQ-CF87 could be used for measuring health and to evaluate the efficacy of treatment in child patients with TMD pain.
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Affiliation(s)
- Elizabeth Jedel
- Faculty of Health and Caring Sciences, Institute of Occupational and Physical Therapy, Sahlgrenska Academy at Göteborg University, SE-40530 Göteborg, Sweden.
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Prevalence and risk factors of unexplained somatic symptoms in school-aged children of Sharkia Governorate. MIDDLE EAST CURRENT PSYCHIATRY 2011. [DOI: 10.1097/01.xme.0000405086.70462.8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Mary Lynn Dell
- Division of Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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18
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Leo RJ, Srinivasan SP, Parekh S. The Role of the Mental Health Practitioner in the Assessment and Treatment of Child and Adolescent Chronic Pain. Child Adolesc Ment Health 2011; 16:2-8. [PMID: 32847226 DOI: 10.1111/j.1475-3588.2010.00578.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic and recurrent benign pain complaints are common among children and adolescents. Although many young persons with chronic pain adapt well, a small, but significant, proportion experience marked functional deficits. Pain can produce life disruptions, e.g. impeding activities and maturation, and interferes with family functioning. Conventional medically-based approaches have been inadequate in addressing chronic pain and its sequelae. Instead, effective management requires an interdisciplinary approach involving paediatricians and mental health practitioners working collaboratively to treat psychiatric comorbidities, enhance the patient's functional adaptation, restore the child or adolescent's maturational and social capabilities and reduce family disruptions.
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Affiliation(s)
- Raphael J Leo
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shiva Prakash Srinivasan
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shrenik Parekh
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
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Bohman H, Jonsson U, Von Knorring AL, Von Knorring L, Päären A, Olsson G. Somatic symptoms as a marker for severity in adolescent depression. Acta Paediatr 2010; 99:1724-30. [PMID: 20545935 DOI: 10.1111/j.1651-2227.2010.01906.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study aims to investigate the prevalence of somatic symptoms in depressed adolescents and in their healthy peers. A second aim is to investigate the correlation, in the depressed adolescents, between the number of somatic symptoms and severe concurrent symptoms, signs and life events. METHODS The total population of 16-17 year olds - in the city of Uppsala - was screened for depression and then interviewed using a structured interview questionnaire. Depressed subjects and matched controls were identified. A total of 177 pairs were used for pair-wise analyses of somatic symptoms. Severe symptoms, signs and life events were selected for analysing their relation to depression with somatic symptoms. RESULTS The adolescents with depressive disorders experienced considerably more somatic symptoms than their healthy controls. The duration and depth of the depression correlated with the number of somatic symptoms. There was a strong correlation between depression with many somatic symptoms and suicidal plans/thoughts, suicidal attempts, disruptive behaviour, as well as multiple stressful relationships. CONCLUSION This study demonstrates that somatic symptoms are common in adolescent depression. Multiple somatic symptoms within depression imply a higher severity in terms of duration, depth and psychiatric comorbidity. The strong correlation with suicidal plans, suicidal attempts and disruptive behaviour is concerning.
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Affiliation(s)
- Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
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20
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Helgeland H, Sandvik L, Mathiesen KS, Kristensen H. Childhood predictors of recurrent abdominal pain in adolescence: A 13-year population-based prospective study. J Psychosom Res 2010; 68:359-67. [PMID: 20307703 DOI: 10.1016/j.jpsychores.2009.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 10/13/2009] [Accepted: 10/20/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate maternal and child emotional symptoms, physical health problems, and negative life events measured at children's age 18 months and 12 years as potential predictors for self-reported recurrent abdominal pain (RAP) in adolescents (14 years). METHODS A population-based prospective study conducted at child health clinics (preventive health care) in Norway followed a cohort of 916 mothers with children from children's age 18 months until adolescence. Child self-report was obtained from 12 years of age. Outcome measure was adolescent self-reported RAP. RESULTS Of 456 adolescents, 58 (13%) reported RAP. Of these, 36 (62%) were girls. By multivariate analyses, the following maternal factors predicted RAP in adolescence: psychological distress at children's age 18 months (OR, 2.5; 95% CI, 1.3-4.8) and a maternal history of psychological distress at children's age 12 years (OR, 3.2; 95% CI, 1.7-6.2). The following child factors measured at age 12 years predicted RAP in adolescence: abdominal (OR, 2.5; 95% CI, 1.3-4.9) and extraintestinal pain (OR, 2.3; 95% CI, 1.2-4.4) by maternal report, self-reported frequent extraintestinal pain (OR, 2.9; 95% CI, 1.4-5.9), and self-reported depressive symptoms (OR, 2.4; 95% CI, 1.1-5.1). Negative life events and physical health in mothers and toddlers did not predict RAP. CONCLUSIONS This is the first cohort study that finds maternal psychological distress in early childhood to predict RAP in their offspring 13 years later. Our results support that maternal psychological distress and preadolescent children's depressive and somatic symptoms may play a role in the development of RAP.
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Affiliation(s)
- Helene Helgeland
- Department of Child and Adolescent Psychiatry, Innlandet Hospital Trust, Gjovik, Norway.
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21
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Janssens KAM, Rosmalen JGM, Ormel J, van Oort FVA, Oldehinkel AJ. Anxiety and depression are risk factors rather than consequences of functional somatic symptoms in a general population of adolescents: the TRAILS study. J Child Psychol Psychiatry 2010; 51:304-12. [PMID: 19788552 DOI: 10.1111/j.1469-7610.2009.02174.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related to FSS. We hypothesized that anxiety contributes to the development of FSS and that depression is a consequence of FSS. METHODS FSS, anxiety, and depression were measured in adolescents (N = 2230, 51% women) by subscales of the Youth Self-Report during three assessment waves (adolescents successively aged: 10-12, 12-14, and 14-17) and by corresponding subscales of the Child Behavior Checklist. Using structural equation models, we combined trait and state models of FSS with those of anxiety and depression, respectively. We identified which relationships (contemporaneous and two-year lagged) significantly connected the states of FSS with the states of anxiety and depression. RESULTS Trait variables were all highly interrelated (r = .54-.63). Contrary to our hypothesis, both state anxiety (beta = .35) and state depression (beta = .45) had a strong contemporaneous effect on state FSS. In turn, state FSS had a weak two-year lagged effect on state anxiety (beta = .11) and an even weaker effect on state depression (beta = .06). CONCLUSIONS While the effect of anxiety and depression on FSS is strong and immediate, FSS exert a weaker and delayed influence on anxiety and depression. Further research should be done to detect the exact ways in which anxiety and depression lead to FSS, and FSS lead to anxiety and depression.
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Affiliation(s)
- Karin A M Janssens
- Interdisciplinary Center for Psychiatric Epidemiology and Graduate Schools for Behavioral and Cognitive Neurosciences and for Health Research, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands.
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22
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Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM. Functional somatic symptoms and associated impairment in 5-7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol 2009; 24:625-34. [PMID: 19633995 DOI: 10.1007/s10654-009-9366-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 06/25/2009] [Indexed: 01/26/2023]
Abstract
Research on somatisation or functional disorders, characterised by the subjective report of physical symptoms in the absence of clear physical pathology, in young children is limited. This study investigates the distribution, types and co-occurrence of parent-reported functional somatic symptoms (FSS) and their impairment in a population-based sample of Danish 5-7-year-old children. Data were obtained from a 5-7-year follow-up of the Copenhagen Child Cohort 2000. The entire study population included 3,000 randomly sampled children from the cohort. Among these FSS measures were obtained for 1,327 children. The newly introduced parent interview, the soma assessment interview, was used to assess the child's FSS. Impairing symptoms were defined as FSS that caused substantial discomfort, impairment of everyday life, absence from day-care or school and/or help-seeking in the health care system. The 1-year prevalence of any FSS was 23.2% (N = 308) and higher in girls than boys (27.6 vs. 18.8%, P < 0.0001). Impairing FSS were found in 4.4% (N = 58). Pain complaints, i.e. limb pain, headache and abdominal pain, were the most frequently reported FSS. Among the 308 children with FSS, 66 (21.4%) presented with two or more of these functional pain complaints, while 15 (4.9%) had all three types. The findings indicate that FSS are common health complaints in 5-7-year-old children. A subgroup with impairing FSS with a likely need of clinical intervention was identified. This suggests that a somatisation pattern may start early in life and call for future studies to include associated impairment in the investigation of childhood FSS.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Regional Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark.
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23
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González-Valcárcel Espinosa M, Alonso García L, Brañas Fernández P, Pedreira Massa JL. [Hospital admissions in adolescents with psychosomatic illnesses]. An Pediatr (Barc) 2008; 69:115-8. [PMID: 18755114 DOI: 10.1157/13124888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To determine the prevalence of hospital admissions due to psychosomatic diseases in the adolescents. To define the most frequent symptomatology that accompanies these disorders, the triggering factors, the complementary tests made and the possible existence of psychiatric illness in the parents. PATIENTS AND METHOD A retrospective study was carried out with patients of 10 to 18 years who were admitted to the Niño Jesús Children's Hospital during the period from January 2002 to August 2006, whose discharge diagnosis included symptomatology of psychosomatic origin. RESULTS The number of medical histories was 33. In this period the frequency of admissions due to psychosomatic diseases was 2.6 %. We found a predominance of female patients, with an average age of 11.5 years; the most frequent symptom was abdominal pain, isolated or accompanied by other pathology. The duration of the symptom before going to the hospital was 11 days. In 13/33 (39.4 %) of the cases previous symptoms of psychosomatic aetiology existed. The complementary study to discard organic disease was negative in all cases. The average stay was 5 days. The existence of triggering factors was found in 21/33 (63.6 %), school problems being the most common. In 7/33 (21 %) there was a family history of psychiatric disease. CONCLUSIONS The most frequent somatic symptom was abdominal pain, being the triggering factor in most of the patients. The complementary study did not find significant abmormalities. In one out of five cases there was a family history of psychiatric disease. It is recommended to give these patients multidisciplinary care from the beginning of the stay, using consultation and link technique.
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McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Eccleston C, Finley GA, Goldschneider K, Haverkos L, Hertz SH, Ljungman G, Palermo T, Rappaport BA, Rhodes T, Schechter N, Scott J, Sethna N, Svensson OK, Stinson J, von Baeyer CL, Walker L, Weisman S, White RE, Zajicek A, Zeltzer L. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. THE JOURNAL OF PAIN 2008; 9:771-83. [PMID: 18562251 DOI: 10.1016/j.jpain.2008.04.007] [Citation(s) in RCA: 589] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 04/09/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
Abstract
UNLABELLED Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 26 professionals from academia, governmental agencies, and the pharmaceutical industry participated in a 2-stage Delphi poll and a consensus meeting that identified core outcome domains and measures that should be considered in clinical trials of treatments for acute and chronic pain in children and adolescents. Consensus was refined by consultation with the international pediatric pain community through announcement of our recommendations on the Pediatric Pain List and inviting and incorporating comments from external sources. There was consensus that investigators conducting pediatric acute pain clinical trials should consider assessing outcomes in pain intensity; global judgment of satisfaction with treatment; symptoms and adverse events; physical recovery; emotional response; and economic factors. There was also agreement that investigators conducting pediatric clinical trials in chronic and recurrent pain should consider assessing outcomes in pain intensity; physical functioning; emotional functioning; role functioning; symptoms and adverse events; global judgment of satisfaction with treatment; sleep; and economic factors. Specific measures or measurement strategies were recommended for different age groups for each domain. PERSPECTIVE Based on systematic review and consensus of experts, core domains and measures for clinical trials to treat pain in children and adolescents were defined. This will assist in comparison and pooling of data and promote evidence-based treatment, encourage complete reporting of outcomes, simplify the review of proposals and manuscripts, and facilitate clinicians making informed decisions regarding treatment.
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25
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Health-related quality of life in survivors of BMT for paediatric malignancy: a systematic review of the literature. Bone Marrow Transplant 2008; 42:73-82. [DOI: 10.1038/bmt.2008.156] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007; 27:855-71. [PMID: 17804131 DOI: 10.1016/j.cpr.2007.07.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 06/04/2006] [Accepted: 02/07/2007] [Indexed: 01/30/2023]
Abstract
A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.
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Affiliation(s)
- D Mary Eminson
- Bolton Hospitals NHS Trust, Child and Adolescent Mental Health Services, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton BL4 OJR, UK.
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27
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Abstract
Headache can affect all aspects of a child's functioning, leading to negative affective states (eg, anxiety, depression, anger) and increased psychosocial problems (for instance, school absences, problematic social interactions). For children and adolescents who experience frequent headache problems, comorbid psychological issues are a well-recognized, but poorly understood, clinical phenomenon. The confusion surrounding the relationship between pediatric headache and psychopathology exists for several reasons. First, in some cases, headache has been inappropriately attributed to psychological or personality features based on anecdotal observations or interpretations that go beyond the available data. Additionally, measures of psychopathology have not always adhered to the American Psychiatric Association's diagnostic criteria, thus reducing the reliability of diagnostic judgments. Furthermore, the diagnosis of headache has not always followed standard criteria, and has been complicated by the emergence of new terms and evolving measures. Finally, methodological shortcomings, such as incomplete descriptions of the procedures and criteria used for the study, inadequate descriptions of headache severity, lack of a control group for comparison with individuals without headaches, reliance primarily on cross-sectional research designs that are often discussed with inferences to causal hypotheses, and the use of unstandardized assessment measures, have significantly limited the validity of research findings. The goal of the current review is to examine the extant literature to provide the most up-to-date picture on what the research has made available about the magnitude, specificity, and causes of psychopathology in children and adolescents with headache, in an effort to further elucidate their relationship and prompt a more methodologically rigorous study of these issues.
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Affiliation(s)
- Scott W Powers
- Division of Behavioural Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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28
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Little CA, Williams SE, Puzanovova M, Rudzinski ER, Walker LS. Multiple somatic symptoms linked to positive screen for depression in pediatric patients with chronic abdominal pain. J Pediatr Gastroenterol Nutr 2007; 44:58-62. [PMID: 17204954 PMCID: PMC3144697 DOI: 10.1097/01.mpg.0000243423.93968.7c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Abdominal pain is a frequent childhood complaint, comprising 2% to 4% of all reasons for pediatric office visits. Patients referred for evaluation of chronic abdominal pain (CAP) frequently present with comorbid nonspecific somatic symptoms that may complicate the medical evaluation and lead to unnecessary diagnostic tests and procedures. We tested the hypothesis that multiple nongastrointestinal (GI) symptoms in children presenting with CAP is a marker for clinically significant levels of depressive symptoms. METHODS Participants were 400 consecutive new patients (ages 8-17 years; 63% female) referred to the pediatric gastroenterology clinic for evaluation of abdominal pain of > 3 months' duration. Patients reported how frequently they experienced 7 non-GI symptoms. Patients were screened for depression with the Children's Depression Inventory. RESULTS On the basis of their Children's Depression Inventory scores, 58 (15%) patients had a positive screen for clinically significant depressive symptoms. Patients with a positive versus negative depression screen did not differ by sex, pain duration or laboratory evidence of organic disease. Patient report of > or = 3 non-GI symptoms maximized sensitivity (71%) and specificity (75%) in prediction of depression screening results. With each addition of a non-GI symptom, the odds of a positive screen for depression doubled. CONCLUSIONS For patients with and without organic disease findings associated with CAP, the presence of > or = 3 non-GI symptoms should signal the practitioner to evaluate for depression and may be used as an indicator of the likelihood of depression in the absence of specific inquiry into emotional symptoms.
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Affiliation(s)
- Cheryl A. Little
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Sara E. Williams
- Department of Pediatrics, Division of Adolescent Medicine and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Martina Puzanovova
- Department of Pediatrics, Division of Adolescent Medicine and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Erin R. Rudzinski
- Department of Pathology, Division of Investigative Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn S. Walker
- Department of Pediatrics, Division of Adolescent Medicine and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
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Abstract
BACKGROUND Little is known about the extent of pain among adolescent psychiatric patients, and the relationships with psychosocial factors and psychiatric symptoms. METHOD A representative sample of 129 adolescent patients were assessed with measures including the Youth Self-Report, the Mood and Feelings Questionnaire, and instruments assessing self-perceptions, coping styles, stresses, sociodemographic factors, and childhood abuse. RESULTS More than half of the adolescents (54%) reported to be bothered currently by frequent pain. Frequent pain correlated with depression, self-harm, suicide attempt, and with ruminative and emotion oriented coping. Adolescents suffering from frequent pain had more often experienced childhood abuse/neglect. A stepwise multiple regression analysis revealed that depression, alcohol intoxication and childhood neglect were the strongest concurrent predictors of frequent pain. CONCLUSIONS Clinicians should ask child and adolescent psychiatric patients about pain, and be aware of possible connections with abuse/neglect, depression and suicidality.
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Affiliation(s)
- Bjørn Reigstad
- Department of Child and Adolescent Psychiatry, Nordlandssykehuset, Bodø, Norway. E-mail:
| | - Kirsti Jørgensen
- Department of Child and Adolescent Psychiatry, Nordlandssykehuset, Bodø, Norway. E-mail:
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
BACKGROUND The proportion of Swedish schoolchildren that reports psychosomatic complaints has increased during recent decades, parallel to major structural changes in Swedish society. AIM To investigate the association of psychosomatic complaints in relation to household socio-economic conditions. METHODS Cross-sectional study based on data from child supplements linked to nationally representative household surveys in Sweden during 2000-2003, covering a sample of 5390 children aged 10-18 y. Symptom variables were based on child interviews, while data from parental interviews were used to create socio-economic variables. RESULTS Girls more often reported headache and recurrent abdominal pain (RAP) than boys, and these differences became more pronounced with age. Economic stress in the household was associated with headache (OR 1.21, p<0.05), RAP (OR 1.46, p<0.001) as well as difficulties falling asleep (OR 1.35, p<0.01), while there were no consistent associations between symptoms and social class or unemployed parents. Children in single-parent families consistently reported somewhat more symptoms than children in two-parent families (OR 1.26 for at least two of the three symptoms, p<0.05). CONCLUSION Economic stress, but not social class, was a significant but moderate risk factor for all three psychosomatic symptoms. It is possible that a growing proportion of families in economic stress has contributed to the parallel increase in reported psychosomatic complaints among Swedish schoolchildren. Further studies are needed to clarify the relation between lack of money, relational strain/support and psychosomatic complaints.
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Affiliation(s)
- Viveca Ostberg
- Centre for Health Equity Studies, CHESS, Stockholm University/Karolinska Institute, Stockholm, and Department of Clinical Sciences, Karolinska University Hospital, Huddinge, Sweden
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Mulvaney S, Lambert EW, Garber J, Walker LS. Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain: a 5-year longitudinal study. J Am Acad Child Adolesc Psychiatry 2006; 45:737-744. [PMID: 16721324 PMCID: PMC3124957 DOI: 10.1097/10.chi.0000214192.57993.06] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. METHOD The Children's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated. RESULTS A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived self-worth, and more negative life events. CONCLUSIONS These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated long-term risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning.
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Affiliation(s)
- Shelagh Mulvaney
- Dr. Mulvaney is with the Department of Pediatrics and Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Lambert is with the Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Garber is with the Department of Psychology, Vanderbilt University; and Dr. Walker is with the Department of Pediatrics, Vanderbilt University Medical Center.
| | - E Warren Lambert
- Dr. Mulvaney is with the Department of Pediatrics and Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Lambert is with the Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Garber is with the Department of Psychology, Vanderbilt University; and Dr. Walker is with the Department of Pediatrics, Vanderbilt University Medical Center
| | - Judy Garber
- Dr. Mulvaney is with the Department of Pediatrics and Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Lambert is with the Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Garber is with the Department of Psychology, Vanderbilt University; and Dr. Walker is with the Department of Pediatrics, Vanderbilt University Medical Center
| | - Lynn S Walker
- Dr. Mulvaney is with the Department of Pediatrics and Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Lambert is with the Center for Evaluation and Program Improvement, Vanderbilt University; Dr. Garber is with the Department of Psychology, Vanderbilt University; and Dr. Walker is with the Department of Pediatrics, Vanderbilt University Medical Center
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Abstract
This study was conducted to establish race/ethnic-specific prevalence for 10 physical symptoms in American youths and to examine the extent to which socioeconomic status and depressive symptoms explained racial differences in those symptoms. This descriptive study was based on a cross-sectional analysis of survey data from Wave I of the National Longitudinal Study of Adolescent Health including a school-based sample of over 20,000 adolescents in Grades 7 through 12. Self-reported physical symptoms during the past 12 months were examined. White youths reported the highest frequency of headaches, musculoskeletal pain, and dizziness; feeling hot, chest pain, cold sweats, and urinary symptoms were more common in Black youths. The three symptoms reported by Whites remained significant after controlling for family income and depressive symptoms, whereas racial differences in the four symptoms prominent in Blacks were accounted for by family income and depressive symptoms. Findings highlight racial differences in symptom types and in psychosocial factors contributing to physical symptoms in adolescents and warn against health-care providers' stereotyping associations between physical symptoms and socioeconomic status.
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Affiliation(s)
- Hyekyun Rhee
- Department of Family, Community and Mental Health Systems, University of Virginia, School of Nursing, Charlottesville, VA 22908, USA.
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Santalahti P, Aromaa M, Sourander A, Helenius H, Piha J. Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland. Pediatrics 2005; 115:e434-42. [PMID: 15805346 DOI: 10.1542/peds.2004-1261] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aims of the study were to determine whether the prevalence of children's somatic symptoms, such as headache, abdominal pain, other pain, and nausea and vomiting, changed from 1989 to 1999 and to study the similarity of parents' and children's reports of the child's symptoms. Furthermore, the aims were to explore possible comorbidity in somatic symptoms and to investigate the associations between somatic and psychiatric symptoms. METHODS Two cross-sectional, representative samples were compared. All children born in 1981 (1989 sample, n = 985) and 1991 (1999 sample, n = 962) and living in selected school districts in southwest Finland served as study samples. The response rate for the 1989 sample was 95% and that for the 1999 sample was 86%. Both children and parents were asked about the children's somatic symptoms, whereas parents, children, and teachers were asked about psychiatric symptoms. To study psychiatric symptoms, the Children's Depression Inventory and Rutter's parent and teacher scales were used. RESULTS The prevalence of frequent headaches and abdominal pain increased somewhat from 1989 to 1999. Parents often failed to recognize their children's psychosomatic problems. Child-reported somatic symptoms were associated with conduct and hyperactivity symptoms, in addition to a previously well-documented association with depression. In associations between somatic symptoms and psychiatric symptoms, there were some differences between the 1989 and 1999 samples. CONCLUSIONS In clinical work, questions about somatic and psychiatric symptoms should also be addressed to children themselves, because parents and teachers do not always recognize children's symptoms. When somatic problems are being evaluated, psychiatric symptoms should be asked about, and vice versa. More research is needed to explore the reasons for the increased prevalence of somatic symptoms and their associations with psychiatric symptoms.
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Affiliation(s)
- Paivi Santalahti
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland.
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Chapman MV. Neighborhood quality and somatic complaints among American youth. J Adolesc Health 2005; 36:244-52. [PMID: 15737781 DOI: 10.1016/j.jadohealth.2004.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Accepted: 02/10/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE This study examines the relationship between the social context of neighborhood and somatic complaints in a national probability sample of adolescents. METHODS Structural equation modeling is used to estimate paths of influence between neighborhood quality and somatic complaints. An analysis of variance highlights the relationship between demographic characteristics and neighborhood quality. RESULTS Neighborhood quality appears to play an indirect role in producing somatic complaints in adolescents. Linkages between correlates of somatic complaints, such as stressful life events, family environment, psychological distress, and measures of neighborhood quality are discussed. CONCLUSIONS These findings emphasize the need to conceptualize adolescent somatization as contextually dependent and to use an ecological perspective when intervening with somaticizing teens.
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Affiliation(s)
- Mimi V Chapman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3550, USA.
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35
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Haavisto A, Sourander A, Multimäki P, Parkkola K, Santalahti P, Helenius H, Nikolakaros G, Nikalakaros G, Kumpulainen K, Moilanen I, Piha J, Aronen E, Puura K, Linna SL, Almqvist F. Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study. J Affect Disord 2004; 83:143-54. [PMID: 15555707 DOI: 10.1016/j.jad.2004.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Revised: 06/28/2004] [Accepted: 06/28/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim is to study associative and predictive factors for self-reported depressive symptoms among 18-year-old boys. METHODS The participants in this community-based 10-year follow-up study consisted of 2348 boys born during 1981. At baseline, three informant sources were used: parents, teachers, and the children themselves. At follow-up, self-report questionnaires were used to study boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI). RESULTS Poor adaptive functioning within family and in education, having fewer than two close friends, somatic health problems, and using illicit drugs were all independently associated with a high level of depressive symptoms in the cross-sectional data at age 18. Self-reported depressive symptoms (Children's Depression Inventory, CDI) at age 8 independently predicted an increased number of depressive symptoms 10 years later. LIMITATIONS Only self-reported questionnaires were used at follow-up. CONCLUSIONS The high association between depressive symptoms at age 8 and at age 18 gives grounds for paying special attention to children's own intimations of distress already in the early school years. Using self-report screening questionnaires in school health care may help identify children's depressive symptoms.
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Affiliation(s)
- Antti Haavisto
- Child Welfare and School Health Care Clinic, Joint Authority of Health Work in Rauma Region, PO Box 283, 26101 Rauma, Finland.
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36
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Virtanen R, Aromaa M, Koskenvuo M, Sillanpää M, Pulkkinen L, Metsähonkala L, Suominen S, Rose RJ, Helenius H, Kaprio J. Externalizing problem behaviors and headache: a follow-up study of adolescent Finnish twins. Pediatrics 2004; 114:981-7. [PMID: 15466094 DOI: 10.1542/peds.2003-1103-l] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the association of teacher- and parent-rated behavior with headache in a prospective follow-up study of adolescent Finnish twins. METHODS Questionnaire data were collected during 1995-2001 from a nationwide sample of Finnish families of 11-year-old twins who were born 1983-1987 (n = 5393) and again at age of 14. Psychological factors were measured by using parents' and teachers' ratings of a 37-item multidimensional rating instrument at the ages of 11 and 14. RESULTS At age 11, headache frequency (5 categories) was associated with total scales of externalizing and internalizing problem behaviors and adaptive behaviors, assessed by parents, but only with externalizing problem behaviors assessed by teachers. Results were similar at age 14. The incidence of at least monthly headache between the ages of 11 and 14 years was predicted by externalizing problem behaviors and 2 subscales of adaptive behaviors: constructiveness and poor compliance. In twin pairs discordant for headache, externalizing and internalizing problem behaviors were more common among headache sufferers than among headache-nonsufferers. Headache-discordant monozygotic co-twins confirmed the association of externalizing problem behaviors with headache. CONCLUSIONS The frequency of adolescents' headache is predicted by psychological factors, especially by externalizing problem behaviors. This seems to be independent of genetic or familial influences on behavior and headache. Behavioral problems may be a sign of worsening of headache or vice versa.
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Affiliation(s)
- Ruut Virtanen
- Department of Public Health, University of Turku, Lemminkäisenkatu 1, 20014, Turku, Finland.
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37
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Breau LM, Camfield CS, McGrath PJ, Finley GA. Risk factors for pain in children with severe cognitive impairments. Dev Med Child Neurol 2004; 46:364-71. [PMID: 15174527 DOI: 10.1017/s001216220400060x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diagnosing cause of pain in children with severe cognitive impairments is difficult due to their problems with communication. Identification of risk factors for specific pain etiologies might help professionals in this task. The aim of this study was to determine whether child-related characteristics increase risk for specific types of pain. Participants were the caregivers of 41 females and 53 males with moderate to profound mental retardation, who were aged 3 to 18 years 8 months (mean 10:1, SD 4:4) but who communicated at the level of a typical child of 13.8 months (SD 10 months): 44 of the children had cerebral palsy (CP) and 59 a seizure disorder. Caregivers reported the cause of children's episodes of pain for four 1-week periods over 1 year. Logistic regression analyses were used to predict occurrence of specific types of pain using children's demographic, medical, and physical characteristics. Children had 406 episodes of pain due to accident, gastrointestinal conditions, musculoskeletal problems, infection, recurrent conditions, and common childhood causes. Results indicated that a unique set of risk factors predicted each pain type in this sample. Significant risk factors for pain included: lack of visual impairment and leg impairment (accidental pain); seizures, leg impairment, and greater number of medications (non-accidental pain); being male and tube fed (musculoskeletal pain); age <7 years, absence of CP, visual impairment, and less frequent medical monitoring (infection pain); being female and with arm impairment (gastrointestinal pain); and being tube fed and taking fewer medications (common childhood pains). In most cases, models were more specific than sensitive, indicating that the significant predictors are more useful for eliminating potential pain causes. These results suggest that population risk factors may be helpful in structuring diagnostic investigations for individual children with severe cognitive impairments.
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Affiliation(s)
- Lynn M Breau
- Pediatric Pain Research Lab, IWK Health Centre, Halifax, Nova Scotia, Canada.
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38
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Hagekull B, Bohlin G. Predictors of middle childhood psychosomatic problems: An emotion regulation approach. INFANT AND CHILD DEVELOPMENT 2004. [DOI: 10.1002/icd.366] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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39
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Sáinz de la Maza. VT, Hernández Bou S, Carballo Ruano E, García García J, Macià Rieradevall E, Alda Díez J, Luaces Cubells C. Trastornos somatomorfos: una entidad emergente en pediatría. An Pediatr (Barc) 2003. [DOI: 10.1016/s1695-4033(03)77988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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40
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Abstract
This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African-American and Caucasian young women enrolled (from racially congruent households) at ages 9-10 in the longitudinal multicenter National Heart Lung and Blood Institute's Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19-23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self-reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. Results show that chronic pain is common in this population of young women, although based on the CPG severity scores, only a small percentage is dysfunctional. Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40-3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16-3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African-Americans controlling for SES, but they were also reported to have an earlier onset.
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Affiliation(s)
- Octavia Plesh
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, 707 Parnassus Avenue, San Francisco, CA 94143-0758, USA Department of Nutritional Sciences and Toxicology, Center for Weight and Health, University of California, Berkeley, Berkeley, CA 94720, USA Department of Preventive and Restorative Dental Sciences, Center Addressing Disparities in Children's Oral Health, Center for Health and Community, University of California, San Francisco, 3333 California St, Ste 495, San Francisco, CA 94143-1361, USA
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41
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Fichtel A, Larsson B. Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents. Headache 2002; 42:766-75. [PMID: 12390639 DOI: 10.1046/j.1526-4610.2002.02178.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The psychosocial impact of headache combined with other pains has previously been insufficiently investigated. OBJECTIVE The present study examined the prevalence of headache, its comorbidity with other pains and psychosocial impact among adolescents. METHODS 793 adolescents in a sample recruited from 8 schools in the middle of Sweden were assessed. RESULTS Forty-five percent of the adolescents reported ongoing pain during assessment and more than half of the adolescents reported at least one frequent pain during the previous 6 months. The most common pain among girls was headache (42%), but for boys muscle pain (32%) was most prevalent. Number of pains and perceived pain disability were also higher among girls than boys. One-third of the headache sufferers had headache only, while one-third reported one other frequent pain and the others had at least two other frequent pains. Overall, adolescents with frequent headaches had higher levels of anxiety or depressive symptoms, in addition to functional disability and usage of analgesic medication. Frequent headache sufferers reported more problems in everyday life areas than those with infrequent headaches. CONCLUSIONS It is recommended that adolescents suffering from recurrent headaches routinely should be asked about the presence of other pains, anxiety and depressive symptoms, medication usage, in addition to psychosocial consequences in their everyday life activities. Longitudinal research is also needed to delineate causal relationships between psychosocial factors and recurrent pains, in particular regarding possible sex differences.
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Affiliation(s)
- Asa Fichtel
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala Science Park, S-751 83, Sweden
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42
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Fearon P, Hotopf M. Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study. BMJ (CLINICAL RESEARCH ED.) 2001; 322:1145. [PMID: 11348907 PMCID: PMC31590 DOI: 10.1136/bmj.322.7295.1145] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To elucidate the associations between frequent headache and psychosocial factors in childhood and to determine whether such children are at an increased risk of headache, multiple physical symptoms, and psychiatric symptoms in adulthood. DESIGN Population based birth cohort study. SETTING General population. PARTICIPANTS People participating in the national child development study, a population based birth cohort study established in 1958. MAIN OUTCOME MEASURES Headache, multiple physical symptoms, and psychiatric morbidity at age 33. RESULTS Headache in childhood was associated with several psychosocial factors. Prospectively, children with frequent headache had an increased risk in adulthood of headache (odds ratio 2.22, 95% confidence interval 1.62 to 3.06), multiple physical symptoms (1.75, 1.46 to 2.10), and psychiatric morbidity (1.41, 1.20 to 1.66). The outcomes of headache and multiple physical symptoms were not accounted for by psychiatric morbidity. CONCLUSION Children with headache are at an increased risk of recurring headache in adulthood and may complain of other physical and psychiatric symptoms. Strategies for coping with psychosocial adversity in childhood may improve the prognosis in adulthood.
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Affiliation(s)
- P Fearon
- Institute of Psychiatry and Guy's, King's and St Thomas's School of Medicine, De Crespigny Park, London SE5 8AF.
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43
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Boey CC, Goh KL. Stressful life events and recurrent abdominal pain in children in a rural district in Malaysia. Eur J Gastroenterol Hepatol 2001; 13:401-4. [PMID: 11338070 DOI: 10.1097/00042737-200104000-00017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The purpose of this study was to look at the correlation between recurrent abdominal pain and the presence of recent stressful life events among schoolchildren in a rural district in Malaysia. METHOD This is a cross-sectional study of schoolchildren aged 9-15 years based in Kuala Langat, a rural district located in the south-west of the Malaysian state of Selangor. Schoolchildren were selected randomly and given questionnaires to fill in. This was followed by interview with the children on the same day by one of the authors (CCMB) to ensure consistency of response. Recurrent abdominal pain was defined as 'at least three episodes of abdominal pain, severe enough to affect their activities over a period longer than three months' [1]. The children were also asked to answer either 'yes' or 'no' to whether they had experienced various life events in the previous year. RESULTS A sample of 1462 schoolchildren (722 boys and 740 girls) aged between 9 and 15 years were included in the study. There were 768 Malays, 393 Chinese and 301 Indians. Of these 1462 children, 161 (11.0%) had recurrent abdominal pain. On performing multiple logistic regression analysis, two life events were significantly associated with recurrent abdominal pain: death of a family member (P = 0.008; odds ratio 0.61, 95% CI 0.43-0.88) and a change in occupation of an immediate family member (P = 0.003; odds ratio 0.53, 95% CI 0.35-0.81). CONCLUSION This study suggests that recurrent abdominal pain in children is associated with recent stressful life events in the children's lives.
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Affiliation(s)
- C C Boey
- Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
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Bandell-Hoekstra I, Abu-Saad HH, Passchier J, Knipschild P. Recurrent headache, coping, and quality of life in children: a review. Headache 2000; 40:357-70. [PMID: 10849029 DOI: 10.1046/j.1526-4610.2000.00054.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To clarify the concepts of coping with pain and quality of life (QoL) and to present a literature review of the strategies that children with recurrent headaches use to cope with their pain, the impact of recurrent headaches on children's QoL, and the influence of personal and situational variables on headache, coping, and QoL in children. METHODS The literature search encompassed published articles that were found by means of a CD-ROM search of MEDLINE (1966 to December 1998) and PsycLIT (1974 to December 1998) and the snowball method. RESULTS In pediatric headache research, only three studies have been found in which children report the use of various coping strategies, and only two studies considered QoL. Demographic factors and psychological variables such as depression, anger, and anxiety influence headache prevalence. The impact of headache-related variables such as headache type, severity, perceived cause, and prior experience on QoL has only been studied in adults. CONCLUSIONS More research on coping and QoL is needed in pediatric headache. The conceptual model that is presented in this article may serve as a guide.
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Affiliation(s)
- I Bandell-Hoekstra
- Department of Health Care Studies, Centre for Nursing Research, The Netherlands.; Department of General Practice, The Netherlands
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45
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Huikko E, Tuompo-Johansson E, Kairemo AC, Piha J, Moilanen I, Räsänen E, Tamminen T, Almqvist F. Behavioural/emotional symptoms among 8-9-year-old children with somatic symptoms or illnesses as reported by their teacher. Eur Child Adolesc Psychiatry 2000; 8 Suppl 4:55-61. [PMID: 10654134 DOI: 10.1007/pl00010701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to assess children's behavioural/emotional symptoms at school and to compare these symptoms of somatically healthy children with those of children with somatic illnesses or symptoms. The Rutter Teacher Questionnaire (RB2) was used for measuring psychiatric symptoms in 5813 children aged 8-9 years. The parents reported the somatic symptoms and illnesses of their children during the previous 12 months. One hundred and sixty one children had a marked or serious chronic illness, 292 had a mild chronic illness, and 92 had one or several symptoms. The findings suggest that boys with a marked or serious chronic somatic illness are prone to manifest psychiatric symptoms in their interactions with peers and teachers at school and that boys with a mild chronic illness have less psychiatric symptoms than healthy boys.
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Affiliation(s)
- E Huikko
- Tuusula Child Guidance Clinic, Finland
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46
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Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ. Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry 1999; 38:1093-101. [PMID: 10504807 DOI: 10.1097/00004583-199909000-00012] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine whether classification as pediatric "somatizers" identifies a group of children and adolescents at high risk for psychopathology, functional impairment, and frequent use of health services in a large, multisite study of pediatric primary care. METHOD Parental reports of frequent aches and pains and visits to the doctor for medically unexplained symptoms in children aged 4 to 15 years were used to construct a classification of somatization in pediatric primary care. Affected and unaffected children and adolescents were compared on measures of demographics, family functioning, psychopathology, functional status, and service use. RESULTS Classification as a somatizer was more common in adolescents, females, minority subjects, urban practices, nonintact families, and families with lower levels of parental education and was associated with heightened risk of clinician- and parent-identified psychopathology, family dysfunction, poor school performance and attendance, perceived health impairment, and more frequent use of health and mental health services. CONCLUSIONS Children classified as pediatric somatizers are at heightened risk for psychiatric disorder, family dysfunction, functional impairment, and frequent use of health services. Additional research is warranted, and clinicians should recognize the need for careful assessment and potential behavioral health referral in this population.
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Affiliation(s)
- J V Campo
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, USA.
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Egger HL, Costello EJ, Erkanli A, Angold A. Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry 1999; 38:852-60. [PMID: 10405503 DOI: 10.1097/00004583-199907000-00015] [Citation(s) in RCA: 289] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the associations of somatic complaints with DSM-III-R-defined depression, anxiety disorders, conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder in a population-based sample of children and adolescents. METHODS Data from 4 annual waves of interviews with 9- to 16-year-olds from the Great Smoky Mountains Study were analyzed. RESULTS Overall, somatic complaints were strongly associated with emotional disorders in girls and with disruptive behavior disorders in boys. For girls, stomach aches and headaches together and musculoskeletal pains alone were associated with anxiety disorders. For boys, stomach aches were associated with oppositional defiant disorder and attention-deficit hyperactivity disorder. Musculoskeletal pains were associated with depression in both girls and boys. CONCLUSIONS There were gender-, illness- and complaint-specific associations between somatic complaints and psychopathology. It appears likely that there are differences in the psychobiological processes underlying these associations in boys and girls. Clinical recommendations include screening children and adolescents with persistent complaints of headaches, stomach aches, or musculoskeletal pains for psychiatric disorders with an awareness that gender may affect the type of psychopathology associated with the somatic complaints.
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Affiliation(s)
- H L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Zwaigenbaum L, Szatmari P, Boyle MH, Offord DR. Highly somatizing young adolescents and the risk of depression. Pediatrics 1999; 103:1203-9. [PMID: 10353930 DOI: 10.1542/peds.103.6.1203] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if high levels of somatization symptoms in 13- to 16-year-olds from the general population predict risk of major depression and other psychiatric disorders 4 years later. METHOD Cohort study, using interview and self-report survey data from the 1983 Ontario Child Health Study (OCHS) and 1987 OCHS Follow-up. The study population included 1015 13- to 16-year-olds from the general community within Ontario. Baseline levels of somatization and emotional disorder were measured by the Survey Diagnostic Instrument, a checklist based on DSM-III criteria. Data were also collected for a range of sociodemographic factors, as well as the presence of chronic health problems. Major depression, anxiety disorders, and substance abuse and dependency at follow-up were measured using a self-administered questionnaire derived from the Diagnostic Interview Schedule. Bivariate and multiple logistic regression techniques were used to assess the relationship between high levels of somatization symptoms (>90th percentile) and later emotional morbidity, with adjustment for potential confounding factors, including gender and baseline disorders. RESULTS Highly somatizing adolescents are at increased risk of major depression 4 years later, an association that is not explained by detectable emotional disorder at baseline or gender differences between groups. There is an important interaction between somatization and emotional disorder in predicting risk of major depression. It is primarily the group of 13- to 16-year-olds not recognized as being emotionally disordered at the initial OCHS survey in which somatization symptoms increased risk of later depression. The young teen with high levels of somatic complaints had as much risk of later depression as his/her peer with more typical symptoms of emotional disorder. Highly somatizing adolescents were also more likely to describe panic attacks at 4-year follow-up. There was no increased risk of substance abuse/dependency in the highly somatizing group or in generalized anxiety. CONCLUSIONS High levels of somatic symptoms identified in young adolescents in the community represent a significant risk factor for major depression 4 years later, particularly in those individuals who do not present with more typical symptoms of emotional disorder. To detect the emergence of this serious emotional morbidity, adequate follow-up and continuity of care for these challenging patients are needed.
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Affiliation(s)
- L Zwaigenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Arvidson J, Larsson B, Lönnerholm G. A long-term follow-up study of psychosocial functioning after autologous bone marrow transplantation in childhood. Psychooncology 1999; 8:123-34. [PMID: 10335556 DOI: 10.1002/(sici)1099-1611(199903/04)8:2<123::aid-pon344>3.0.co;2-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Psychosocial functioning was assessed in 26 subjects treated with autologous bone marrow transplantation (ABMT) for leukaemia or lymphoma before the age of 18 years. The median time from ABMT was 7 years (range 2-10 years), and the median age of the subjects at the evaluation was 16 years (range 7-24 years). Patients, parents and teachers were used as informants. Parents of subjects in the ABMT group reported more behaviour problems than in a normative sample of school children, in particular of the internalising problem type, a finding also supported by the teachers' report on the children's behaviour at school. The magnitude of the behaviour problems correlated positively to CNS treatment intensity. The parents rated their children's school competence as lower than did parents of a normative sample. All school children (n = 18) were in regular education, although five pupils were receiving individual tutorial help. Overall, the patients reported a positive view on their own functioning, in contrast to the higher levels of psychosocial problems reported by their parents and teachers. The results thus show, that the psychosocial functioning seen in children treated because of cancer is dependent on the type of informant used.
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Affiliation(s)
- J Arvidson
- Department of Paediatrics, University of Uppsala, Sweden.
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Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36:1329-38. [PMID: 9334545 DOI: 10.1097/00004583-199710000-00014] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To review the literature on somatoform disorders in children and adolescents relevant to recertification by the American Board of Psychiatry and Neurology. METHOD The psychiatric, pediatric, and psychological literatures were searched for clinical or research articles in the past 10 years dealing with somatization and somatoform disorders. RESULTS Somatizing presentations are organized conceptually; somatization disorder, body dysmorphic disorder, hypochondriasis, conversion disorder, vocal cord dysfunction, pain disorder, and recurrent abdominal pain are described in children and adolescents; empirical evidence for treatment efficacy is scant, but clinically reasonable approaches are applied. CONCLUSION More developmentally appropriate diagnostic schemas and better outcome studies are needed in all the somatoform disorders for children and adolescents.
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Affiliation(s)
- G K Fritz
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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