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Kolaitis G, van der Ende J, Zaravinos-Tsakos F, White T, Derks I, Verhulst F, Tiemeier H. The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first? Eur Child Adolesc Psychiatry 2022; 31:1933-1941. [PMID: 34137940 DOI: 10.1007/s00787-021-01821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/03/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child's experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.
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Affiliation(s)
- Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
| | - Jan van der Ende
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Foivos Zaravinos-Tsakos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece
| | - Tonya White
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ivonne Derks
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, The Netherlands
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
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Yang PL, Burr RL, Buchanan DT, Pike KC, Kamp KJ, Heitkemper MM. Indirect effect of sleep on abdominal pain through daytime dysfunction in adults with irritable bowel syndrome. J Clin Sleep Med 2021; 16:1701-1710. [PMID: 32620184 DOI: 10.5664/jcsm.8658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Sleep deficiency, psychological distress, daytime dysfunction, and abdominal pain are common in adults with irritable bowel syndrome. Prior research on individuals with chronic pain has identified the indirect effect of sleep on pain through psychological distress or daytime dysfunction; however, this effect is less clear in irritable bowel syndrome. The purpose of this study was to examine potential indirect effects of sleep on abdominal pain symptoms simultaneously through psychological distress and daytime dysfunction in adults with irritable bowel syndrome. METHODS Daily symptoms of nighttime sleep complaints (sleep quality and refreshment), psychological distress, daytime dysfunction (fatigue, sleepiness, and difficulty concentrating), and abdominal pain were collected in baseline assessments from 2 randomized controlled trials of 332 adults (mean age 42 years and 85% female) with irritable bowel syndrome. Structural equation modeling was used to examine the global relationships among nighttime sleep complaints, psychological distress, daytime dysfunction, and abdominal pain. RESULTS The structural equation modeling analyses found a strong indirect effect of poor sleep on abdominal pain via daytime dysfunction but not psychological distress. More than 95% of the total effect of nighttime sleep complaints on abdominal pain was indirect. CONCLUSIONS These findings suggest that the primary impact of nighttime sleep complaints on abdominal pain is indirect. The indirect effect appears primarily through daytime dysfunction. Such understanding provides a potential avenue to optimize personalized and hybrid behavioral interventions for adults with irritable bowel syndrome through addressing daytime dysfunction and sleep behaviors. Additional study integrating symptoms with biological markers is warranted to explore the underlying mechanisms accounting for these symptoms. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov. Name: Nursing Management of Irritable Bowel Syndrome: Improving Outcomes, Nursing Management of IBS: Improving Outcomes. URLs: https://clinicaltrials.gov/ct2/show/NCT00167635, https://clinicaltrials.gov/ct2/show/NCT00907790. Identifiers: NCT00167635, NCT00907790.
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Affiliation(s)
- Pei-Lin Yang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington.,Office of Nursing Research, School of Nursing, University of Washington, Seattle, Washington
| | - Diana T Buchanan
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| | - Kenneth C Pike
- Office of Nursing Research, School of Nursing, University of Washington, Seattle, Washington
| | - Kendra J Kamp
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, Washington
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
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Sjölund J, Uusijärvi A, Tornkvist NT, Kull I, Bergström A, Alm J, Törnblom H, Olén O, Simrén M. Prevalence and Progression of Recurrent Abdominal Pain, From Early Childhood to Adolescence. Clin Gastroenterol Hepatol 2021; 19:930-938.e8. [PMID: 32344151 DOI: 10.1016/j.cgh.2020.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/04/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Little is known about the natural history of childhood recurrent abdominal pain (RAP). We investigated the prevalence and progression of childhood RAP and its association with Rome III abdominal pain-related functional gastrointestinal disorders (AP-FGID) and irritable bowel syndrome (IBS) during adolescence. METHODS We collected data from a prospective population-based birth cohort study of 4089 children, born from 1994 through 1996 in Sweden. We analyzed data from 2455 children with complete follow-up evaluation at ages 1, 2, 12, and 16 years and no parent-reported diagnoses of inflammatory bowel diseases or celiac disease at ages 12 or 16 years. A subpopulation of 2374 children who had answered questions based on the Rome III criteria at age 16 years was identified. We assessed RAP at 3 assessment points and defined it as parent-reported attacks of colic in early childhood (1-2 years) and as self-reported weekly abdominal pain at ages 12 years and 16 years. AP-FGID at age 16 years was defined according to the Rome III criteria. RESULTS RAP was reported by 26.2% of children on at least 1 of 3 assessment points, of which 11.3% reported symptoms more than once. Children with RAP at 12 years had persistent symptoms at 16 years in 44.9% of cases and increased risks for RAP (relative risk, 2.2; 95% CI, 1.7-2.8), any AP-FGID (relative risk, 2.6; 95% CI, 1.9-3.6), and IBS (relative risk, 3.2; 95% CI, 2.0-5.1) at 16 years. Early childhood RAP was not associated significantly with any outcome. CONCLUSIONS RAP affects many children from early childhood through age 16 years, but most children do not have persistent symptoms throughout childhood. RAP at age 12 years is a risk factor for RAP, any Rome III AP-FGID, and IBS, at age 16 years.
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Affiliation(s)
- Jessica Sjölund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Agneta Uusijärvi
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Sweden
| | - Navkiran T Tornkvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Johan Alm
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Olén
- Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina
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Tired of pain or painfully tired? A reciprocal relationship between chronic pain and fatigue. Pain 2019; 159:1178-1179. [PMID: 29768307 DOI: 10.1097/j.pain.0000000000001194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reply. Pain 2018; 159:1179-1180. [DOI: 10.1097/j.pain.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coenders A, Chapman C, Hannaford P, Jaaniste T, Qiu W, Anderson D, Glogauer M, Goodison-Farnsworth E, McCormick M, Champion D. In search of risk factors for chronic pain in adolescents: a case-control study of childhood and parental associations. J Pain Res 2014; 7:175-83. [PMID: 24707186 PMCID: PMC3971911 DOI: 10.2147/jpr.s48154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods Our case–control study involved 101 adolescents aged 10–18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children’s Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, <0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, non-migraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%–49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess.
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Affiliation(s)
| | - Cindy Chapman
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Tiina Jaaniste
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
| | - Wen Qiu
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Anderson
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Maline Glogauer
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Marianne McCormick
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
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Petanidou D, Giannakopoulos G, Tzavara C, Dimitrakaki C, Kolaitis G, Tountas Y. Adolescents' multiple, recurrent subjective health complaints: investigating associations with emotional/behavioural difficulties in a cross-sectional, school-based study. Child Adolesc Psychiatry Ment Health 2014; 8:3. [PMID: 24461305 PMCID: PMC3903038 DOI: 10.1186/1753-2000-8-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescence has been documented as the peak age of onset for mental health perturbations, clinical disorders and unsubstantiated health complaints. The present study attempted to investigate associations between multiple, recurrent subjective health complaints (SHC) with emotional/behavioural difficulties, as measured by the Strengths and Difficulties Questionnaire scale (SDQ), among Greek adolescents. METHODS Questionnaires were administered in a large, nation-wide, random, school-based sample of Greek adolescents, aged 12-18 years. Data from 1170 participants were analyzed. Adolescents with multiple, recurrent SHC were compared in terms of their emotional/behavioural difficulties to their peers with lower levels of health complaints. SDQ scales were separately investigated for their associations with multiple, recurrent SHC, after adjustment for gender, age and socioeconomic status (ses). Further analysis included multiple logistic regression models with multiple, recurrent SHC as the dependent variable and gender, age, ses and SDQ Total difficulties score as independent factors. Potential gender and age interactions were also explored. RESULTS Almost half of the study participants reported multiple, recurrent SHC. Adolescents with multiple, recurrent SHC had higher scores on all SDQ scales, except from the Prosocial behavior scale, compared to their peers with lower levels of health complaints. Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention and Peer Problems were associated with greater likelihood of having multiple, recurrent SHC, after adjustment for gender, age and ses. The multiple logistic regression models revealed that older adolescents and girls, as well as those with increased Total difficulties score had an increased risk for multiple, recurrent SHC reporting. No significant interaction between SDQ scales and gender or age was found. CONCLUSIONS Our study highlights the magnitude of psychological burden among adolescents experiencing multiple, recurrent SHC. Professionals in school and clinical settings should be cautious for impaired emotional/behavioural functioning when assessing adolescents with multiple, recurrent SHC, so as early identification of at-risk individuals and timely, appropriate referrals are facilitated.
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Affiliation(s)
- Dimitra Petanidou
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str,, 11527 Athens, Greece.
| | - George Giannakopoulos
- Department of Child Psychiatry, Athens University Medical School, “Aghia Sophia” Children’s Hospital, Greece, Thivon and Papadiamantopoulou, 115 27 Athens, Greece
| | - Chara Tzavara
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., 11527 Athens, Greece
| | - Christine Dimitrakaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., 11527 Athens, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, Athens University Medical School, “Aghia Sophia” Children’s Hospital, Greece, Thivon and Papadiamantopoulou, 115 27 Athens, Greece
| | - Yannis Tountas
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., 11527 Athens, Greece
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Lavigne JV, Saps M, Bryant FB. Models of Anxiety, Depression, Somatization, and Coping as Predictors of Abdominal Pain in a Community Sample of School-Age Children. J Pediatr Psychol 2013; 39:9-22. [DOI: 10.1093/jpepsy/jst060] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vila M, Kramer T, Obiols JE, Garralda ME. Abdominal pain in British young people: associations, impairment and health care use. J Psychosom Res 2012; 73:437-42. [PMID: 23148811 DOI: 10.1016/j.jpsychores.2012.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/12/2012] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the frequency and associations of abdominal pain in a sample of British secondary school young people and to examine predictors of impairment and health care use. METHODS Cross-sectional study of young people aged 11-16 years that completed questionnaires documenting abdominal pain, related impairment and health care consultations. They also provided information detailing other physical symptoms, health problems and mental health status. RESULTS 1173 students completed questionnaires; 598 (53%) reported abdominal pains in the previous 3 months (15% >once a week). Pains were significantly linked to reporting medical illness, to high levels of a broad range of physical symptoms and with students deeming these symptoms to be stress/mood sensitive. They were also linked to depressive and other emotional and behavioural problems and with medical help seeking (seeing a health professional in the previous year and contact ever with mental health practitioners). Considerable impairment was reported by 36%; this was independently predicted by abdominal pain frequency, higher levels of concurrent physical symptoms and symptom stress/mood sensitivity. In 18% of students the abdominal pains had led to medical consultations; this was independently predicted by pain related impairment. CONCLUSIONS Frequent abdominal pains are common in British secondary school adolescents; they are linked to emotional symptoms and are often impairing and lead to medical consultations. Impairment was associated not only to pain frequency but also to reporting other physical symptoms and symptom stress/mood sensitivity, and impairment was a strong predictor of medical help seeking.
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Affiliation(s)
- Mar Vila
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, Norfolk Place, London, UK.
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Psychosocial determinants of headache, abdominal pain, and sleep problems in a community sample of Finnish adolescents. Eur Child Adolesc Psychiatry 2012; 21:301-13. [PMID: 22350133 DOI: 10.1007/s00787-012-0261-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
The aims of this study were to examine the prevalence, co-occurrence, and psychosocial determinants of self-perceived headache, abdominal pain, and sleep problems among adolescents. The adolescents from two cities in Finland (n = 2,215, 90.9% of the target population) attending 7th and 9th grade (age range 13-18 years) participated in the cross-sectional survey inquiring about frequency of headache, abdominal pain, sleep problems, and psychosocial difficulties. The 6-month prevalence of weekly headache was 13%, abdominal pain 6%, and sleep problems 27%. All three symptoms were strongly associated with each other. Of the adolescents suffering from one symptom, 32% reported one co-occurring symptom and 17% two co-occurring symptoms. In the multivariate analysis, female gender, experience of psychological difficulties, emotional symptoms, smoking, victimization, and feeling not cared about by teachers were independently associated with all the individual symptoms, as well as an increasing number of symptoms. Sleep problems were associated with older age and peer and alcohol problems. Abdominal pain was associated with conduct problems, and both headache and abdominal pain were linked with immigration background. An increasing number of symptoms was associated with older age, having a chronic illness, and conduct and alcohol problems. Adolescents' headache, abdominal pain and sleep problems were common and often co-occurred. An increasing frequency of each symptom and number of symptoms were associated with psychosocial factors in a similar way. Screening for psychiatric symptoms, substance use, victimization and difficulties with teachers should be included in the assessment of adolescents who suffer from recurrent headache, abdominal pain or sleep problems.
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Wu HP, Chen CY, Kuo IT, Wu YK, Fu YC. Diagnostic Values of a Single Serum Biomarker at Different Time Points Compared with Alvarado Score and Imaging Examinations in Pediatric Appendicitis. J Surg Res 2012; 174:272-7. [DOI: 10.1016/j.jss.2011.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/08/2010] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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Wolff NJ, Darlington ASE, Hunfeld JAM, Jaddoe VWV, Hofman A, Raat H, Verhulst FC, Passchier J, Tiemeier H. Concurrent and Longitudinal Bidirectional Relationships Between Toddlers' Chronic Pain and Mental Health: The Generation R Study. J Pediatr Psychol 2012; 37:546-56. [DOI: 10.1093/jpepsy/jsr122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVES The aim of the study was to identify prognostic factors for the persistence of chronic abdominal pain (CAP) in children. MATERIALS AND METHODS For this systematic review, MEDLINE, EMBASE, and PsycINFO were searched up to June 2008 for prospective follow-up studies of pediatric CAP as defined by the criteria of Apley, von Baeyer, or the Rome committee. The outcome measure of interest was persistence of CAP. Persistent CAP was considered only when the abdominal pain of children with CAP persisted during follow-up at the same level of frequency and severity. For each study the risk for bias was assessed. The evidence for prognostic factors was summarized according to a best-evidence synthesis. RESULTS Eight studies, which examined 17 prognostic factors, were included. Moderate evidence was found that having a parent with gastrointestinal symptoms predicts the persistence of CAP. Strong evidence was found for no association between female sex and the duration of CAP, and moderate evidence that the severity of abdominal pain does not predict persistence of CAP. There is conflicting evidence as to whether psychological factors prevent, or have no relation with, persistence of CAP. CONCLUSIONS Because there are few prognostic follow-up studies on pediatric CAP, the evidence for prognostic factors is limited. Physicians should ask about parental gastrointestinal problems because this is a risk factor for persistence of CAP in children. The hypothesis that psychological factors of the child predict persistence of CAP is not supported by evidence from the follow-up studies.
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Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy? Eur Child Adolesc Psychiatry 2011; 20:39-48. [PMID: 21174221 PMCID: PMC3012208 DOI: 10.1007/s00787-010-0146-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 10/30/2010] [Indexed: 11/27/2022]
Abstract
The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children's hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8-17 years, using the Diagnostic Interview Schedule for Children-parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children's Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.
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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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McNally JD, Matheson LA, Rosenberg AM. Epidemiologic considerations in unexplained pediatric arthralgia: the role of season, school, and stress. J Rheumatol 2009; 36:427-33. [PMID: 19040297 DOI: 10.3899/jrheum.080358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine demographic and epidemiologic characteristics in children with unexplained joint pain. METHODS The study population included 730 children (< 18 yrs of age) referred between 1981 and 2007 to the Saskatchewan Pediatric Rheumatology Program, University of Saskatchewan, because of arthralgia. Parents and patients completed a questionnaire at the time of initial presentation, and a diagnosis of unexplained arthralgia was assigned based on clinical assessment. Serum vitamin D levels were measured in 73 patients diagnosed with arthralgia. RESULTS Subjects with arthralgia were more likely to report psychosocial stresses including family discord and illness in the family, and to be cared for by a single parent as a consequence of parental separation or death. Significantly more patients reported fall and winter (30%) as the season of symptom onset compared to spring or summer (20%; p = 0.01). Significantly more survey respondents in the arthralgia group reported missing school compared to the control group (62% vs 31%; p = 0.001). Referrals from northern Saskatchewan were significantly more numerous than from southern Saskatchewan (107 vs 45 per 100,000; p < 0.001). Serum vitamin D concentrations measured in a subgroup of patients (n = 73) showed that 62 (82%) were abnormally low, 42% between 50 and 75 nmol/l (insufficient), and 40% < 50 nmol/l (deficient). CONCLUSION Our results suggest an association between psychosocial stress, school absenteeism, vitamin D insufficiency, and unexplained arthralgia in children.
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Affiliation(s)
- J Dayre McNally
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Wiles NJ, Jones GT, Haase AM, Lawlor DA, Macfarlane GJ, Lewis G. Physical activity and emotional problems amongst adolescents : a longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2008; 43:765-72. [PMID: 18438732 DOI: 10.1007/s00127-008-0362-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 04/08/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Promotion of physical activity (PA) is at the top of the public health agenda. However, there are few longitudinal studies investigating the relationship between PA and children's mental health. Therefore, we aimed to investigate the association between self-reported physical activity (PA) and emotional problems 1-year later in a cohort of schoolchildren. METHODS A total of 1,446 children aged 11-14 years from 39 schools in the North West of England completed a self-report questionnaire in class. Each child reported the total number of sessions of sporting activities (lasting more than 20 min) in which they participated during the previous week, including activities both in school and out of school. This total was averaged for the week in order to determine whether the child was physically active at recommended levels (1 h per day). Childhood emotional problems were measured using the Strengths and Difficulties Questionnaire (SDQ) (self-report) at baseline and 1-year later. Data on potential confounders were also collected by self-report questionnaire at baseline. RESULTS In unadjusted analyses, children who, on average, participated in at least 1 h of sporting activity on a daily basis had fewer emotional problems at 1-year follow-up. This attenuated substantially after adjustment for gender (girls were less active but more likely to report emotional problems than boys). After adjustment for additional confounders including emotional problems at baseline, children who met recommended levels for PA had, on average, a score on the emotional problems sub-scale that was 0.29 units lower (-0.29 (95%CI: -0.61, 0.022)) at 1 year follow-up compared to children who did not undertake recommended levels of PA. Children who were physical activity also had higher scores on the hyperactivity sub-scale of the SDQ 1 year later, but there was no evidence to support an association between PA and other behavioural problems. CONCLUSIONS Children who met recommended levels for PA had fewer emotional problems 1-year later, although the magnitude of this difference was reduced after adjustment for confounders, particularly gender. Future longitudinal studies need to record both PA and emotional problems at more frequent intervals in order to enable us to determine the effect of maintaining a physically active lifestyle on adolescent mental health outcomes.
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Affiliation(s)
- Nicola J Wiles
- Academic Unit of Psychiatry, Dept. of Community Based Medicine, University of Bristol, Bristol, UK.
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