Do headache and abdominal pain in childhood predict suicides and severe suicide attempts? Finnish nationwide 1981 birth cohort study

The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance

OBJECTIVES

Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research.

METHODS

The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area.

RESULTS

Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors.

DISCUSSION

Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.

Association of defecation disorders with suicidal ideation in young adult with chronic abdominal discomfort

BACKGROUND

The role of physical symptoms on suicidal ideation in adolescents is incompletely understood. The purpose of this study was to discover the potential physical symptoms predictors for suicidal ideation in college freshmen.

METHODS

This cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (N = 2449). Questionnaire evaluated suicidal ideation as well as related psychosocial risks and gastrointestinal (GI) physical symptoms. The association between the suicidal ideation and potential predictors was analyzed by Mann-Whitney test and multiple logistic regression analysis.

RESULTS

A total of 2053 (83.8%) completed this survey and 64 (3.1%) was reported to have suicidal ideation. Anxiety (OR 5.44(2.40-12.35)), depression (OR 8.36(3.90-17.94)) and chronic abdominal discomfort (OR 2.06(1.07-3.94)) were independent predictors for suicidal ideation. In freshmen with chronic abdominal discomfort, interestingly, defecation disorder(P = 0.01) and low satisfaction of defecation (P = 0.04) was associated with high risk for suicidal ideation.

CONCLUSION

Defecation disorders were associated with high risk of suicidal intention in young adult with chronic abdominal discomfort. Our result implied that clinicians should be vigilant for suicidal ideation in chronic abdominal discomfort patients, especially those with defecation disorders.

Chronic pain and suicide risk: A comprehensive review

Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.

Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

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.

Are adolescents with high self-esteem protected from psychosomatic symptomatology?

This study investigated the role of self-esteem, social (need to belong, loneliness, competitiveness, and shyness), and health (smoking, drinking) behaviors in Hungarian adolescents' psychosomatic symptoms. Our sample of 490 students (ages 14-19 years) from Debrecen (Hungary) completed the questionnaires. Besides descriptive statistics, correlation and multiple regression analyses were applied to test interrelationships. Frequency analysis revealed that fatigue was the most commonly experienced psychosomatic symptom in this sample, followed by sleeping problems and (lower) back pain. Girls reported experiencing more symptoms. Multiple regression analyses suggested that (1) need to belong, shyness, and competitiveness may serve as social behavioral risk factors for adolescents' psychosomatic symptomatology, whereas (2) self-esteem may play a protective role. The role of social and health behaviors was modified when analyzed by gender: the psychosomatic index score was positively related to smoking and shyness among girls, and need to belong among boys. Self-esteem provided protection for both sexes.

CONCLUSION

We conclude that problems with social relationships (namely, unmet need to belong, competitiveness, and shyness) may lead to psychosomatic health complaints, whereas self-esteem may serve as a protection. Findings suggest that social skills training and strengthening self-esteem should be an important part of children's health promotion programs in schools to improve their psychosomatic health and well-being.

WHAT IS KNOWN

• Despite being free of serious physical illness, many adolescents often report subjective health complaints, such as psychosomatic symptoms • As children in this life stage develop independence and autonomy, new types of social relationships, and identity, their social needs and skills also change What is new: • Need to belong, shyness, and competitiveness may serve as social behavioral risk factors for adolescents' psychosomatic symptomatology, whereas self-esteem may play a protective role • The role of social and health behaviors may vary by gender.

The impact of physical pain on suicidal thoughts and behaviors: Meta-analyses

Although the relationship between physical pain and suicidal thoughts and behaviors has been explored in multiple epidemiologic and clinical studies, it is still far from being well understood. Consequently, we conducted a meta-analysis of studies comparing rates of suicidal thoughts and behaviors in individuals with and without physical pain. We searched MEDLINE and PsycINFO (May 2015) for studies comparing rates of current and lifetime suicidal thoughts and behaviors (death wish, suicide ideation, plan, attempt and death: DW, SI, SP, SA, SD) in individuals with any type of physical pain (headache, back, neck, chest, musculoskeletal, abdominal and pelvic pains, arthritis, fibromyalgia, medically unexplained pain, and other not specified pain) versus those without it. Data were analyzed with Cochrane Collaboration Review Manager Software (RevMan, version 5.3). We assessed the methodological quality of the studies with the STROBE statement. Of the 31 included studies, three focused on lifetime DW, twelve focused on current SI (six lifetime), six focused on current SP (two lifetime), nine focused on current SA (11 lifetime) and eight on SD. Individuals with physical pain were more likely to report lifetime DW (p = 0.0005), both current and lifetime SI (both p < 0.00001), SP (current: p = 0.0008; lifetime: p < 0.00001), and SA (current: p < 0.0001; lifetime: p < 0.00001). Moreover, they were more likely to report SD (p = 0.02). In all analyses, the between study heterogeneity was high. Moreover, the presence of publication bias has been detected in the main outcomes. Physical pain is a consistent risk factor for suicidal thoughts and behaviors. Further research is required to investigate the specific impact of: 1) chronic versus acute pain, 2) different types of pain (e.g., medically unexplained pain), and 3) risk factors for suicide in chronic pain patients.

Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample

BACKGROUND

Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity.

METHOD

The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment.

RESULTS

Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders.

CONCLUSIONS

Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.

The pain suicidality association: a narrative review

OBJECTIVES

The objective of this narrative review was to examine recent evidence and, when necessary, past evidence on the association between pain and suicidality.

DESIGN

Fifty-eight research reports were found on this topic, which had not previously been reviewed. These reports were divided into groups by whether they addressed suicide ideation (SI), suicide attempts (SAs), or suicide completion (SC), and what population they represented (acute pain patients [APPs], chronic pain patients [CPPs], other than APPs/CPPs) and whether they controlled for relevant confounders. Information as to whether the results of these studies supported/did not support the association of pain and suicidality was abstracted. For each group of studies (above), a vote counting method was utilized to determine the overall percentage of studies supporting/not supporting the association of pain and suicidality. According to this percentage, the consistency of the data supporting this association was rated according to Agency for Healthcare Research and Quality guidelines.

RESULTS

The following groups of studies received an A consistency rating (consistent evidence from multiple studies): SI, SA, and SC for other than APPs/CPPs; and SI, SA, and SC for CPP prevalence greater than an appropriate control group. Also, a subgroup of the SI, SA, and SC studies for other than APPs/CPPs had controlled for behavioral issues (potential confounders). These three subgroups also received an A consistency rating. The 58 studies also identified a number of new predictor variables for SI, SA, and SC in CPPs.

CONCLUSIONS

These studies solidify the evidence for an association between pain and SI, SA, and SC in both CPPs and other than APPs/CPPs.

Exploring Prospective Predictors of Completed Suicides

Background: This study was based on over 30,000 respondents who completed General Social Surveys between 1978 and 2002. Aims: We approached these respondents prospectively, comparing and contrasting the responses of those who subsequently died by suicide (N = 141) with those who died from all other causes (N = 9,115). Method: We employed chi-square and logistic regression analyses of important demographic confounders to test for statistically significant differences between suicide decedents and all other decedents. Results: Suicide decedents died on average 2 years sooner than all other decedents. When covariates of age and gender were applied, suicide decedents exhibited greater acceptance of suicide for dealing with various adverse life circumstances, were more likely to have been the gun owners in their households, lived in regions where gun ownership was more commonplace, and held less strong religious beliefs and less of a belief of an afterlife. Conclusion: The observed affinity between attitudes of suicide acceptability and completed suicide suggests a potential for creating a meaningful assessment tool to identify those positioned at the extreme end of the suicide risk continuum.