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Hogendoorn E, Münker L, Rimvall MK, Frostholm L, Carlsen AH, Jeppesen P, Rosmalen JGM, Rask CU. Family healthcare patterns as a proxy for transgenerational transmission of functional somatic symptoms in early childhood - A longitudinal cohort study. J Psychosom Res 2024; 184:111805. [PMID: 38944597 DOI: 10.1016/j.jpsychores.2024.111805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Functional somatic symptoms (FSS) accumulate within families. Exposure to family patterns of high healthcare use may induce maladaptive symptom coping and thereby potentially contribute to the transgenerational transmission of FSS. This study aimed to uncover associations between parental and child healthcare use during the child's first years of life (age 0-4) and childhood FSS at age 5-7. METHODS We utilized data from the Copenhagen Child Cohort (CCC2000), a population-based birth cohort. Parent-reported FSS of their 5-7-year-old children were linked to Danish national registry data on parental and child healthcare use (including general practitioner [GP] consultations and hospital contacts) during child age 0-4 years. Logistic regression analyses were performed to investigate longitudinal associations between family healthcare use and child FSS. RESULTS We found an association between prior parental healthcare use and child FSS at age 5-7 (OR = 1.02, 95% CI [1.01-1.04]). Key sensitivity analyses specifically focusing on GP consultations, revealed modest but statistically significant associations between parental (OR = 1.03, 95% CI [1.02-1.05]) and child (OR = 1.18, 95% CI [1.04-1.34]) GP consultations and impairing FSS at age 5-7. CONCLUSION Family healthcare use, especially within the general practice, may play a role in the transgenerational transmission of FSS. Early-stage FSS identification and care might be improved through training aimed at GPs. Future research may identify vulnerable families at whom parent-focused interventions for symptom-coping could be targeted. This could potentially contribute to the prevention of transgenerational transmission of FSS.
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Affiliation(s)
- Elske Hogendoorn
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Lina Münker
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Anders Helles Carlsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Münker L, Rimvall MK, Frostholm L, Ørnbøl E, Wellnitz KB, Jeppesen P, Maria Rosmalen JG, Rask CU. Exploring the course of functional somatic symptoms (FSS) from pre- to late adolescence and associated internalizing psychopathology - an observational cohort-study. BMC Psychiatry 2024; 24:495. [PMID: 38977964 PMCID: PMC11232134 DOI: 10.1186/s12888-024-05937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Functional somatic symptoms (FSS), which commonly cannot be attributed to well-defined organic pathology, often co-occur with internalizing psychopathology and fluctuate throughout different life stages. We examined FSS courses throughout adolescence, and the association between preadolescent FSS, FSS severity and internalizing psychopathology at late adolescence. METHODS Data from the Copenhagen Child Cohort (CCC2000) were utilized from assessments at ages 11-12 years (preadolescence; T0) and 16-17 years (late adolescence; T1). Self-report questionnaire and interview data on FSS, internalizing psychopathology, chronic medical conditions, and sociodemographic data from Danish national registers were available for 1285 youths. FSS courses were categorized into persistent (high FSS at T0 & T1), remission (high FSS only at T0), incident (high FSS only at T1) or no FSS (no FSS at T0 & T1). Multiple linear and multinomial logistic regressions were conducted to investigate the FSS/psychopathology association. RESULTS 1.8% of adolescents fell into the persistent FSS course group throughout adolescence. Higher preadolescent FSS predicted FSS (b = 0.07, p < .001), anxiety (b = 0.05, p < .001) and depression (b = 0.06, p < .001) at age 16/17, even after controlling for sex, parental education, a chronic medical condition and internalizing psychopathology in preadolescence. Persistent, incident, and remittent FSS courses were associated with significantly higher mean levels of anxiety and depression compared to the reference group (no FSS). CONCLUSIONS FSS during pre- and late adolescence might increase and co-occur with anxiety and depression throughout adolescence, potentially due to shared underlying risk factors and processes.
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Affiliation(s)
- Lina Münker
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark.
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Judith Gerarda Maria Rosmalen
- Departments of Psychiatry and Internal medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Larsen LB, Daley D, Lange AM, Sonuga-Barke E, Thomsen PH, Jensen JS, Rask CU. Functional somatic symptoms in preschool attention-deficit/hyperactivity disorder: a secondary analysis of data from a randomized controlled trial of parent training. Eur Child Adolesc Psychiatry 2023; 32:1979-1988. [PMID: 35748937 DOI: 10.1007/s00787-022-02025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) can be more stress-vulnerable, and thereby, it has been suggested, prone to develop functional somatic symptoms (FSS) compared to their peers. In this paper, using data from 160 children aged 3-7 years with ADHD from the D'SNAPP study, a randomized controlled trial testing a parent training intervention, we addressed a number of questions about the role of FSS in ADHD. First, are FSS levels higher in an ADHD sample than in the children of the general population. Second, do FSS levels predict psychopathology and health-related quality of life (HRQoL) in ADHD samples. Third, does FSS levels moderate the effect of parent training on ADHD symptoms. We found that preschoolers with ADHD experienced more severe FSS than a general population-based sample (18.80% vs. 2.11%). Severe FSS were associated with increased psychopathology and impaired daily function and lower HRQoL. Level of baseline FSS did not moderate the effect of parent training on ADHD. FSS in preschool children with ADHD is associated with impaired daily functioning, but further research is warranted to determine the clinical impact of FSS in children with ADHD.
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Affiliation(s)
- Liva Bundgaard Larsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.
| | - David Daley
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Anne-Mette Lange
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Stager L, Mueller C, Morriss S, Szaflarski JP, Fobian AD. Sense of control, selective attention, cognitive inhibition, and psychosocial outcomes after Retraining and Control Therapy (ReACT) in pediatric functional seizures. Epilepsy Behav 2023; 142:109143. [PMID: 36872138 PMCID: PMC10164678 DOI: 10.1016/j.yebeh.2023.109143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Differences in sense of control, cognitive inhibition, and selective attention in pediatric functional seizures (FS) versus matched controls implicate these as potential novel treatment targets. Retraining and Control Therapy (ReACT), which targets these factors, has been shown in a randomized controlled trial to be effective in improving pediatric FS with 82% of patients having complete symptom remission at 60 days following treatment. However, post-intervention data on sense of control, cognitive inhibition, and selective attention are not yet available. In this study, we assess changes in these and other psychosocial factors after ReACT. METHODS Children with FS (N = 14, Mage = 15.00, 64.3% female, 64.3% White) completed 8 weeks of ReACT and reported FS frequency at pre and post-1 (7 days before and after ReACT). At pre, post-1, and post-2 (60 days after ReACT), all 14 children completed the Pediatric Quality of Life Inventory Generic Core Scales, Behavior Assessment System (BASC2), and Children's Somatic Symptoms Inventory-24 (CSSI-24), and 8 children completed a modified Stroop task with seizure symptoms condition in which participants are presented with a word and respond to the ink color (e.g., "unconscious" in red) to assess selective attention and cognitive inhibition. At pre and post-1, ten children completed the magic and turbulence task (MAT) which assesses sense of control via 3 conditions (magic, lag, turbulence). In this computer-based task, participants attempt to catch falling X's while avoiding falling O's while their control over the task is manipulated in different ways. ANCOVAs controlling for change in FS from pre- to post-1 compared Stroop reaction time (RT) across all time points and MAT conditions between pre and post-1. Correlations assessed the relationships between changes in Stroop and MAT performance and change in FS from pre- to post-1. Paired samples t-tests assessed changes in quality of life (QOL), somatic symptoms, and mood pre to post-2. RESULTS Awareness that control was manipulated in the turbulence condition of the MAT increased at post-1 vs. pre- (p = 0.02, η2 = 0.57). This change correlated with a reduction in FS frequency after ReACT (r = 0.84, p < 0.01). Reaction time significantly improved for the seizure symptoms Stroop condition at post-2 compared to pre- (p = 0.02, η2 = 0.50), while the congruent and incongruent conditions were not different across time points. Quality of life was significantly improved at post-2, but the improvement was not significant when controlling for change in FS. Somatic symptom measures were significantly lower at post-2 vs. pre (BASC2: t(12) = 2.25, p = 0.04; CSSI-24: t(11) = 4.17, p < 0.01). No differences were observed regarding mood. CONCLUSION Sense of control improved after ReACT, and this improvement was proportional to a decrease in FS, suggesting this as a possible mechanism by which ReACT treats pediatric FS. Selective attention and cognitive inhibition were significantly increased 60 days after ReACT. The lack of improvement in QOL after controlling for change in FS suggests QOL changes may be mediated by decreases in FS. ReACT also improved general somatic symptoms independent of FS changes.
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Affiliation(s)
- Lindsay Stager
- University of Alabama at Birmingham, Department of Psychology, United States
| | - Christina Mueller
- University of Alabama at Birmingham, Department of Neurology, United States
| | - Skylar Morriss
- University of Alabama at Birmingham, Department of Psychology, United States
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham, Department of Neurology, United States; University of Alabama at Birmingham, Departments Neurosurgery and Neurobiology and the UAB Epilepsy Center, United States
| | - Aaron D Fobian
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, United States.
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Rytter MJH. Difficult questions about long COVID in children. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:595-597. [PMID: 35752193 PMCID: PMC9221929 DOI: 10.1016/s2352-4642(22)00167-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Maren Johanne Heilskov Rytter
- Department of Paediatrics and Adolescent Medicine, Slagelse Hospital, 4200 Slagelse, Denmark; Department of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Pelsser L, Stobernack T, Frankena K. Physical Complaints Decrease after Following a Few-Foods Diet in Children with ADHD. Nutrients 2022; 14:3036. [PMID: 35893890 PMCID: PMC9332265 DOI: 10.3390/nu14153036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/01/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) symptoms may significantly decrease after following a few-foods diet (FFD). The results of a small randomised controlled trial (RCT) showed that co-occurring physical complaints in children with ADHD decreased as well. To further investigate the effect of an FFD on physical complaints, we analysed unpublished data from previously published studies (i.e., 'Impact of Nutrition on Children with ADHD' [INCA], an RCT, and 'Biomarker Research in ADHD: the Impact of Nutrition' [BRAIN], an open-label trial). In both trials, the association between an FFD, ADHD, and 21 individual physical complaints was assessed. Children either followed a 5-week FFD (the INCA FFD group and BRAIN participants) or received healthy food advice (the INCA control group). The ADHD rating scale and a physical complaint questionnaire were filled in at the start and end of the trials. The INCA results showed, for 10 of 21 complaints, a clinically relevant reduction in the FFD group compared to the control group. The open-label BRAIN results confirmed the outcomes of the FFD group. No association was detected between the decrease in physical complaints and the decrease in ADHD symptoms. The results point toward an association between the FFD and a decrease in thermoregulation problems, gastrointestinal complaints, eczema, and sleep problems.
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Affiliation(s)
- Lidy Pelsser
- ADHD Research Centre, 5624 JE Eindhoven, The Netherlands
| | - Tim Stobernack
- Department of Animal Science, Wageningen University and Research, 6708 WD Wageningen, The Netherlands;
| | - Klaas Frankena
- Adaptation Physiology Group, Wageningen University and Research, 6708 WD Wageningen, The Netherlands;
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Jungmann SM, Wagner L, Klein M, Kaurin A. Functional Somatic Symptoms and Emotion Regulation in Children and Adolescents. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e4299. [PMID: 36397947 PMCID: PMC9667419 DOI: 10.32872/cpe.4299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Functional Somatic Symptoms (FSS; i.e. symptoms without sufficient organic explanation) often begin in childhood and adolescence and are common to this developmental period. Emotion regulation and parental factors seem to play a relevant role in the development and maintenance of FSS. So far, little systematic research has been conducted in childhood and adolescence on the importance of specific emotion regulation strategies and their links with parental factors. Method In two studies, children and adolescents (Study 1/Study 2: N = 46/68; 65%/60% female, Age M = 10.0/13.1) and their parents completed questionnaires on children's FSS and adaptive and maladaptive emotional regulation (in Study 2, additionally parental somatization and child/parental alexithymia). Results In both studies, child-reported FSS were negatively associated with children's adaptive emotion regulation (r = -.34/-.31, p < .03; especially acceptance) and positively with children's maladaptive emotion regulation and alexithymia (r = .53/.46, p < .001). Moreover, children's maladaptive emotion regulation (β = .34, p = .02) explained incremental variance in child-reported FSS beyond children's age/sex, parental somatization and emotion regulation. In contrast, parental somatization was the only significant predictor (β = .44, p < .001) of parent-reported FSS in children/adolescents. Conclusion Our results suggest that particularly rumination and alexithymia and parental somatization are important predictors of FSS in children/adolescents. Overall, the results showed a dependence on the person reporting children's FSS (i.e., method-variance). So, for future studies it is relevant to continue using the multi-informant approach.
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Affiliation(s)
- Stefanie M. Jungmann
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Louisa Wagner
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marlene Klein
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Aleksandra Kaurin
- Department of Clinical Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
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Bernstorff M, Rask CU, Rytter D, Hansen SN, Bech BH. Multiple health complaints in preadolescence and hospital contacts during adolescence: a prospective cohort study. Sci Rep 2022; 12:7412. [PMID: 35523807 PMCID: PMC9076908 DOI: 10.1038/s41598-022-11167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Multiple health complaints (MHC) is increasing among preadolescents in many countries, but their prognostic effect for individual thriving or societal resource use is scarcely studied. This makes interpreting the significance of this increase challenging. We contribute by examining whether MHC in preadolescence predicts hospital contacts in adolescence by doing a nation-wide population-based cohort-study following preadolescents from the Danish National Birth-Cohort from 2010 to 2018. 96,382 children were invited at age 11. Responses to a modified version of the Health Behaviour in School Children Symptom Checklist (headache, dizziness, stomachache, irritability, feeling nervous, difficulty in getting to sleep and feeling low) was dichotomized into MHC (≥ 2 concurrent symptoms, each with a frequency of at least weekly, yes/no). Hospital contacts were derived from Danish registers from the date of answering the questionnaire to December 31st 2018. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Analyses were further broken down by hospital sector (psychiatric/somatic) and contact type (in-patient/out-patient/emergency room). 47,365 (49.1%) responded. Mean age was 11.2 years, 52% girls. 10.3% of responders reported MHC. For hospital contacts, the unadjusted IRR was 1.74 [95% CI 1.65, 1.83]. Results were robust to adjustment for sociodemographic variables and somatic/psychiatric morbidity diagnosed before baseline, IRR 1.62 [95% CI 1.54-1.71]. In conclusion, MHC in preadolescents are prognostic of hospital contacts. This shows that we cannot ignore MHC, and to prevent potentially unhelpful healthcare use, we must act. Future research should focus on the underlying causes of MHC to understand which changes will be most helpful and thus how to act.
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Affiliation(s)
- Martin Bernstorff
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Stefan Nygaard Hansen
- Research Unit for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Abstract
OBJECTIVE Parent chronic illness may increase somatic symptomology risk in children. The current study examines this association in relation to a variety of chronic illnesses and also considers possible related parental and adolescent background factors. METHODS Secondary analyses used longitudinal data from the University of North Carolina National Longitudinal Study of Adolescent to Adult Health. Interviews were used to assess demographics, adolescent somatic symptoms, living situation, and parental illness and general physical health. Somatic symptoms in adolescents with no ill parents (n = 2302 adolescents; Mage = 15.3) were compared with adolescents with ill mothers (n = 2336; Mage = 15.3), ill fathers (n = 1304; Mage = 15.3), or two ill parents (n = 3768; Mage = 15.3) using Poisson regression models. We also examined the role of living status, adolescent sex, and parent general physical health on somatic symptom outcomes. RESULTS Elevated somatic symptoms were observed in adolescents with ill mothers (mean ratio [MR] = 1.15, p = .015) and with both parents ill (MR = 1.10, p < .001). Among adolescents with ill parents, females had more symptoms than males (ill mother: MR = 1.12, p < .001; ill father: MR = 1.23, p < .001; and both parents ill: MR = 1.23, p < .001). Poorer maternal physical health also increased somatic symptom risk (MR = 1.12, p = .02). Longitudinally, adolescents with ill mothers (MR = 1.14, p < .001), ill fathers (MR = 1.13, p < .001), or both parents ill (MR = 1.16, p < .001) had increased somatic symptom risk. Wave I somatic symptoms also increased future risk: ill mother (MR = 1.19, p < .001), ill father (MR = 1.22, p < .001), or both parents ill (MR = 1.20, p < .001). CONCLUSIONS The results highlight that having an ill parent is a risk factor for adolescent somatic symptoms. In addition, other factors such as adolescent sex play an additional role in adolescent somatic symptoms.
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Affiliation(s)
- Lindsey C. Elliott
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
- Department of Psychiatry, University of Texas at Austin
| | - Lindsay M. Stager
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Dustin Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Aaron D. Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL
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Berezowski L, Ludwig L, Martin A, Löwe B, Shedden-Mora MC. Early Psychological Interventions for Somatic Symptom Disorder and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosom Med 2022; 84:325-338. [PMID: 34524264 PMCID: PMC8983947 DOI: 10.1097/psy.0000000000001011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Psychological treatments for somatic symptom disorder and functional somatic syndromes (SSD/FSS) achieve moderate effects only, potentially because of the high chronicity in these patients. Therefore, we aimed to evaluate whether early treatment, that is, treatment in populations at risk or with recent onset, improves outcome. METHODS We conducted a systematic review and meta-analysis of (cluster-)randomized controlled trials evaluating early psychological interventions in the prevention and treatment of SSD/FSS in adults compared with inactive control conditions, standard care, or placebo. Individuals at risk for SSD/FSS, suffering from subthreshold symptoms or new onsets of SSD/FSS, or presenting with SSD/FSS for the first time were included. RESULTS We identified 30 eligible studies, mostly examining pain-related conditions. Interventions were diverse, ranging from bibliotherapy to cognitive-behavioral therapy. We found positive effects on depression post-treatment (Hedges' g = 0.12 [95% confidence interval = 0.03-0.2], k = 5) as well as on somatic symptom severity (g = 0.25 [0.096-0.41], k = 17) and health care utilization (g = 0.31 [0.18-0.44], k = 3) at follow-up. However, because of a high risk of bias, sensitivity to corrections for meta-bias, and missing outcome data, findings should be interpreted cautiously. CONCLUSIONS Our review shows that targeting SSD/FSS at an early stage represents a conceptual and practical challenge. Readily accessible interventions addressing transsymptomatic processes of SSD/FSS development and consolidation are highly needed. Future studies are needed to evaluate individuals with diverse symptoms, examine symptom history thoroughly, use placebo controls, and report outcomes completely to determine the efficacy of early psychological interventions for SSD/FSS.PROSPERO Registration:CRD42020140122.
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Affiliation(s)
- Lukas Berezowski
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Lea Ludwig
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Alexandra Martin
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Bernd Löwe
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Meike C. Shedden-Mora
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
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11
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Stepan MD, Cioboata R, Vintilescu ŞB, Vasile CM, Osman A, Ciolofan MS, Popescu M, Petrovici IL, Zavate AC. Pediatric Functional Abdominal Pain Disorders following COVID-19. Life (Basel) 2022; 12:509. [PMID: 35455000 PMCID: PMC9027938 DOI: 10.3390/life12040509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Functional abdominal pain disorders (FAPD) are a group of functional gastrointestinal disorders with multifactorial etiology and are subclassified using Rome IV criteria into a series of clinically distinct entities represented by irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain that is not otherwise specified. Digestive functional disorders associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be mediated by the involvement of complex pathogenic mechanisms, which have been under investigation in children since the beginning of the coronavirus disease pandemic (COVID-19). METHODS In this retrospective, observational descriptive and analytical study, we investigated the presence of chronical functional abdominal pain in preschool children (4-6 years old) from the south-west of Romania in the pre-pandemic (18 cases) and COVID-19 pandemic period (34 cases), as well as the association with the COVID-19 positive and COVID-19 negative statuses, gender, environment origin, and viral infection-associated symptoms. Age-specific Rome IV criteria were used to diagnose functional abdominal pain. We performed an integrated statistical analysis of the results utilizing an electronic database in which we compared the data in order to assess the impact of COVID-19 on the clinical-epidemiological parameters analyzed. RESULTS In the pre-pandemic group, irritable bowel syndrome predominated (77.8%), followed by functional dyspepsia (22.2%), the other types of functional abdominal pain being absent, while for the pandemic group, irritable bowel syndrome was the most common (79.4%), followed by abdominal migraine (11.8%), abdominal dyspepsia (5.9%) and functional abdominal pain not otherwise specified (2.9%). We found a female/male ratio difference of 0.84 and an urban/rural ratio of 1.83 in favor of the pandemic group. These discrepancies were mainly caused by the differences between the COVID-19 positive and negative pandemic groups, where we observed statistical association of the positive pandemic group with IBS and urban environment, and a tendency of FAPDs diagnostic mainly with males. The predominant symptoms associated with COVID-19 positive cases were digestive (60.9%) or respiratory (39.1%). CONCLUSIONS Our study demonstrates viral-mediated sensitivity of the gastrointestinal tract in preschool children, considering different clinical-epidemiological profiles related to the prevalence of FAPD and according to gender and environment origin, while the contribution of the pandemic context remains to be demonstrated in larger studies.
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Affiliation(s)
- Mioara Desdemona Stepan
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ramona Cioboata
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania;
| | - Ştefăniţa Bianca Vintilescu
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Osman
- Department of Anatomy and Embryology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mircea Sorin Ciolofan
- Department of ENT, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ilaria Lorena Petrovici
- Department of Pediatric Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.L.P.); (A.C.Z.)
| | - Andrei Calin Zavate
- Department of Pediatric Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.L.P.); (A.C.Z.)
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12
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Helin N, Kolho K, Merras‐Salmio L. Parentally reported early childhood upper gastrointestinal symptoms alleviate at school age. Acta Paediatr 2022; 111:174-182. [PMID: 34516678 DOI: 10.1111/apa.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/20/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
AIM This study estimated follow-up outcomes for children presenting with troublesome upper gastrointestinal (GI) symptoms in early childhood. METHODS We identified from our upper endoscopy registry children with undefined GI symptoms having undergone an oesophagogastroduodenoscopy to rule out oesophagitis at a median age of 2.6 years in 2006-2016. We included only those with normal findings. In early 2020, we performed a National Patient Data Repository and Prescription Service review to note patients' current GI symptoms, medications and medical consultations. We also employed a study-specific questionnaire with a validated quality-of-life measure (the PedsQL). RESULTS After a median of 7.9 years of follow-up, the children (n = 199) had a median age of 10.6 years. Medical consultations related to upper GI symptoms were rare. However, parents reported recurrent GI symptoms in 24% of the children, and 41% followed a specific diet. Regular anti-acid medication was in use in 3.5% of the cohort, more often when with a predisposing condition for reflux disease. The current quality of life was good. CONCLUSION Although some upper GI symptoms may persist after early childhood, patients without diseases predisposing to reflux disease have a good quality of life without GI-related morbidity in school age.
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Affiliation(s)
- Noora Helin
- Children's Hospital Paediatric Research Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Kaija‐Leena Kolho
- Children's Hospital Paediatric Research Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Laura Merras‐Salmio
- Children's Hospital Paediatric Research Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
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13
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Crouse JJ, Ho N, Scott J, Martin NG, Couvy-Duchesne B, Hermens DF, Parker R, Gillespie NA, Medland SE, Hickie IB. Days out of role and somatic, anxious-depressive, hypo-manic, and psychotic-like symptom dimensions in a community sample of young adults. Transl Psychiatry 2021; 11:285. [PMID: 33986245 PMCID: PMC8119948 DOI: 10.1038/s41398-021-01390-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Improving our understanding of the causes of functional impairment in young people is a major global challenge. Here, we investigated the relationships between self-reported days out of role and the total quantity and different patterns of self-reported somatic, anxious-depressive, psychotic-like, and hypomanic symptoms in a community-based cohort of young adults. We examined self-ratings of 23 symptoms ranging across the four dimensions and days out of role in >1900 young adult twins and non-twin siblings participating in the "19Up" wave of the Brisbane Longitudinal Twin Study. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) quantified associations between impairment and different symptom patterns. Three individual symptoms showed significant associations with days out of role, with the largest association for impaired concentration. When impairment was assessed according to each symptom dimension, there was a clear stepwise relationship between the total number of somatic symptoms and the likelihood of impairment, while individuals reporting ≥4 anxious-depressive symptoms or five hypomanic symptoms had greater likelihood of reporting days out of role. Furthermore, there was a stepwise relationship between the total number of undifferentiated symptoms and the likelihood of reporting days out of role. There was some suggestion of differences in the magnitude and significance of associations when the cohort was stratified according to sex, but not for age or twin status. Our findings reinforce the development of early intervention mental health frameworks and, if confirmed, support the need to consider interventions for subthreshold and/or undifferentiated syndromes for reducing disability among young people.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Nicholas Ho
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jan Scott
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
- Diderot University, Paris, France
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Baptiste Couvy-Duchesne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- ARAMIS Laboratory, Paris Brain Institute, Paris, France
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Virginia, USA
| | - Sarah E Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Ian B Hickie
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
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14
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Cantiani C, Dondena C, Capelli E, Riboldi EM, Molteni M, Riva V. Effects of COVID-19 Lockdown on the Emotional and Behavioral Profiles of Preschool Italian Children with and without Familial Risk for Neurodevelopmental Disorders. Brain Sci 2021; 11:477. [PMID: 33918593 PMCID: PMC8070543 DOI: 10.3390/brainsci11040477] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
The effects of COVID-19 containment measures on the emotional and behavioral development of preschoolers are not clear. We investigated them within an ongoing longitudinal project including typically developing children (TD) and children at high familial risk for neurodevelopmental disorders (HR-NDD) who were potentially more vulnerable. The study included ninety children aged 2-6 years (TD = 48; HR-NDD = 42). Before the emergency phase (T0), all children received a clinical assessment, including the parent questionnaire Child Behavior Checklist for Ages 1.5-5 (CBCL 1.5-5). The same questionnaire was filled out again during the emergency (T1), together with an ad-hoc questionnaire investigating environmental factors characterizing the specific period. Changes in the CBCL profiles between T0 and T1 were evaluated. Overall, irrespective of familial risk, the average T-scores on specific CBCL scales at T1 were higher than at T0. Associations emerged between delta scores reflecting worsening scores on specific CBCL scales and clinical and environmental factors. Our results confirmed the negative impact of the lockdown on preschool children's emotional/behavioral profiles, and highlight the need for strategic approaches in the age range of 2-6 years, especially for more susceptible children owing to environmental factors and pre-existing emotional problems.
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Affiliation(s)
- Chiara Cantiani
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy; (C.D.); (E.C.); (E.M.R.); (M.M.); (V.R.)
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15
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Olsen EM, Rask CU, Elberling H, Jeppesen P, Clemmensen L, Munkholm A, Li XQ, Hansen MH, Rimvall MK, Linneberg A, Munch IC, Larsen M, Jørgensen T, Skovgaard AM. Cohort Profile: The Copenhagen Child Cohort Study (CCC2000). Int J Epidemiol 2021; 49:370-371l. [PMID: 31876909 DOI: 10.1093/ije/dyz256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Else Marie Olsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Aarhus, Aarhus, Denmark
| | - Hanne Elberling
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Services, Capital Region, Copenhagen, Denmark
| | - Pia Jeppesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Services, Capital Region, Copenhagen, Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health Services, Capital Region, Copenhagen, Denmark.,Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Anja Munkholm
- Child and Adolescent Mental Health Services, Capital Region, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Xiao Qiang Li
- Department of Ophthalmology, Rigshospitalet Glostrup, Capital Region, Copenhagen, Denmark
| | | | - Martin K Rimvall
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Services, Capital Region, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Inger Christine Munch
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Zealand University Hospital, Region of Zealand, Roskilde, Denmark
| | - Michael Larsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet Glostrup, Capital Region, Copenhagen, Denmark
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Aarlborg, Denmark
| | - Anne Mette Skovgaard
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
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16
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Casanovas M, Kramer T, Clarke V, Goddard A, M Elena G, Khadr S. Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study. PSYCHOL HEALTH MED 2021; 27:546-558. [PMID: 33573390 DOI: 10.1080/13548506.2021.1874437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.
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Affiliation(s)
- Marta Casanovas
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Tami Kramer
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Venetia Clarke
- The Havens. King's College Hospital NHS Foundation Trust, London, UK
| | - Andrea Goddard
- The Havens. King's College Hospital NHS Foundation Trust, London, UK.,Department of Paediatrics. Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Garralda M Elena
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Sophie Khadr
- The Havens. King's College Hospital NHS Foundation Trust, London, UK.,Institute of Child Health(ICH), Population, Policy and Practice. University College London (UCL), London, UK
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17
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Daming M, Xin L, Shuwen H, Pengfei G, Shuai L, Feng G, Xiaomei C, Binbin C, Hui Z. Somatization Symptoms Regulate Emotional Memory Bias in Adolescents With Major Depressive Disorder. Front Psychiatry 2021; 12:656198. [PMID: 34512408 PMCID: PMC8428275 DOI: 10.3389/fpsyt.2021.656198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Somatization symptoms are commonly comorbid with depression. Furthermore, people with depression and somatization have a negative memory bias. We investigated the differences in emotional memory among adolescent patients with depressive disorders, with and without functional somatization symptoms (FSS). Methods: We recruited 30 adolescents with depression and FSS, 38 adolescents with depression but without FSS, and 38 healthy participants. Emotional memory tasks were conducted to evaluate the emotional memory of the participants in the three groups. The clinical symptoms were evaluated using the Hamilton Depression Rating Scale (HDRS) and the Children's Somatization Inventory (CSI). Results: The valence ratings and recognition accuracy rates for positive and neutral images of adolescent patients were significantly lower than those of the control group (F = 12.208, P < 0.001; F = 6.801, P < 0.05; F = 14.536, P < 0.001; F = 6.306, P < 0.05, respectively); however, the recognition accuracy rate for negative images of adolescent patients of depression without FSS was significantly lower than that of patients with FSS and control group participants (F = 10.316, P < 0.001). These differences persisted after controlling for HDRS scores. The within-group analysis revealed that patients of depression with FSS showed significantly higher recognition accuracy rates for negative images than the other types (F = 5.446, P < 0.05). The recognition accuracy rate for negative images was positively correlated with CSI scores (r = 0.352, P < 0.05). Conclusion: Therefore, emotional memory impairment exists in adolescent patients of depression and FSS are associated with negative emotional memory retention.
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Affiliation(s)
- Mo Daming
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Li Xin
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Hu Shuwen
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Guo Pengfei
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Liu Shuai
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Geng Feng
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Cao Xiaomei
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Chen Binbin
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
| | - Zhong Hui
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China
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18
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Holstein BE, Damsgaard MT, Ammitzbøll J, Madsen KR, Pedersen TP, Rasmussen M. Recurrent abdominal pain among adolescents: trends and social inequality 1991-2018. Scand J Pain 2020; 21:95-102. [PMID: 32892190 DOI: 10.1515/sjpain-2020-0062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The association between socioeconomic status and recurrent abdominal pain (RAP) among adolescents is an understudied issue. No study has examined whether such an association changes over time. The aim was to examine trends in RAP among adolescents in Denmark from 1991 to 2018, to examine whether there was social inequality in RAP and whether this inequality varied over time. METHODS The study used data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study of nationally representative samples of 11-, 13- and 15-year-olds. This study pooled data from eight comparable surveys from 1991 to 2018, overall participation rate 88.0%, n=30,048. The definition of RAP was self-reported stomach-ache daily or several days per week during the past six months. We reported absolute inequality as prevalence difference in RAP between low and high socioeconomic status and relative inequality as odds ratio for RAP by socioeconomic status. RESULTS In the entire study population, 5.6% reported RAP, 3.1% among boys and 7.8% among girls. There was a significant increase in RAP from 1991 to 2018 among boys and girls, test for trend, p<0.0001. The prevalence of RAP was significantly higher in low than high socioeconomic status, OR=1.63 (95% CI: 1.42-1.87). The absolute social inequality in RAP fluctuated with no consistent increasing or decreasing pattern. CONCLUSIONS The prevalence of RAP increased from 1991 to 2018. The prevalence was significantly higher among girls than among boys, and significantly higher in low socioeconomic status families. Professionals should be aware of RAP as common and potentially serious health problems among children and adolescents. In addition to clinical examination it is important to focus on improving the child's quality of life, reduce parents' and children's concerns about the seriousness of the condition, and consider supplements to medicine use.
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Affiliation(s)
- Bjørn E Holstein
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Mogens Trab Damsgaard
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Janni Ammitzbøll
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Katrine Rich Madsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Mette Rasmussen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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19
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Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations. J Behav Ther Exp Psychiatry 2020; 68:101565. [PMID: 32171996 DOI: 10.1016/j.jbtep.2020.101565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 02/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents. METHODS Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires. RESULTS MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR2 = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01). LIMITATIONS Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending. CONCLUSIONS A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.
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20
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Saunders NR, Gandhi S, Chen S, Vigod S, Fung K, De Souza C, Saab H, Kurdyak P. Health Care Use and Costs of Children, Adolescents, and Young Adults With Somatic Symptom and Related Disorders. JAMA Netw Open 2020; 3:e2011295. [PMID: 32701161 PMCID: PMC7378752 DOI: 10.1001/jamanetworkopen.2020.11295] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Somatic symptom and related disorders are highly prevalent mental health disorders among young people. Presentation can be varied, and patients often face long delays and see multiple practitioners to receive a diagnosis. OBJECTIVE To evaluate the health care use and costs in a population-based sample of children and young people with somatic symptom and related disorders in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal single-payer health insurance plan. Participants included children aged 4 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 to 24 years residing in Ontario, Canada, during the period of April 1, 2008, to March 31, 2015. Included participants had a first health record diagnosis of somatic symptom and related disorders and were grouped based on the setting of their index somatic symptom and related disorders contact: outpatient, emergency department, or inpatient. Data were analyzed from August 1, 2017, to February 1, 2018. EXPOSURES One year before and 1 year after diagnosis of somatic symptom and related disorders. MAIN OUTCOMES AND MEASURES Outcome measures included overall and mental health-specific ambulatory and acute care visits and overall health system costs and sector-specific costs. RESULTS A total of 33 272 patients (median [interquartile range {IQR}] age, 20 [16-22] years; 17 387 female [52.3%]) were included in the analysis. Among these patients, 3875 (11.6%) were aged 4 to 12 years, 7273 (21.9%) were aged 13 to 17 years, and 22 124 (66.5%) were aged 18 to 24 years. A total of 17 893 (53.8%) had their index visit as outpatients, whereas 13 310 (40.0%) and 2069 (6.2%) were diagnosed in the emergency department and inpatient settings, respectively. Ambulatory physician visits were frequent and persisted 1 year after diagnosis within each setting (before vs after 1 year, median [IQR] visits, inpatient setting: 7 [3-13] vs 7 [3-13]; emergency department setting: 4 [2-8] vs 4 [2-9]; outpatient setting: 3 [1-7] vs 4 [2-7]; P < .001). After diagnosis, many did not receive physician-delivered mental health care (35.3% [730 of 2069] in an inpatient setting, 59.1% [7866 of 13 310] in an emergency department setting, 58.5% [10 467 of 17 893] in an outpatient setting; P < .001). Acute care use was frequent and remained so after diagnosis across settings. Of those hospitalized as inpatients at diagnosis, 37.7% (779 of 2069) were readmitted within 1 year. Mean (SD) 2-year patient costs were CAD$9845 ($39 725) (median [IQR], $2401 [$960-$7019]). Hospitalized patients had a 2-year mean (SD) cost of $51 424 ($100 416) (median [IQR], $21 997 [$12 510-$45 841]) per-patient expenditure. CONCLUSION AND RELEVANCE This study found that children and young people with somatic symptom and related disorders frequently used the health system with substantial health system costs before and after diagnosis. Many of these patients did not receive physician-delivered mental health care. These findings suggest that this population may be under-recognized, and initiatives for early recognition and engagement with mental health support may be warranted.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Claire De Souza
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hana Saab
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Abstract
OBJECTIVE Somatization and functional somatic symptoms reflect conditions in which physical symptoms are not sufficiently explained by medical conditions. Literature suggests that these somatic symptoms may be related to illness exposure in the family. Children with a parent or sibling with a chronic illness may be particularly vulnerable to developing somatic symptoms. This study provides a systematic review of the literature on somatic symptoms in children with a chronically ill family member. METHODS A systematic review (PROSPERO registry ID: CRD42018092344) was conducted using six databases (PubMed, EMBASE, PsychINFO, Scopus, CINAHL, and Cochrane) from articles published before April 5, 2018. All authors evaluated articles by title and abstract, and then by full-text review. Relevant data were extracted by the first author and reviewed by remaining authors. RESULTS Twenty-seven unique studies met the criteria. Seventeen examined somatic symptoms in children with a chronically ill parent, and seven evaluated somatic symptoms in children with a chronically ill sibling. Three studies examined somatic symptoms in children with an unspecified ill relative. The strongest relationship between child somatization and familial illness was found with children with a chronically ill parent (13/17 studies). Evidence for somatic symptoms in children with an ill sibling was mixed (4/7 studies found a positive association). CONCLUSIONS The literature on somatic symptoms in children suggests that parental illness is related to increased somatic symptoms in children. Research examining the effects of having a sibling with an illness on somatic symptoms is mixed. Several areas of future research are outlined to further clarify the relationship between familial chronic illness and somatic symptoms.
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Hulgaard DR, Rask CU, Risor MB, Dehlholm G. Illness perceptions of youths with functional disorders and their parents: An interpretative phenomenological analysis study. Clin Child Psychol Psychiatry 2020; 25:45-61. [PMID: 31079473 DOI: 10.1177/1359104519846194] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. METHODS A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11-15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. RESULTS Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants' illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. CONCLUSIONS The label 'functional disorder' was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.
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Affiliation(s)
- Ditte Roth Hulgaard
- Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Ulrikka Rask
- Research Unit, Centre for Child and Adolescent Psychiatry, Central Denmark Region, Aarhus University Hospital, Denmark
| | - Mette Bech Risor
- General Practice Research Unit, Department of Community Medicine, UiT, The Arctic University of Norway, Norway
| | - Gitte Dehlholm
- Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Denmark
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23
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Bonduelle SL, Vanderfaeillie J, Denijs K, Lampo A, Imeraj L. Factors influencing adherence to therapeutic recommendations made after diagnostic reassessment of medically unexplained symptoms in children and adolescents. Clin Child Psychol Psychiatry 2020; 25:62-77. [PMID: 30818976 DOI: 10.1177/1359104519827995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. OBJECTIVES After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. METHODS Parents of 27 children aged 7-17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. RESULTS Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. CONCLUSION Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.
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Affiliation(s)
- Sam Lb Bonduelle
- PAika (Department of Child and Adolescent Psychiatry), UZ Brussel (University Hospital Brussels), Belgium.,Vrije Universiteit Brussel (Dutch-Speaking Free University of Brussels), Belgium
| | - Johan Vanderfaeillie
- PAika (Department of Child and Adolescent Psychiatry), UZ Brussel (University Hospital Brussels), Belgium.,Vrije Universiteit Brussel (Dutch-Speaking Free University of Brussels), Belgium
| | - Katrien Denijs
- PAika (Department of Child and Adolescent Psychiatry), UZ Brussel (University Hospital Brussels), Belgium
| | - Annik Lampo
- PAika (Department of Child and Adolescent Psychiatry), UZ Brussel (University Hospital Brussels), Belgium.,Vrije Universiteit Brussel (Dutch-Speaking Free University of Brussels), Belgium
| | - Lindita Imeraj
- PAika (Department of Child and Adolescent Psychiatry), UZ Brussel (University Hospital Brussels), Belgium.,Vrije Universiteit Brussel (Dutch-Speaking Free University of Brussels), Belgium
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Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.32217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.A narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.There were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.
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Østbye SV, Wang CEA, Granheim IPH, Kristensen KE, Risør MB. Epistemological and methodological paradoxes: secondary care specialists and their challenges working with adolescents with medically unexplained symptoms. Int J Ment Health Syst 2018; 12:52. [PMID: 30258491 PMCID: PMC6151926 DOI: 10.1186/s13033-018-0232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/19/2018] [Indexed: 12/03/2022] Open
Abstract
Background Early adolescence is considered a critical period for the development of chronic and recurrent medically unexplained symptoms (MUS), and referrals and system-initiated patient trajectories often lead to an excess of examinations and hospitalizations in the cross-section between mental and somatic specialist care for this group of patients. Dimensions of the relationship and communication between clinician and patient are shown in primary care studies to be decisive for subsequent illness pathways, often creating adverse effects, but knowledge on clinical communication in specialist care is still scarce. Methods This study explores communicative challenges specific to clinical encounters between health professionals and adolescent patients in specialist care, as presented through interviews and focus group data with highly experienced specialists working in adolescent and child services at a Norwegian university hospital. Results The results are presented in a conceptual model describing the epistemological and methodological paradoxes inherent in the clinical uncertainty of MUS. Within these paradoxes, the professionals try to solve the dilemmas by being creative in their communication strategies; applying metaphors and other rhetorical devices to explain complex ideas; creating clinical prototypes as a way to explain symptoms and guide them in clinical action; relying on principles from patient-centered care involving empathy; and trying to balance expertise and humility. Conclusion The challenges in communication arise as a result of opposing discourses on biomedicine, family, health and adolescence that create dilemmas in everyday clinical work. By moving away from a positivist and biomedical framework towards an interpretive paradigm, where culturally derived and historically situated interpretations are used to understand the social life-world of the patient, one can create a more humane health service in accordance with ideals of patient-centered care.
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Affiliation(s)
- Silje Vagli Østbye
- 1Department of Psychology, Faculty of Health, UiT-Arctic University of Norway, Tromsø, Norway
| | | | | | | | - Mette Bech Risør
- 4Department of Community Medicine, General Practice Research Unit, Faculty of Health, UiT-Arctic University of Norway, Tromsø, Norway
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26
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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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27
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Stokholm L, Juhl M, Lønfeldt NN, Mikkelsen SH, Obel C, Strandberg-Larsen K. Obstetric synthetic oxytocin use and subsequent hyperactivity/inattention problems in Danish children. Acta Obstet Gynecol Scand 2018; 97:880-889. [DOI: 10.1111/aogs.13344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lonny Stokholm
- Section of Epidemiology; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Mette Juhl
- Department of Midwifery; Metropolitan University College; Copenhagen Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Nicole N. Lønfeldt
- Child and Adolescent Mental Health Services, Research Unit; Capital Region of Denmark Psychiatry; Copenhagen Denmark
| | - Susanne H. Mikkelsen
- Section for General Medical Practice; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Carsten Obel
- Section for General Medical Practice; Department of Public Health; Aarhus University; Aarhus Denmark
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28
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van Eck van der Sluijs JF, Ten Have M, de Graaf R, Rijnders CAT, van Marwijk HWJ, van der Feltz-Cornelis CM. Predictors of Persistent Medically Unexplained Physical Symptoms: Findings From a General Population Study. Front Psychiatry 2018; 9:613. [PMID: 30524322 PMCID: PMC6262298 DOI: 10.3389/fpsyt.2018.00613] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: To explore the persistency of Medically Unexplained Symptoms (MUS) and its prognostic factors in the general adult population. Knowledge of prognostic factors of MUS may indicate possible avenues for intervention development. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face cohort study among the Dutch general population aged 18-64 years. We selected subjects with MUS at baseline and who participated at follow-up (N = 324) and reassessed those subjects for having MUS at 3 year follow-up. Logistic regression analyses were used to determine risk factors for persistency of MUS. Results: 36.4% of the subjects had persistent MUS at follow-up. In logistic regression analyses adjusted for sex and age, persistency of MUS was predicted by the number of comorbid chronic medical disorder(s), lower education, female sex, not having a paid job, parental psychopathology as well as lower functioning. In the logistic regression analysis in which all significant variables adjusted for sex and age were entered simultaneously, three variables predicted persistent MUS: parental psychopathology, the number of comorbid chronic medical disorder(s) and physical functioning, with odds ratios of 2.01 (1.20-3.38), 1.19 (1.01-1.40), and 0.99 (0.97-1.00), respectively. Conclusion: In the adult general population, MUS were persistent in over one third of the subjects with MUS at baseline. Persistency was significantly predicted by parental psychopathology, number of comorbid chronic medical disorders, and physical functioning. These findings warrant further research into early intervention and treatment options for persons with an increased risk of persistent MUS.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Top clinical Center for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Tranzo, Tilburg University, Tilburg, Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | | | - Harm W J van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, United Kingdom
| | - Christina M van der Feltz-Cornelis
- Top clinical Center for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Tranzo, Tilburg University, Tilburg, Netherlands.,Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
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30
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Bonvanie IJ, Kallesøe KH, Janssens KAM, Schröder A, Rosmalen JGM, Rask CU. Psychological Interventions for Children with Functional Somatic Symptoms: A Systematic Review and Meta-Analysis. J Pediatr 2017; 187:272-281.e17. [PMID: 28416243 DOI: 10.1016/j.jpeds.2017.03.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/03/2017] [Accepted: 03/07/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects. STUDY DESIGN Cochrane, PubMed, PsycINFO, EMBASE, and CINAHL were searched for randomized controlled trials published in peer-reviewed journals. Randomized controlled trials studying the effect of a psychological treatment on symptom load and disability in children with functional somatic symptoms were selected. Data on symptom load, disability, and school absence directly post-treatment and at follow-up were extracted by 2 assessors. Studies were appraised with the Cochrane risk of bias tool. Standardized mean differences were pooled in a random-effects model. Heterogeneity in effect-sizes was explored by use of meta-regressions. PROSPERO Registration ID: CRD42015029667. RESULTS Out of 4098 identified records, 27 studies were included in this review of which 21 were included in meta-analyses. Psychological treatments reduced symptom load (Hedges g = -0.61), disability (Hedges g = -0.42), and school absence (Hedges g = -0.51) post-treatment in children suffering from various functional somatic symptoms. Effects were maintained at follow-up. Type and duration of symptoms, age, and treatment dose did not explain heterogeneity in effect-sizes between studies. Effect-sizes should be interpreted with caution because of the variety in outcome measures, unexplained heterogeneity in found effects and potential publication bias. CONCLUSIONS Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.
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Affiliation(s)
- Irma J Bonvanie
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
| | - Karen H Kallesøe
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Karin A M Janssens
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Judith G M Rosmalen
- University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Charlotte U Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Child and Adolescent Psychiatric Center Risskov, Aarhus University Hospital, Aarhus, Denmark
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31
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Græsholt-Knudsen T, Skovgaard AM, Jensen JS, Rask CU. Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs. Arch Dis Child 2017; 102:617-623. [PMID: 28137707 DOI: 10.1136/archdischild-2016-311808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/09/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Knowledge about childhood functional somatic symptoms (FSS) and healthcare costs is scarce. This study aims to assess whether FSS in children aged 5-7 years are associated with increased future primary healthcare. DESIGN At baseline of the observational cohort study, between years 2005 and 2007, 1327 children from the Copenhagen Child Cohort were assessed at ages 5-7 years for FSS and chronic physical diseases using the Soma Assessment Interview. Information on primary healthcare use was obtained from the National Health Insurance Service Register, and measured as the price of all medical services outside the hospital during a 4.5-year follow-up period from the day of assessment. Regression with bootstrap bias-corrected and accelerated CIs were performed. RESULTS 1018 (76.8%) children had no FSS with primary healthcare use adjusted for other child health problems, maternal education and family changes of €448.2, 388.2-523.8 and number of face-to-face contacts: 11.90, 10.71-13.25; 250 (18.9%) had FSS with healthcare use €441.0, 355.0-550.3 and face-to-face contacts: 11.22, 9.60-12.91, and 58 (4.4%) had impairing FSS with healthcare use: €625.9, 447.9-867.8 and face-to-face contacts: 14.65, 11.20-19.00. In unadjusted regression analysis, impairing FSS were associated with increased healthcare use (increased costs: €246.0, 67.6-494.3). The adjusted association was slightly attenuated (increased costs: €177.8, 1.3-417.0). CONCLUSIONS Impairing FSS in children aged 5-7 years is a predictor for the child's future primary healthcare use. More research on complex predictive models is needed to further explore the clinical significance of these results, and to contribute to the underpinning of early interventions towards impairing FSS in children.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Anne Mette Skovgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark.,Regional Centre for Child and Adolescent Psychiatry, Risskov, Aarhus University Hospital, Aarhus N, Denmark
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Tøt-Strate S, Dehlholm-Lambertsen G, Lassen K, Rask CU. Clinical features of functional somatic symptoms in children and referral patterns to child and adolescent mental health services. Acta Paediatr 2016; 105:514-21. [PMID: 26666703 DOI: 10.1111/apa.13310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Abstract
AIM Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them. METHODS The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not. RESULTS Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response. CONCLUSION Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS.
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Affiliation(s)
- Simone Tøt-Strate
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Gitte Dehlholm-Lambertsen
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Karin Lassen
- Department of Paediatrics; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics; Aarhus University Hospital; Aarhus Denmark
- Regional Centre for Child and Adolescent Psychiatry; Risskov; Aarhus University Hospital; Aarhus Denmark
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Measuring Somatic Complaints in Primary School Children: Validation and Revision of the German Children's Somatization Inventory (CSI) and its Parental Version. Child Psychiatry Hum Dev 2015; 46:786-99. [PMID: 25416581 DOI: 10.1007/s10578-014-0520-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The objective was a psychometric examination of a German translation of the Children's Somatization Inventory (CSI) and its parents' version (P-CSI) and a replication of the item selection process of Walker et al. in J Pediatr Psychol 34:430-440 [5] for their revised version to create shorter German versions. Based on a school sample of 1,539 parents and 731 children, we explored the psychometric properties and dimensionality of the original and a shortened revised version. A clinical sample of 70 parental reports served as an additional sample. Walker et al.'s item selection could be largely replicated. Dimensionality differed between samples and versions (original vs. revised), but original DSM-III symptom clusters could mostly be identified. Symptom intensity was associated with age and mental health. Internal consistency, test-retest- and inter-rater reliability were good. Both German versions, the CSI and the P-CSI can be regarded as a useful screening instrument for somatic complaints in children.
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Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS One 2015; 10:e0126982. [PMID: 25992621 PMCID: PMC4439136 DOI: 10.1371/journal.pone.0126982] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain. Methods The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood. Results A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events. Conclusion Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence.
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Affiliation(s)
- Judith J Korterink
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Kay Diederen
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
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Straube A, Heinen F, Ebinger F, von Kries R. Headache in school children: prevalence and risk factors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:811-8. [PMID: 24333367 DOI: 10.3238/arztebl.2013.0811] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recurrent headache is a common problem in school children. Evaluation generally leads to the diagnosis of a primary headache syndrome (migraine or tension-type headache). This review is addressed to the question whether headaches in school children are becoming more common and, if so, what risk factors are associated with the rise in frequency. METHOD We selectively searched the PubMed database for pertinent publications that contained the terms "primary headache AND children/adolescent AND risk factors/prevalence." Articles published in either English or German up to April 2013 were considered. Articles on secondary types of headache were excluded. RESULTS Headaches are becoming more common among school children. At present, 66% to 71% of 12- to 15- year-olds have at least one headache every three months, and 33% to 40% have at least one per week. Headache is often accompanied by other physical and/or emotional manifestations. Studies from Scandinavia reveal increasing prevalence in age groups from 8 years of age and upward. Various studies have identified the following risk factors for headache or for its chronification (up to 5.8-fold elevation of risk): a dysfunctional family situation, the regular consumption of alcohol, caffeine ingestion, smoking, a low level of physical activity, physical or emotional abuse, bullying by peers, unfair treatment in school, and insufficient leisure time. CONCLUSION Headaches are becoming more common among children and adolescents. They are often associated with other physical and emotional complaints.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University of Munich, Campus Grosshadern, Department of Pediatric Neurology, University of Munich, Campus Innenstadt, Dr. von Haunersches Kinderspital, Clinic for Child and Adolescent Medicine, St. Vincent Hospital, Paderborn, and Center for Child and Adolescent Medicine, University of Heidelberg, Institute of Social Paediatrics and Adolescent Medicine, University of Munich
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. The association between GP consultations for non-specific physical symptoms in children and parents: a case-control study. PLoS One 2014; 9:e108039. [PMID: 25251344 PMCID: PMC4176724 DOI: 10.1371/journal.pone.0108039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences. OBJECTIVE To investigate associations between GP consultations for NSPS in parents and their children. METHODS Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354). PRIMARY OUTCOME MEASURE child consultation status for NSPS. RESULTS Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms. CONCLUSIONS Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
- Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
- Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | | | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
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Jensen JF, Gottschau M, Siersma VD, Graungaard AH, Holstein BE, Knudsen LE. Association of maternal self-medication and over-the-counter analgesics for children. Pediatrics 2014; 133:e291-8. [PMID: 24394687 DOI: 10.1542/peds.2013-1107] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child's frequency of pain into account. METHODS A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use. RESULTS After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child's pain was adjusted for (odds ratio 3.00, P = .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics. CONCLUSIONS Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child's pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.
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Hart SL, Hodgkinson SC, Belcher HME, Hyman C, Cooley-Strickland M. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med 2013; 36:454-65. [PMID: 22772584 PMCID: PMC3726557 DOI: 10.1007/s10865-012-9440-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
Somatic symptoms are a common physical response to stress and illness in childhood. This study assessed 409, primarily African American (85.6 %), urban elementary school children to examine the association between: (1) somatic symptoms and potential external stressors (school and peer stress, family conflict, and community violence) and (2) parent and child agreement on children's self-report of somatic symptoms. The odds of self-report of somatic complaints were significantly associated with family conflict, school and peer stress, and community violence exposure (OR = 1.26, 95 % CI: 1.05-1.50; OR = 1.18, 95 % CI 1.08-1.28; and OR = 1.02, 95 % CI: 1.00-1.05, respectively). Identifying the associations between social, family, and community based stress and somatic symptoms may improve the quality of life for children living in urban environments through early identification and treatment.
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Affiliation(s)
- Shayla L. Hart
- Department of Psychology, Howard University, Washington, DC, USA
| | | | - Harolyn M. E. Belcher
- Family Center at Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA. Johns Hopkins University School of Medicine, Baltimore, MD, USA. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Corine Hyman
- Family Center at Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Michele Cooley-Strickland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. University of California, Los Angeles, Los Angeles, CA, USA
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Rask CU, Ørnbøl E, Fink PK, Skovgaard AM. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds. Pediatrics 2013; 132:e459-67. [PMID: 23837183 DOI: 10.1542/peds.2013-0159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. METHODS We assessed 1327 children from the Copenhagen Child Cohort 2000 for FSS at ages 5 to 7 years. Register data on past health care use in general practice were compared between children with and those without parent-reported medical consultation for FSS at the age of 5 to 7 years: respective consulters (n = 96) and nonconsulters (n = 211) and children without FSS (n = 1019). Degree of parental worries about the child's symptoms and parent-reported symptom characteristics and associated impacts were compared between consulters and nonconsulters. RESULTS Among 308 children with FSS, 31.1% were consulters. Being a consulter was significantly associated with multisymptomatic presentation, parental worries about the symptoms, symptom impact, and a higher past health care use in general practice. Multiple logistic regression analysis controlled for gender, comorbid physical disease, and symptom severity revealed that the number of face-to-face contacts in general practice during the child's first 4 years of life predicted being an consulter for FSS at 5 to 7 years (odds ratio 1.03, 95% confidence interval 1.00-1.06; odds ratio interpreted per unit change in number of contacts). CONCLUSIONS This study adds to our understanding of health care use for FSS in childhood by highlighting the influence of parents' early consultation patterns with their child and the influence of parental perceptions of their child's health and FSS-related impact on pediatric health care use for FSS. Management of health care use in children with FSS should address these aspects.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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Rask CU, Ørnbøl E, Olsen EM, Fink P, Skovgaard AM. Infant behaviors are predictive of functional somatic symptoms at ages 5-7 years: results from the Copenhagen Child Cohort CCC2000. J Pediatr 2013; 162:335-42. [PMID: 23026486 DOI: 10.1016/j.jpeds.2012.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 06/13/2012] [Accepted: 08/02/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate infancy predictors of impairing functional somatic symptoms (FSS) at child ages 5-7 years with a focus on problems with feeding, sleep, and tactile reactivity. STUDY DESIGN This study is part of a longitudinal birth cohort study, Copenhagen Child Cohort CCC2000. Child health, development, and functioning were assessed by community health nurses at 4 home visits from birth to age 10 months. FSS at ages 5-7 years were measured by the Soma Assessment Interview in 1327 children. Sociodemographic data and information on maternal psychiatric illness were obtained from the Danish National Registers. RESULTS Multiple logistic regression analysis controlled for maternal psychiatric illness and annual household income revealed that combined infancy regulatory problems (ie, at least 2 of 3 problems of feeding, sleeping, or tactile reactivity during the first 10 months of living) predicted impairing FSS at 5-7 years (aOR = 2.9, 95% CI: 1.3-6.6). Maternal psychiatric illness during the child's first year of living was also associated with later child FSS (aOR = 7.1, 95% CI: 1.8-27.8). CONCLUSION Regulatory problems may be an early marker of disturbed sensory reactivity in young children, which together with maternal psychiatric problems, point to possible early risk mechanisms of impairing FSS in childhood.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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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: 25] [Impact Index Per Article: 2.1] [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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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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Champion D, Pathirana S, Flynn C, Taylor A, Hopper JL, Berkovic SF, Jaaniste T, Qiu W. Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome. Eur J Pain 2012; 16:1224-31. [PMID: 22416025 DOI: 10.1002/j.1532-2149.2012.00130.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Growing pains (GP) is a prevalent familial childhood disorder of unknown aetiology. Familial occurrence of GP, and individual and familial association of GP with restless legs syndrome (RLS) has been reported. METHODS We applied a twin family design to search for evidence of genetic susceptibility to GP, and for a genetic relationship between GP and RLS. The parents of 1843 twin pairs aged 3-16 years were administered a questionnaire, which identified 88 pairs with at least one twin individual fulfilling criteria for GP. Standard questionnaires for history of GP and RLS were completed for these twin pairs, their siblings and parents. RESULTS Twenty-five of 34 monozygotic (MZ) pairs were concordant for GP, compared with 12 of the 54 dizygotic (DZ) pairs. The casewise concordance was 0.85 and 0.36 for MZ and DZ pairs, respectively (p < 0.001). The lifetime GP prevalence for relatives of twins with GP was 51% for non-twin siblings, 47% for parents. Twenty-three percent of twin individuals with GP met RLS criteria compared with 8% of twin individuals without GP (p = 0.03). Of the twins with GP concordance, 19% met RLS criteria compared with 2% of twins with GP discordance (p = 0.01). In two MZ pairs, one had GP and the other RLS. The lifetime prevalence of RLS was 40% for mothers, and 24% for fathers and 18% for non-twin siblings. CONCLUSION This first twin family study of GP provides evidence for a genetic aetiology and for a genetic relationship to RLS.
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Affiliation(s)
- D Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, Australia.
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Serra Giacobo R, Jané MC, Bonillo A, Ballespí S, Díaz-Regañon N. Somatic symptoms, severe mood dysregulation, and aggressiveness in preschool children. Eur J Pediatr 2012; 171:111-9. [PMID: 21611729 DOI: 10.1007/s00431-011-1495-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/09/2011] [Indexed: 12/11/2022]
Abstract
Many researchers have studied somatic symptoms in children. However, its association with severe mood dysregulation (SMD) is poorly known. The aim of this study is to detect the presence of SMD in preschool children and to know the prevalence of somatic symptoms and associations with psychopathology, SMD, and aggressiveness. The study population consists of children between 3 to 6 years of age enrolled in Barcelona's kindergarten schools (n = 319). Their parents completed questionnaires about the presence of somatic symptoms in children, absences from school and pediatric visits, child psychiatric symptoms, presence of symptoms of SMD, and aggressiveness. Teachers were also informed about SMD and aggressiveness. Children who complained frequent somatic symptoms (three or more in the last 2 weeks) were compared with those who did not. Two hundred five children (64.3%) reported at least one physical complaint in the 2 weeks preceding the study. One hundred participants (31.3%) reported frequent somatic complaints. Positive associations were found with anxiety symptomatology, separation anxiety, social phobia, pediatric visits, and school absences, but not with aggressiveness or SMD symptoms. Somatic symptoms are common in a sample of preschool children but do not show a positive association with the symptoms of SMD.
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Affiliation(s)
- Rodrigo Serra Giacobo
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Campus de Bellaterra, Bellaterra, Spain.
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Parental-Reported Health Anxiety Symptoms in 5- to 7-Year-Old Children: The Copenhagen Child Cohort CCC 2000. PSYCHOSOMATICS 2012; 53:58-67. [DOI: 10.1016/j.psym.2011.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 11/22/2022]
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Pathirana S, Champion D, Jaaniste T, Yee A, Chapman C. Somatosensory test responses in children with growing pains. J Pain Res 2011; 4:393-400. [PMID: 22247622 PMCID: PMC3255993 DOI: 10.2147/jpr.s24875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To further the understanding of growing pains (GP), in particular, the nature of this pain disorder. METHODS This study included 33 children aged 5-12 years who met criteria for GP (cases) and 29 children without GP of similar age and sex (controls). Nineteen controls were siblings of cases. GP was diagnosed by standard consensus questionnaires. A questionnaire addressed characteristics of the pain and family history of GP. Evidence for peripheral neuropathic disorder was tested by somatosensory testing and provocation tests of peripheral nerves. Somatosensory testing by a blinded researcher involved threshold determination and/or response magnitude to nonpainful stimuli including touch, dynamic brush, cold, vibration, and deep pressure applied to limb and abdominal sites. RESULTS Distributional, temporal, and quality characteristics of the pain were in accordance with published descriptions. There was no indication of primary musculoskeletal disorder. No evidence was found that GP is a peripheral neuropathic pain syndrome. There were minor but statistically significantly increased responses to cutaneous cold, vibration, and to deep pressure stimuli in cases compared to controls, evident in a wider distribution than the symptomatic lower limbs. CONCLUSION GP is a regional pain syndrome with evidence in this study of mild widespread disorder of somatosensory processing.
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Affiliation(s)
- Shanthi Pathirana
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - David Champion
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Department of Rheumatology, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Tiina Jaaniste
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Anthony Yee
- Department of Rheumatology, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Cindy Chapman
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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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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Eating patterns in a population-based sample of children aged 5 to 7 years: association with psychopathology and parentally perceived impairment. J Dev Behav Pediatr 2011; 32:572-80. [PMID: 21918471 DOI: 10.1097/dbp.0b013e31822bc7b7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is still a lack of research on childhood eating patterns and their correlates in relation to psychopathology and parentally perceived impact in general population samples. We aimed to determine which eating patterns were more likely to be identified as problematic by parents, and their impact and association with childhood psychopathology (emotional, behavioral, and pervasive developmental disorders) in a general population child cohort. METHODS We collected data as part of the 5- to 7-year-old follow-up of a randomly derived subsample of the Copenhagen Child Cohort 2000. Of the eligible 2912, 1327 (45.6%) children and parents participated in the study. Parents were interviewed using a composite instrument assessing eating behaviors and their impact. Associations with contemporaneous psychopathology were determined using logistic regression. RESULTS Five eating patterns were identified (good eating/overeating, picky eating, slow/poor eating, delayed eating behaviors, and snacking behaviors); among these, picky eating and slow/poor eating were described as a problem by more than half of parents and they also had high impact. Picky eating was associated with psychopathology across disorders. Emotional undereating was associated with emotional and functional somatic symptoms. A quarter of parents described at least one eating behavior as a problem. CONCLUSIONS Eating behaviors in a general population cohort were differentially associated with impact and psychopathology. Picky eating was highlighted among other behaviors as having negative correlates. Better knowledge of how childhood eating behaviors impact on children and their association with psychopathology will aid adequate assessment and treatment.
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Hofman A, van Duijn CM, Franco OH, Ikram MA, Janssen HLA, Klaver CCW, Kuipers EJ, Nijsten TEC, Stricker BHC, Tiemeier H, Uitterlinden AG, Vernooij MW, Witteman JCM. The Rotterdam Study: 2012 objectives and design update. Eur J Epidemiol 2011; 26:657-86. [PMID: 21877163 PMCID: PMC3168750 DOI: 10.1007/s10654-011-9610-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Jaddoe VWV, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2010. Eur J Epidemiol 2010; 25:823-41. [PMID: 20967563 PMCID: PMC2991548 DOI: 10.1007/s10654-010-9516-7] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 09/27/2010] [Indexed: 01/09/2023]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. General follow-up rates until the age of 4 years exceed 75%. Data collection in mothers, fathers and preschool children included questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome wide association screen is available in the participating children. Regular detailed hands on assessment are performed from the age of 5 years onwards. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Vincent W V Jaddoe
- The Generation R Study Group (AE006), Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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