Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study

Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study

PURPOSE

Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms.

METHODS

Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms.

RESULTS

The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys.

CONCLUSION

Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Child and Family Antecedents of Pain During the Transition to Adolescence: A Longitudinal Population-Based Study

Pediatric persistent pain is associated with poorer physical and psychosocial functioning in children, as well as immediate and long-term societal costs. Onset typically occurs in early adolescence, suggesting that late childhood is a key window for identifying potential intervention targets before pain symptoms become entrenched. This study used population-based data from the Longitudinal Study of Australian Children (n = 3,812) and adopted a biopsychosocial and ecological systems approach to investigate child, family, and sociodemographic factors associated with pain problems in children transitioning to adolescence. The prevalence of at least weekly parent-reported pain in the study sample was approximately 5% at 10 to 11 years of age, and pain continued at 12 to 13 years of age for 40% of these children. Key factors at 10 to 11 years that uniquely predicted parent-reported pain problems at 12 to 13 years were frequency of previous pain (1-3 times weekly: odds ratio [OR] = 7.49; 95% confidence interval [CI], 4.3-13.0; 4-7 times weekly: OR = 17.8; 95% CI, 8.7-36.5) and sleep difficulties (OR = 1.86; 95% CI, 1.16-2.97). This study highlights the importance of early intervention for persistent pain in childhood, because pain complaints in late childhood tend to persist into early adolescence.

PERSPECTIVE

This article used a biopsychosocial and ecological systems approach to understanding predictors of pain problems during the transition to adolescence within a nationally representative community-based cohort. Sleep difficulties at 10 to 11 years uniquely predicted pain at ages 12 to 13 years, suggesting that early intervention using sleep interventions may be a promising direction for future research.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Pharmacological treatment of depression with and without headache disorders: an appraisal of cost effectiveness and cost utility of antidepressants

BACKGROUND

Depression and headache are highly prevalent in clinical settings. The co-occurrence of headache may impact choice of antidepressants, healthcare utilisation, and outcomes in patients with depression. The current study aims to examine the cost-effectiveness and cost-utility of different antidepressants for treating patients with depression and comorbid headache disorders.

METHODS

Adult patients prescribed with antidepressants for depression (n=96,501) were identified from the National Health Insurance Research Database in Taiwan. A cost-effectiveness and cost-utility analysis was conducted comparing selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), and by the presence of comorbid headache disorders and other pain conditions.

RESULTS

In this study, SSRIs dominated SNRIs in both cost-effectiveness and cost-utility. As revealed in the cost-effectiveness acceptability curves, TCAs were likely to have a cost-utility advantage compared to SSRIs and SNRIs in improving quality-adjusted life years (QALYs) for patients with comorbid headache; SSRIs remained as the most cost-effective option for patients with other pain conditions.

LIMITATIONS

Limitations include the use of proxy definition of remission as effectiveness measure and the adoption of utility values from previous studies.

CONCLUSIONS

Given a pre-determined willingness-to-pay level, TCAs can be considered as a cost-effective option to improve QALYs for depressed patients with headache disorders. Future research is needed to further clarify factors influencing the cost-effectiveness and cost-utility of pharmacological treatments in depressed patients with specific pain conditions.

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

This study investigated associations between pain symptoms in mid-childhood and severe suicidality in adolescence and early adulthood. Severe suicidality was defined as completed suicide or suicidal attempt requiring hospital admission. In a nationwide prospective population-based study (n = 6,017), parents and children were asked about the child's headache and abdominal pain at age eight. The outcome was register-based data on suicide or suicidal attempt requiring hospital treatment by age 24. Family composition, parental educational level, and the child's psychiatric symptoms reported by the child, parents and teacher at baseline were included as covariates in statistical analyses. Boys' abdominal pain reported by the parents was associated with later severe suicidality after adjusting for family composition, parental educational level, and childhood psychiatric symptoms at baseline. In addition, the association between boys' own report of headache and later severe suicidality reached borderline significance in unadjusted analysis. Girls' pain symptoms did not predict later severe suicidality.

Functional somatic symptoms in childhood and adolescence

PURPOSE OF REVIEW

Functional somatic symptoms (FSS) are common in children and adolescents, but explanatory models that synthesize research findings are lacking. This article reviews the studies published from January 2012 to March 2013 that investigate the neurophysiological mechanisms that may underlie FSS.

RECENT FINDINGS

Studies from diverse medical disciplines suggest that FSS are associated with functional differences in hypothalamic-pituitary-adrenal function, imbalances in vagal-sympathetic tone, upregulation of immune-inflammatory function, and primed cognitive-emotional responses that serve to amplify reactivity to threatening stimuli, thereby contributing to the subjective experience of somatic symptoms.

SUMMARY

FSS appear to reflect dysregulations of the stress system. When seemingly disparate research findings are interpreted together within an overarching 'stress-system' framework, a coherent explanatory model begins to emerge.