Psychological symptoms in children of parents with chronic pain-the HUNT study

Prevalence of chronic and multisite pain in adolescents and young adults with ADHD: a comparative study between clinical and general population samples (the HUNT study)

Attention-deficit/hyperactivity disorder (ADHD) and chronic pain are prevalent and associated. We examined the prevalence and distribution of chronic pain in adolescents and young adults with ADHD using 9-years longitudinal data (from T1:2009-2011 to T3:2018-2019) with three time points from a clinical health survey compared to two age-matched reference population-based samples. Mixed-effect logistic regression and binary linear regression were used to estimate the probability for chronic and multisite pain at each time point and to compare the prevalence of chronic pain with the reference populations. The prevalence of chronic and multisite pain was high in those with ADHD, especially in female young adults, with highly prevalent chronic pain at 9 years of follow-up (75.9%) compared to 45.7% in females in the reference population. The probability of having pain was only statistically significant for chronic pain in males at 3 years of follow-up (41.9%, p = 0.021). Those with ADHD were at higher risk of reporting single-site and multisite pain compared to the general population at all measurement points. Longitudinal studies should be tailored to further understand the complex sex differences of comorbid chronic pain and ADHD in adolescents, exploring predictive factors of pain assessing long-term associations with bodyweight, psychiatric comorbidities, and possible mechanisms of stimulant use effects on pain.

Exploring the Lived Experiences of Pain in Military Families: A Qualitative Examination

Chronic pain in Canadian Veterans is twice that of the general population and the prevalence of their related mental health concerns is alarmingly high. This likely puts their children at an increased risk of developing pain and mental health problems that can pervasively impact daily life and persist into adulthood. Pain care and military culture of (acute and chronic) pain have been identified as a top priority of Canadian Veterans. This study aimed to gain an in-depth understanding of the pain experiences of Canadian Armed Forces families. Thirty-five semi-structured qualitative interviews were conducted. Demographic information was collected; age, gender, and ethnicity were reported. Twelve Canadian Armed Forces members/Veterans, 17 youth, and 6 spouses were interviewed. Ninety-two percent of Veteran participants reported chronic pain. Reflexive thematic analyses generated four themes: 1) Military mindset: herd culture and solider identity, 2) The culture of pain within military families, 3) Inseparability of mental health and pain, and 4) Breaking the cycle and shifting the military mindset. Military culture and identity create a unique context within which pain expression and experience is integrally shaped within these families. This study sheds light on how pain is experienced and perceived within military families and can inform research on and efforts to foster resilience in these families. PERSPECTIVE: This is the first qualitative study to explore the lived experiences of pain in Canadian military families. Findings underscore the key role that military culture and identity plays in how pain is experienced and perceived in all family members.

Exploring communication in families affected by parental chronic pain: An occupational perspective

BACKGROUND

Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking.

AIMS/OBJECTIVES

To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice.

MATERIALS AND METHODS

Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain.

RESULTS

Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain.

CONCLUSIONS

Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain.

SIGNIFICANCE

The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.

The Influence of Parent's Cardiovascular Morbidity on Child Mental Health: Results from the National Health Interview Survey

BACKGROUND

This study assessed the association between cardiovascular disease (CVD), the leading cause of death in the United States, among parents and child mental health.

METHODS

Our sample included 9076 children aged 6 to 17 years. Data were pooled from the 2016-2018 waves of the National Health Interview Survey. We fitted a logistic regression to obtain the odds ratios in favor of child mental health problems for parental CVD. We also fitted a multinomial logistic regression to obtain the odds in favor of the severity of mental health problems (i.e., minor, definite, and severe).

RESULTS

The adjusted odds of facing difficulties for a child of a parent with CVD were 1.64 (95% CI: 1.28-2.11) times that of their peers whose parents did not have CVD. The adjusted relative risk of facing minor and definite difficulties for a child of a parent with CVD were 1.48 (95% CI: 1.13-1.94) and 2.25 (95% CI: 1.47-3.46) times that of their peers of parents without CVD.

CONCLUSIONS

The results suggest a strong association between child mental health and parental cardiovascular morbidity, demonstrating the need for the development or adaptation of existing public health interventions to facilitate mental health support for children of parents with CVD.

Unified Multifactorial Model of Parental Factors in Community-Based Pediatric Chronic Pain

OBJECTIVE

The combination of parental chronic pain and internalizing characteristics are relevant to chronic pain experiences in their children. A promising unified multifactorial intergenerational model of chronic pain was published in 2019; however, this model was only generalizable to children with severe chronic pain and some factors had limitations. This study aimed to determine validity of an adapted multifactorial model, including parent and child chronic pain status, pain characteristics, pain-related functioning, and internalizing symptoms, in a community setting. Subgroup analyses based on presence of chronic pain in parents and children were explored to determine whether effects were stronger in certain subsamples.

METHODS

Adolescents (N = 1,450, Mage=12.7 years, 50% female), and their parents (82% mothers), were recruited from five schools to complete online surveys. Structural equation modeling was used to investigate interrelated pain-related experiences between parents and their offspring.

RESULTS

The adapted unified multifactorial model had good model fit in the community sample. Significant weak associations were found between all parent and child factors. The strongest associations were found in the subsample of parents and children with chronic pain. In all subgroups, internalizing factors were the most strongly linked intergenerational constructs.

CONCLUSIONS

Our results support the validity of the unified multifactorial model of parental factors in pediatric chronic pain, although associations were weaker in the community sample than those previously reported in a clinical sample. In children who develop chronic pain, it is important to consider their parent's chronic pain and internalizing symptoms to best manage intergenerational effects.

Maternal migraine and the risk of psychiatric disorders in offspring: a population-based cohort study

AIMS

Maternal migraine may contribute to mental heath problems in offspring but empirical evidence has been available only for bipolar disorders. Our objective was to examine the association between maternal migraine and the risk of any and specific psychiatric disorders in offspring.

METHODS

This population-based cohort study used individual-level linked Danish national health registers. Participants were all live-born singletons in Denmark during 1978-2012 (n = 2 069 785). Follow-up began at birth and continued until the onset of a psychiatric disorder, death, emigration or 31 December 2016, whichever came first. Cox proportional hazards model was employed to calculate the hazard ratios (HRs) of psychiatric disorders.

RESULTS

Maternal migraine was associated with a 26% increased risk of any psychiatric disorders in offspring [HR, 1.26; 95% confidence interval (CI), 1.22-1.30]. Increased rates of psychiatric disorders were seen in all age groups from childhood to early adulthood. Increased rates were also observed for most of the specific psychiatric disorders, in particular, mood disorders (HR, 1.53; 95% CI, 1.39-1.67), neurotic, stress-related and somatoform disorders (HR, 1.44; 95% CI, 1.37-1.52) and specific personality disorders (HR, 1.47; 95% CI, 1.27-1.70), but not for intellectual disability (HR, 0.84; 95% CI, 0.71-1.00) or eating disorders (HR, 1.10; 95% CI, 0.93-1.29). The highest risk was seen in the offspring of mothers with migraine and comorbid psychiatric disorders (HR, 2.13; 95% CI, 1.99-2.28).

CONCLUSIONS

Maternal migraine was associated with increased risks of a broad spectrum of psychiatric disorders in offspring. Given the high prevalence of migraine, our findings highlight the importance of better management of maternal migraine at childbearing ages for early prevention of psychiatric disorders in offspring.

The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age

BACKGROUND

Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported.

OBJECTIVE

We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age.

METHODS

A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness.

RESULTS

There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001).

CONCLUSION

Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.

Parental Chronic Illness, Internalizing Problems in Young Adulthood and the Mediating Role of Adolescent Attachment to Parents: A Prospective Cohort Study

Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) (N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care.

MeCP2 mediates transgenerational transmission of chronic pain

Pain symptoms can be transmitted across generations, but the mechanisms underlying these outcomes remain poorly understood. Here, we identified an essential role for primary somatosensory cortical (S1) glutamate neuronal DNA methyl-CpG binding protein 2 (MeCP2) in the transgenerational transmission of pain. In a female mouse chronic pain model, the offspring displayed significant pain sensitization. In these mice, MeCP2 expression was increased in S1 glutamate (Glu^S1) neurons, correlating with increased neuronal activity. Downregulation of Glu^S1 neuronal MeCP2 in maternal mice with pain abolished offspring pain sensitization, whereas overexpression of MeCP2 in naïve maternal mice induced pain sensitization in offspring. Notably, single-cell sequencing and chromatin immunoprecipitation analysis showed that the expression of a wide range of genes was changed in offspring and maternal Glu^S1 neurons, some of which were regulated by MeCP2. These results collectively demonstrate the putative importance of MeCP2 as a key regulator in pain transgenerational transmission through actions on Glu^S1 neuronal maladaptation.

Developmental vulnerabilities in children of chronically ill parents: a population-based linked data study

Background

Currently, there is mixed evidence regarding the effects on children when a parent is chronically ill. Research has also primarily been conducted with adolescent samples. This study investigated developmental vulnerabilities in young children of parents with chronic illness.

Methods

This study used linked administrative data. The study population included children born in Western Australia during 2003–2004 (n=19 071; mean age 5.5 years). The outcome measure was a score in the bottom 25% on any of the five developmental domains (physical, social, emotional, communicative and cognitive) of the Australian Early Development Census (2009 collection). Parental chronic illnesses were identified from hospital and cancer registry records, during the period from 1 year prior to the child’s birth and until the end of 2009.

Results

Higher odds of developmental vulnerabilities in physical, social, emotional and communication domains were observed for daughters of chronically ill mothers. Sons of chronically ill mothers had increased odds of language and cognitive difficulties. Risk level increased with each additional year of exposure to maternal chronic illness. Results also indicated increased odds of developmental vulnerabilities for children of mothers experiencing multiple compared with single chronic conditions; however, results were not statistically significant (all p>0.05). No association between fathers’ chronic illness and children’s developmental outcomes was found.

Conclusions

Maternal chronic illness is associated with an increased risk of poor developmental outcomes for children, particularly daughters. Healthcare services have an important role to play in linking families into appropriate family-centred services to best support the needs of chronically ill mothers.

Parental chronic pain and internalizing symptoms in offspring: the role of adolescents' social competence - the HUNT study

Background

A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents’ social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender.

Methods

The current study was based on cross-sectional data from the Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006–2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis.

Results

Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring’s symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=−0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender.

Conclusion

The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers.

Enhancement of Meditation Analgesia by Opioid Antagonist in Experienced Meditators

OBJECTIVE

Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice.

METHODS

Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist naloxone (0.15-mg/kg bolus dose, then 0.2-mg/kg per hour infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation.

RESULTS

Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = .019, Cohen's d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = .001, Cohen's d = 0.68), confirming the presence of meditation analgesia. Comparing saline and naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = .004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = .002, d = 0.62), during meditation under naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia but also made meditation analgesia stronger.

CONCLUSIONS

Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone's blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under naloxone than under saline. Possible biological mechanisms by which naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.

Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model

Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence

The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.

Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study

BACKGROUND

Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children.

METHOD

A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis.

RESULTS

It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services.

CONCLUSION

Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.

Offspring of parents with chronic pain: a systematic review and meta-analysis of pain, health, psychological, and family outcomes

Offspring of parents with chronic pain may be at risk for poorer outcomes than offspring of healthy parents. The objective of this research was to provide a comprehensive mixed-methods systematic synthesis of all available research on outcomes in offspring of parents with chronic pain. A systematic search was conducted for published articles in English examining pain, health, psychological, or family outcomes in offspring of parents with chronic pain. Fifty-nine eligible articles were identified (31 population-based, 25 clinical, 3 qualitative), including offspring from birth to adulthood and parents with varying chronic pain diagnoses (eg, mixed pain samples, arthritis). Meta-analysis was used to synthesize the results from population-based and clinical studies, while meta-ethnography was used to synthesize the results of qualitative studies. Increased pain complaints were found in offspring of mothers and of fathers with chronic pain and when both parents had chronic pain. Newborns of mothers with chronic pain were more likely to have adverse birth outcomes, including low birthweight, preterm delivery, caesarian section, intensive care admission, and mortality. Offspring of parents with chronic pain had greater externalizing and internalizing problems and poorer social competence and family outcomes. No significant differences were found on teacher-reported externalizing problems. The meta-ethnography identified 6 key concepts (developing independence, developing compassion, learning about health and coping, missing out, emotional health, and struggles communicating with parents). Across study designs, offspring of parents with chronic pain had poorer outcomes than other offspring, although the meta-ethnography noted some constructive impact of having a parent with chronic pain.

Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study

Background

Long-term musculoskeletal pain and negative stress are health risks with adverse long-term health effects, and these health risks seem to increase among young people. The mechanisms behind this are unclear. There is a need for a better understanding of perceived stress and musculoskeletal pain among adolescents, in order to improve health promotion and treatment approaches in this group.

Methods

Objectives were to evaluate the current prevalence of perceived stress and musculoskeletal pain in 15 and 16 year olds, to explore stress-pain associations and the probability that perceived stress (PSQ) was related to the reporting of pain and variations in pain, and to investigate possible differences in stress between different types of musculoskeletal pain in the adolescents. A cross-sectional study was conducted. Elementary schools participated. The outcomes were stress (Perceived stress questionnaire; PSQ) and musculoskeletal pain (pain/no pain, pain sites, pain duration and pain intensity (Visual analogue scale; VAS).

Results

Fifty-one point two percent (N = 422) reported pain, of which 70.8 % reported long-term pain. Some more girls (57.9 %) reported pain. 22.0 % of the study population reported moderate to severe stress (PSQ ≥ 0.45), of which 79.6 % were bothered by pain (Pearson Chi-square 38.47, p ≤ .001). All stress and pain variables were significantly associated (p < .01). The strongest association appeared between pain intensity (VAS) and stress (PSQ) (r = 0.40). Perceived stress (PSQ) was associated with the reporting of pain among the adolescents (Odds Ratio [OR] 1.68) and could explain some of the variation in pain intensity (VAS; β = 0.15, p < .001) and number of pain sites (β = 0.14, p < .01), according to the regression analyses. There were no mean differences in stress (PSQ) between different types of musculoskeletal pain.

Conclusions

There was high prevalence of musculoskeletal pain, long-term pain and moderate to severe stress (PSQ ≥ 0.45) in this study sample. Perceived stress (PSQ) was related to the reporting of musculoskeletal pain among the adolescents and could explain some of the variation in pain intensity (VAS) and number of pain sites. There were no differences in stress levels (PSQ) between different types of musculoskeletal pain in the adolescents.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2414-x) contains supplementary material, which is available to authorized users.

Relative deprivation in the Nordic countries-child mental health problems in relation to parental financial stress

BACKGROUND

The Nordic welfare system has been acknowledged as favourable for children, successfully contributing to low child mortality and poverty rates. Nevertheless, mental health problems among children and adolescents are common and the economic situation of the family has been highlighted as an important determinant. In spite of similar social, political and cultural structures, the Nordic countries differ; Iceland was most affected by the global financial crisis in 2008. The aim of this study was to examine potential differences in parental financial stress and the associations to child mental health between the Nordic countries as well as age and gender differences. 

METHODS

The study sample consisted of 6330 children aged 4-16 years old included in the 2011 version of the Nordic Study of Children's Health, Wellbeing and Quality of life. The Strengths and Difficulties Questionnaire was used to measure mental health problems. 

RESULTS

In Iceland, 47.7% of the parents reported financial stress while ≤20% did so in the other countries except for Finland (33.5%). However, in case of parental financial stress the OR of mental health problems comparing children to parents with and without financial stress was significantly lower among the Icelandic children (OR 1.60, 95% CI 1.15-2.24) than among the others: Denmark OR 3.07 (95% CI 2.15-4.39), Finland OR 2.28 (95% CI 1.60-3.25), Norway OR 2.77 (95% CI 1.86-4.12), Sweden OR 3.31(95% CI 2.26-4.86). No significant age or gender differences in the ORs were observed. 

CONCLUSIONS

Besides socioeconomic situation, relative deprivation should be considered an important determinant of child mental health.

Associations between parental chronic pain and self-esteem, social competence, and family cohesion in adolescent girls and boys--family linkage data from the HUNT study

Background

Parental chronic pain has been associated with adverse outcomes in offspring. However, knowledge on individual and family resilience factors in adolescent offspring of chronic pain sufferers is scarce. This study thus aimed to investigate the associations between parental chronic pain and self-esteem, social competence, and family cohesion levels reported by adolescent girls and boys.

Methods

Based on cross-sectional surveys from the Nord Trøndelag Health Study (the HUNT 3 study), the study used independent self-reports from adolescents aged 13 to 18 years (n = 3227) and their parents and conducted separate linear regression analyses for girls and boys.

Results

Concurrent maternal and paternal chronic pain was associated with reduced self-esteem, social competence, and family cohesion in girls. Moreover, maternal chronic pain was associated with higher social competence in boys and reduced self-esteem in girls. The majority of the observed associations were significantly different between girls and boys. Paternal chronic pain was not found to be associated with child outcomes.

Conclusions

The findings indicate that the presence of both maternal and paternal chronic pain could be a potential risk factor for lower levels of individual and family resilience factors reported by girls. Further research on the relationship between parental pain and sex-specific offspring characteristics, including positive resilience factors, is warranted. The study demonstrates the importance of targeting the entire family in chronic pain care.

Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study

The aim of this study was to assess the prevalence of chronic multisite pain with high disability in relation to emotional or behavioral problems and resilience factors in adolescence. A second aim was to investigate if resilience factors could attenuate the associations between psychiatric symptoms and chronic multisite pain. The study was based on a large cross-sectional study carried out in Norway between 2006 and 2008 and included 7,070 adolescents aged 13-19 years. Chronic multisite pain was defined as pain at least once a week during the last 3 months, scoring high on a disability index, and occurring in three or more locations. Chronic multisite pain was prevalent among adolescents with high scores (>85%) for anxiety/depression, social anxiety, conduct or attention problems (22.8-31.0 for girls, 8.8-19.0% for boys). Several coexistent psychiatric symptoms increased the prevalence of chronic multisite pain for both girls and boys. Resilience factors, including high self-esteem, seldom feeling lonely, and high scores for family cohesion or social competence, were associated with a lower prevalence and markedly attenuated the association between psychiatric symptoms and chronic multisite pain. Psychiatrists should be careful to assess and treat comorbid chronic pain in adolescents with emotional or behavioral problems.

Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: patterns and parental risk factors

The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.

Substance use in children of parents with chronic pain - the HUNT study

Purpose

The aim of the present study was to investigate possible associations between parental chronic pain and smoking, alcohol, and drug use in adolescent offspring.

Methods

Cross-sectional data from Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in the period 2006–2008 was utilized. The present sample consisted of adolescents aged 13–18 years (n=3,227) for whom information was available on maternal and paternal health statuses.

Results

Results from multivariable ordinal and binary logistic regression analyses, adjusting for potential confounding factors (child age, parental age, education, and organ specific illness) indicated that the estimated odds ratios (OR) for smoking (OR =1.72, 95% confidence interval [CI] [1.00, 3.05], P=0.049) and alcohol intoxication (drunkenness) (OR =1.56, 95% CI [1.05, 2.33], P=0.029) were higher for boys whose mother and father had chronic pain, compared with boys for whom neither parent had chronic pain. These associations were slightly attenuated by additional adjustment for pain-related factors, such as parental smoking and symptoms of anxiety and depression. Parental chronic pain was not significantly associated with girls’ levels of substance use. There were significant interaction effects between parental chronic pain and child sex on offspring’s alcohol intoxication and smoking.

Conclusion

The present study expands on existing knowledge and provides groundwork for preventive and specific measures targeting substance use in families burdened with parental chronic pain.

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.

Individual and additive effects of mothers' and fathers' chronic pain on health outcomes in young adults with a childhood history of functional abdominal pain

OBJECTIVE

To evaluate effects of mothers' and fathers' chronic pain on health outcomes in adult sons and daughters with a childhood history of functional abdominal pain (FAP).

METHOD

Adults (n = 319; Mean age = 22.09 years) with a childhood history of FAP reported parental history of chronic pain and their own current health (chronic pain, somatic symptoms, disability, use of medication and health care, illness-related job loss).

RESULTS

Positive histories of maternal and paternal chronic pain were each associated with poorer health in sons and daughters, regardless of child or parent gender. Having 2 parents with chronic pain was associated with significantly poorer health than having 1 or neither parent with chronic pain.

CONCLUSIONS

Chronic pain in both mothers and fathers is associated with poor health and elevated health service use in young adults with a childhood history of FAP. Having both parents with chronic pain increases risk for adverse outcomes.