Life stress and psychosomatic symptoms among 14 to 16-year old Finnish adolescents

Changes over time in mental health symptoms among adolescents in Tampere, Finland

Background:

Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland.

Objective:

To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents.

Method:

A time-trend school survey was conducted among 9^th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002–03, 2012–13 and 2018–19 (N = 4,162).

Results:

Compared to the period 2002–03, prevalence of externalizing symptoms decreased in the period 2012–13 and further in 2018–19. The prevalence of internalizing symptoms did not change significantly between 2002–03 and 2012–13; however, in 2018–19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018–19 compared to earlier time periods.

Conclusion:

Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002–03 and 2018–19, the prevalence of internalizing symptoms increased between 2012–13 and 2018–19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.

Somatic symptoms and internalizing problems in urban youth: a cross-cultural comparison of Czech and Russian adolescents

Background

Although the association between somatic complaints and internalizing problems (anxiety, somatic anxiety and depression) is well established, it remains unclear whether the pattern of this relationship differs by gender and in different cultures. The aim of this study was to examine cross-cultural and gender-specific differences in the association between somatic complaints and internalizing problems in youth from the Czech Republic and Russia.

Methods

The Social and Health Assessment, a self-report survey, was completed by representative community samples of adolescents, age 12-17 years, from the Czech Republic (N = 4770) and Russia (N = 2728).

Results

A strong association was observed between somatic complaints and internalizing psychopathology. Although the levels of internalizing problems differed by country and gender, they increased together with and largely in a similar way to somatic complaints for boys and girls in both countries.

Conclusion

The association between somatic symptoms and internalizing problems seems to be similar for boys and girls across cultures.

Somatic symptoms in children who have a parent with cancer: A systematic review

BACKGROUND

This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer.

METHODS

We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group.

RESULTS

The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status.

CONCLUSIONS

Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.

Somatising in children and adolescents. 1. Clinical presentations and aetiological factors

Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.

Somatization disorder among adolescents in southeast Nigeria: a neglected issue

Background

Adolescents do present with somatization disorder which is often neglected by pediatricians. This could have serious consequences if not curbed early.

Objectives

This study is aimed at determining the pattern and types of Somatization disorder among adolescents attending secondary schools in south east Nigeria.

Methods

Somatization disorder was investigated among 485 adolescents from mixed schools using a stratified random sampling of adolescents from four secondary schools in southeast Nigeria. The Enugu somatization scale was used to evaluate for presence of somatization in the participants. Statistical analysis was with statistical package for social sciences (SPPS) version 19 (Chicago IL).

Results

A total of 485 adolescents aged 10–19 years were included in this study. The mean age of the respondents was 16.36 with standard deviation (SD) of 3.14 years. Two hundred and fifty-one (51.8%) had head features, 262 (54.0%) had body features, 303 (62.5%) had either head or body features while 210 (43.3%) had both head and body features. One hundred and thirty-four males (51.3%) compared to 117 females (52.2%) reported symptoms consistent with head symptoms (p = 0.038). One hundred and eleven males (42.5%) compared to 99 females (44.2) reported symptoms related to the head and body (p = 0.137) while 135 males (51.7%) compared to 127 females (56.7%) reported symptoms related to the body (p = 0.925). There were significant associations of age in categories with head, body, either head or body as well as both head and body features (all p value <0.001).

Conclusions

Psychosomatic problems do exist and may be on the rise among adolescents.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-017-0161-3) contains supplementary material, which is available to authorized users.

Exploring Temporal Patterns of Stress in Adolescent Girls with Headache

As part of a larger study on perceived stress and headaches in 2009, momentary perceived stress, head pain levels and stress-related symptom data were collected. This paper explores a temporal analysis of the patterns of stress, as well as an analysis of momentary and retrospective stress-related symptoms compared by level of headache activity. Adolescent girls (N = 31) ages 14-18 were randomly cued by electronic diaries 7 times per day over a 21-day period responding to momentary questions about level of head pain, perceived stress and stress-related symptoms. Multivariate general linear modelling was used to determine significant differences among headache groups in relation to temporal patterns of stress. Significant headache group differences were found on retrospective and momentary stress-related symptom measures. A total of 2841 diary responses captured stress levels, head pain and related symptoms. The chronic headache (CH) group reported the highest levels of hourly and daily stress, followed by the moderate headache (MH) and low headache (LH) groups. Patterns of stress for the three headache groups were statistically distinct, illustrating increased stress in girls with more frequent head pain. This evidence suggests that because of increased stress, girls with recurrent head pain are likely a vulnerable population who may benefit from stress-reducing interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Interpersonal Conflicts and Development of Self-Esteem from Adolescence to Mid-Adulthood. A 26-Year Follow-Up

This study investigated the association between interpersonal conflicts and the trajectory of self-esteem from adolescence to mid-adulthood. The directionality of effects between self-esteem and interpersonal conflicts was also studied. Participants of a Finnish cohort study in 1983 at age 16 (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471) and 42 (N = 1334) using postal questionnaires. Measures covered self-esteem and interpersonal conflicts including, conflicts with parents, friends, colleagues, superiors, partners, break-ups with girl/boyfriends, and divorces. Participants were grouped using latent profile analysis to those having “consistently low”, “decreasing”, or “increasing” number of interpersonal conflicts from adolescence to adulthood. Analyses were done using latent growth curve models and autoregressive cross-lagged models. Among both females and males the self-esteem growth trajectory was most favorable in the group with a consistently low number of interpersonal conflicts. Compared to the low group, the group with a decreasing number of interpersonal conflicts had a self-esteem trajectory that started and remained at a lower level throughout the study period. The group with an increasing number of interpersonal conflicts had a significantly slower self-esteem growth rate compared to the other groups, and also the lowest self-esteem level at the end of the study period. Cross-lagged autoregressive models indicated small, but significant lagged effects from low self-esteem to later interpersonal conflicts, although only among males. There were no effects to the opposite direction among either gender. Our results show that those reporting more and an increasing number of interpersonal conflicts have a lower and more slowly developing self-esteem trajectory from adolescence to mid-adulthood. While the result was expected, it does not seem to imply an effect from interpersonal conflicts to low self-esteem. Rather, if anything, our results seem to suggest that those with low self-esteem are more prone to later interpersonal conflicts.

Determinants of psychosomatic complaints in Swedish schoolchildren aged seven to twelve years

Objective: The aim of this study was to investigate determinants of psychosomatic complaints (PSC) in children. The model assumes that variables are working on three levels: the proximal level (the child), the intermediate level (the family), and the distal level (the society). Methods: Data were obtained from a large cross-sectional survey on children's health and well-being in the Nordic countries. A questionnaire was sent to the parents of a representative sample of 1,163 Swedish children aged seven to 12 years. The analysis included a multivariate analysis using the LISREL program. Results: The best predictors of PSC were the mother's health, the child's mental stability, contacts with peers, and long-term illness/disability. There were many other important relationships, which act via factors, such as school satisfaction, social competence, activities, the parents' sense of coherence, and family economy. Conclusion: PSC in children should be seen in the context of all three levels.

School-Related Stress and Psychosomatic Symptoms among Norwegian Adolescents

This study examines the relationships between school-related stress, gender and psychosomatic symptoms in a sample of 531 adolescents pupils in years (grades) 8, 9 and 10 (aged 13-16 years) from two compulsory schools in Norway. Results showed that 18.1 percent reported being ‘very much’ affected by at least one of the assessed psychosomatic symptoms. Girls reported significantly more psychosomatic symptoms than did boys. Tests of the dimensionality of the school-related stress that was assessed in the present study showed four main categories: (1) difficulties with peers at school; (2) worries about school achievement; (3) schoolwork pressure and (4) conflicts with parents and/or teachers. Results from multiple regression analyses showed that scores for the different stressors were significantly associated with psychosomatic symptoms. Findings suggest that frequency of psychosomatic symptoms might be related to how well or otherwise pupils adapt to the demands of school and to the interpersonal climate of the school. Gender seems to play a differentiating role here. Girls reported significantly more stress that was related to worries about school achievement, whereas boys reported significantly more stress arising from conflicts with parents and/or teachers. Finally, stress due to difficulties with peers at school was more closely correlated with psychosomatic symptoms among boys than among girls.

Lifestyles and psychosomatic symptoms among elementary school students and junior high school students

OBJECTIVES

To examine the relationship between lifestyles and psychosomatic symptoms in children, we conducted a self-administered questionnaire survey of elementary school students and junior high school students in Japan.

METHODS

We designed an original questionnaire to investigate the lifestyles and psychosomatic symptoms of children. In 1997, responses to the questionnaires were elicited from public elementary school fourth grade students (then aged 9-10) and public junior high school seventh grade students (then aged 12-13). The survey was repeated annually for three years as the students advanced through school.

RESULTS

For both boys and girls, each cross-sectional analysis revealed a strong relationship between lifestyle behaviors and psychosomatic symptoms. Psychosomatic, symptoms scores varied according to daily hours of sleep, eating of breakfast, having strong likes and dislikes of food, bowel habits, and daily hours of television watching. Both boys and girls with "good" lifestyle, behaviors evaluated by the HPI (Health Practice Index) showed lower scores for psychosomatic symptoms.

CONCLUSIONS

These findings show that the lifestyle behaviors of children are significantly associated with psychosomatic symptoms and suggest that poor lifestyle behaviors are likely to increase physical and psychological health risks.

Psychopathology, traumatic life events, and coping skills among patients attending a primary-care adolescent clinic

OBJECTIVE

To compare the type of life events experienced and coping styles used by adolescents with and without psychopathology, attending a primary-care adolescent clinic.

METHODS

One hundred adolescents with and without psychopathology attending a drop-in adolescent clinic in a tertiary-care teaching hospital were recruited. Face-to-face interview used Child Behaviour Checklist, Life Event Scale, Coddington's life event scale, Impact of Event Scale and Modified Jalowiec coping scale as measures after getting written, informed consent from the primary care-giver and verbal assent from the adolescents. Bivariate and multivariate comparisons were done between the groups appropriately.

RESULTS

Adolescents with psychopathology had experienced more parental fights, increased arguments with parents, increased arguments between parents, serious illness requiring hospitalization of the adolescent. The intrusive symptoms of PTSD were noted more than avoidant symptoms among those adolescents with life events. Confrontative, emotive and optimistic coping styles were most often used in adolescent with psychopathology.

CONCLUSIONS

In India, adolescents with psychopathology attending a primary care clinic have significant life events and different coping styles. Therefore, adolescents with psychopathology in this setting should be screened for life events as well as dysfunctional coping styles and given appropriate intervention.

Shyness as a Risk-Factor for Somatic Complaints Among Norwegian Adolescents

The associations between shyness, school-related stress, social support and somatic complaints, were assessed in a sample of 501 pupils from two secondary schools in Norway. The main finding from this cross-sectional study revealed a positive significant association between shyness and somatic complaints. Findings also showed a significant positive association between perceived school-related stress and somatic complaints, while there was a negative relationship between emotional support from teachers and somatic complaints. Girls reported a significantly higher degree of somatic complaints than boys did. No significant differences between the genders were found in level of reported shyness.

Relationship of headache-associated stressors and hypnosis therapy outcome in children: a retrospective chart review

This study examined potential psychosocial stressors of 30 children with headaches (mean age, 15 years), and the role of insight generation in the outcome of hypnosis therapy. The mean duration of headache occurrence was 3 years. All of the patients were instructed in how to use hypnosis-induced relaxation and headache-related imagery to improve their symptoms. Thirty-seven percent reported their headaches were associated with fixed stressors, defined as caused by events over which patients had no control, while 63% reported variable stressors, defined as modifiable by the patients' actions. Four patients were lost to follow-up. Overall, 96% (25/26) reported a decrease in headache frequency and/or intensity following use of hypnosis. However, prior to insight generation patients reporting fixed stressors were significantly less likely to improve than those reporting variable stressors (p = 0.018). Thus, insight generation may be more important for achievement of improvement in children whose headaches are associated with fixed stressors.

Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey

Background

Over the last five to ten years there has been an increase in psychosomatic complaints (PSC) in Swedish children. The objective of the study was to examine the relation between PSC and sense of coherence (SOC).

Methods

A cross-sectional school survey in the county of Västmanland, Sweden. All 16- and 19-year old adolescents present at school on the day of the survey were asked to complete a questionnaire in their classrooms during a one-lesson hour session under the supervision of their teachers. Totally 3,998 students in both private and public schools, studying in ninth grade elementary school or third grade secondary school participated.

Results

The results from our study show that there is a statistically significant relation between PSC and SOC among adolescents. It also shows that adolescents with a weak SOC score have more symptoms of PSC.

Conclusion

Our study indicates that SOC can help the adolescents to choose a coping strategy that is appropriate for the situation and thereby may prevent them from developing PSC. However, additional studies are needed to confirm our findings.

Adolescent risk factors for episodic and persistent depression in adulthood. A 16-year prospective follow-up study of adolescents

BACKGROUND

We examined mid-adolescent psychosocial problems as risk factors for subsequent depression up to adulthood proper, and differences in these for episodic and persistent depression.

METHODS

In a 16-year follow-up of an urban Finnish community cohort (547 males and 714 females) from age 16 years risk factors for subsequent depression (S-BDI) were studied. Data were collected with a classroom questionnaire at 16 years and a postal questionnaire at 22 and 32 years. Differences in predictors for episodic depression (only at age of 22 or 32 y) and persistent depression (both at 22 and 32 y) were studied using logistic and multinomial regression analyses.

RESULTS

Mid-adolescent depressive symptoms predicted persistent and female sex episodic depression. Low self-esteem, dissatisfaction with academic achievement, problems with the law, having no dating experiences, and parental divorce all predicted both episodic and persistent depression.

LIMITATIONS

We had two assessment points in adulthood, but no information about depression between these.

CONCLUSIONS

The associations between mid-adolescent psychosocial problems and subsequent depression extended up to adulthood proper, somewhat differently for episodic and persistent depression. Preventive efforts should be focused towards young people at risk.

Medically unexplained symptoms in children and adolescents

A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.

Life events and their impact on bladder control in children

OBJECTIVE

To investigate the relationship between incidence and nature of life events within families and age of bladder control acquisition in healthy children.

SUBJECTS AND METHODS

Thirty-five parents of 36, 6-year-old children were interviewed using the Coddington life events questionnaire.

RESULTS

The children had experienced a total of 185 life events (mean 5, median 4.5, range 1-12) before the time of dryness. The most common were related to childcare/occupation of parent (51%), illness/injury/death (24%), family composition (16%) and living conditions (9%). There was a strong correlation between the number of life events and the age of dryness; the more life events and the older the child was when experiencing them, the later the child became dry. The only single event that was significantly associated with a later age of dryness was the birth of a sister or brother. In general, children had reacted positively (39%) or neutrally, but to 30% of events there was a negative reaction. There was a correlation between the reaction of the child and adaptation to the life event, and if the child had difficulty adapting to an event, that child became day dry at a later age.

CONCLUSION

Although life events are a natural part of daily life, this study supports the conclusion that a large number of events and events to which the child has difficulty adapting can be of importance for the age of acquisition of bladder control.

A Review of Psychological Models and Interventions for Medically Unexplained Somatic Symptoms in Children

The aim of this review is to outline the various psychological models of medically unexplained somatic symptoms in children and the interventions derived from these. The interventions that have been evaluated in randomised controlled trials are reviewed, and the implications of the findings for the models are described.

The association of parental monitoring and family structure with diverse maladjustment outcomes in middle adolescent boys and girls

The aim of this study was to study the associations between family structure, parental monitoring and maladjustment outcomes among middle adolescent girls and boys. Data was collected through a school-based survey of a nationally representative sample of 17,643 Finnish adolescents aged 14-16 years. The less the parents knew the adolescents' friends and whereabouts, the more common were all the maladjustment outcomes studied. Non-intact family structure was associated with maladjustment and had associations independent of parental monitoring. We conclude that parental involvement with adolescents is conducive to healthy development, and that adolescents need the protection provided by parental supervision. Knowing the adolescent's whereabouts and friends is a concrete and easily measurable way of assessing parents' involvement in the adolescent's life.

Long-term psychosocial effects of parental divorce: a follow-up study from adolescence to adulthood

OBJECTIVE

The purpose of this 16-year follow-up study was to investigate whether 32-year-old adults who had experienced parental divorce before 16 years of age (n = 317) differed in psychosocial well-being or life trajectories from those from non-divorced two-parent families (n = 1069).

METHOD

The data were obtained from a follow-up survey of a Finnish urban age cohort from the age of 16 till 32 years (n = 1471). The long-term impact of parental divorce on a variety of outcomes in adulthood, including psychological well-being, life situation, health behaviour, social networks and support, negative life events and interpersonal problems, was assessed.

RESULTS

Females from divorced compared to non-divorced families reported more psychological problems (higher scores in the Beck Depression Inventory, General Health Questionnaire and Psychosomatic Symptoms Score) and more problems in their interpersonal relationships. These differences were not found among males. Shorter education,unemployment, divorce, negative life events and more risky health behaviour were more common among subjects of both genders with a background of parental divorce.

CONCLUSIONS

The study revealed that parental divorce is an indicator of sufficient stress in childhood for its influences to persist well into adulthood, possibly with wider scope among females. It is important to recognise specific needs of children in the divorce process in order to prevent or minimize negative consequences and chain reactions during their subsequent life.

Muscle dissatisfaction in young adult men

Backround

Appearance concerns are of increasing importance in young men's lives. We investigated whether muscle dissatisfaction is associated with psychological symptoms, dietary supplement or anabolic steroid use, or physical activity in young men.

Methods

As a part of a questionnaire assessment of health-related behaviors in the population-based FinnTwin16 study, we assessed factors associated with muscle dissatisfaction in 1245 men aged 22–27 using logistic regression models.

Results

Of men, 30% experienced high muscle dissatisfaction, while 12% used supplements/steroids. Of highly muscle-dissatisfied men, 21.5% used supplements/steroids. Mean body mass index, waist circumference, or leisure aerobic activity index did not differ between individuals with high/low muscle dissatisfaction. Muscle dissatisfaction was significantly associated with a psychological and psychosomatic problems, alcohol and drug use, lower height satisfaction, sedentary lifestyle, poor subjective physical fitness, and lower life satisfaction.

Conclusion

Muscle dissatisfaction and supplement/steroid use are relatively common, and are associated with psychological distress and markers of sedentary lifestyle.

Have there been changes in children's psychosomatic symptoms? A 10-year comparison from Finland

OBJECTIVES

The aims of the study were to determine whether the prevalence of children's somatic symptoms, such as headache, abdominal pain, other pain, and nausea and vomiting, changed from 1989 to 1999 and to study the similarity of parents' and children's reports of the child's symptoms. Furthermore, the aims were to explore possible comorbidity in somatic symptoms and to investigate the associations between somatic and psychiatric symptoms.

METHODS

Two cross-sectional, representative samples were compared. All children born in 1981 (1989 sample, n = 985) and 1991 (1999 sample, n = 962) and living in selected school districts in southwest Finland served as study samples. The response rate for the 1989 sample was 95% and that for the 1999 sample was 86%. Both children and parents were asked about the children's somatic symptoms, whereas parents, children, and teachers were asked about psychiatric symptoms. To study psychiatric symptoms, the Children's Depression Inventory and Rutter's parent and teacher scales were used.

RESULTS

The prevalence of frequent headaches and abdominal pain increased somewhat from 1989 to 1999. Parents often failed to recognize their children's psychosomatic problems. Child-reported somatic symptoms were associated with conduct and hyperactivity symptoms, in addition to a previously well-documented association with depression. In associations between somatic symptoms and psychiatric symptoms, there were some differences between the 1989 and 1999 samples.

CONCLUSIONS

In clinical work, questions about somatic and psychiatric symptoms should also be addressed to children themselves, because parents and teachers do not always recognize children's symptoms. When somatic problems are being evaluated, psychiatric symptoms should be asked about, and vice versa. More research is needed to explore the reasons for the increased prevalence of somatic symptoms and their associations with psychiatric symptoms.

Body dissatisfaction and drive for thinness in young adult twins

OBJECTIVE

We explored correlates of the Eating Disorder Inventory subscales Body Dissatisfaction (BD) and Drive for Thinness (DT) and genetic and environmental influences on these traits.

METHOD

In a population-based sample of 4,667 Finnish twins aged 22-27 years, we conducted twin modeling to explore genetic and environmental contributions to body dissatisfaction and drive for thinness. Logistic regression was used for the correlational analysis.

RESULTS

Various eating and body size-related factors and psychosomatic symptoms were significantly associated with high body dissatisfaction and drive for thinness in both genders. In women, early puberty onset, early initiation of sexual activity, and multiple sex partners were statistically significant risk factors of body dissatisfaction. In gender-specific univariate twin models, additive genes accounted for 59.4% (95% confidence interval [CI] = 53.2-64.7%) of the variance in body dissatisfaction and for 51.0% (95% CI = 43.7-57.5%) of the variance in drive for thinness among females, but for none of the variance among males.

DISCUSSION

There are very distinct gender differences in the heritability patterns of body dissatisfaction and drive for thinness in young adults.

Food habits in 10-11-year-old children with functional gastrointestinal disorders

OBJECTIVE

To evaluate the role of food habits and nutrient intake in children with functional gastrointestinal disorders (FGIDs) considering their association with psychosocial factors.

DESIGN

Cross-sectional.

SETTING

A rural town in Mid-Western Finland.

SUBJECTS

After excluding organic gastrointestinal (GI) disorders, a total of 49 children with FGID and 78 control children without GI symptoms from a cohort of 422 children were studied.

METHODS

Food frequency questionnaire, GI-symptoms questionnaire and the Child Behaviour Check List (CBCL) filled in by parents together with their child, and 24-h dietary recall and anthropometric and haematological measurements.

RESULTS

Compared to control children, fewer children with FGID had daily family dinner (77 vs 91%, P = 0.030) and they used less often vegetables (P = 0.023), fruits (P = 0.027) and berries (P = 0.011), but more often ice cream (P = 0.018) and soft drinks (P = 0.027) and had a higher sucrose intake (9 vs 7E%, P = 0.032) and lower lactose intake (27 vs 36 g, P = 0.001). Reported food-related symptoms were more common among FGID group (69 vs 11%), as well as restricted milk use (31 vs 0%). Children with FGID had higher total problem scores in CBCL (P=0.002), and the behavioural/emotional problems associated with occurrence of FGID (OR 1.04, 95% CI 1.07-1.076) as did the sugar intake (OR 1.1, 95% CI 1.004-1.215).

CONCLUSIONS

This population-based study suggests that school-aged children with FGIDs have less-organized food habits and higher milk avoidance, and they display internalizing psychological characteristics.

SPONSORSHIP

Juho Vainio Foundation, Finland; the Alma and K.A. Snellman Foundation, Oulu, and the Pediatric Research Foundation, Finland.

Externalizing problem behaviors and headache: a follow-up study of adolescent Finnish twins

OBJECTIVE

To examine the association of teacher- and parent-rated behavior with headache in a prospective follow-up study of adolescent Finnish twins.

METHODS

Questionnaire data were collected during 1995-2001 from a nationwide sample of Finnish families of 11-year-old twins who were born 1983-1987 (n = 5393) and again at age of 14. Psychological factors were measured by using parents' and teachers' ratings of a 37-item multidimensional rating instrument at the ages of 11 and 14.

RESULTS

At age 11, headache frequency (5 categories) was associated with total scales of externalizing and internalizing problem behaviors and adaptive behaviors, assessed by parents, but only with externalizing problem behaviors assessed by teachers. Results were similar at age 14. The incidence of at least monthly headache between the ages of 11 and 14 years was predicted by externalizing problem behaviors and 2 subscales of adaptive behaviors: constructiveness and poor compliance. In twin pairs discordant for headache, externalizing and internalizing problem behaviors were more common among headache sufferers than among headache-nonsufferers. Headache-discordant monozygotic co-twins confirmed the association of externalizing problem behaviors with headache.

CONCLUSIONS

The frequency of adolescents' headache is predicted by psychological factors, especially by externalizing problem behaviors. This seems to be independent of genetic or familial influences on behavior and headache. Behavioral problems may be a sign of worsening of headache or vice versa.

Risk for depression: a 6-year follow-up of Finnish adolescents

BACKGROUND

Few longitudinal studies have attempted to identify risk factors in mid-adolescence for subsequent depression in young adulthood. Mid-adolescence is a critical developmental phase for studying vulnerability to depression due to high incidence and prevalence of depression.

METHODS

In a longitudinal study, following an urban Finnish community cohort (761 males and 887 females) from age 16, mid-adolescent risk factors for depression at age 22 years were studied. Data were collected by a questionnaire at school at age 16, and by a postal questionnaire at age 22.

RESULTS

Of the females 116 (13%) and of the males 69 (9%) had depression (S-BDI) in young adulthood. In multivariate analyses baseline depressive symptoms, low self-esteem, dissatisfaction with academic achievement, problems with the law, poor atmosphere at home and having no close friends predicted subsequent depression. Risk factors for males included more 'externalizing' aspects, for females more 'internalizing' factors.

CONCLUSIONS

Mid-adolescence is an important age to study risk for depression, and self-reported perceptions of psychosocial well-being have predictive value. Preventive efforts can be selectively targeted at adolescents who have been exposed to identifiable risk factors.

Early puberty is associated with mental health problems in middle adolescence

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.

One hundred cases of recurrent abdominal pain in children: diagnostic procedures and criteria for a psychosomatic diagnosis

AIMS

To highlight the diagnostic difficulties involved in elucidating the aetiology of recurrent abdominal pain and to evaluate the use of special premises and criteria for the diagnosis of psychosomatic pain.

METHODS

The study included 100 consecutive cases of recurrent abdominal pain in 6 to 15 y-old children who were evaluated at a special paediatric clinic for recurrent abdominal pain and who were followed for at least one year. The investigation included a semi-structured questionnaire, laboratory investigations based on clinical data and diagnoses based on defined criteria. Three premises and seven criteria, based on the assumption that chronic negative stress can cause recurrent pain, were used for the diagnosis of psychosomatic pain.

RESULTS

When the presented premises and criteria were employed for the diagnosis of psychosomatic pain, nearly half of the cases (48%) of recurrent abdominal pain could be explained. An organic or possibly organic diagnosis was found in 25% of the cases. Fourteen children had a possible psychosomatic diagnosis and in 9 cases no known diagnosis could be reached.

CONCLUSION

The presented premises and criteria for the diagnosis of psychosomatic pain can be helpful when diagnosing recurrent abdominal pain, but further validation is needed. According to these criteria, a psychosomatic diagnosis was common in this series, accounting for nearly half of the cases. A medical diagnosis was evident in a quarter of the cases.

A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service

OBJECTIVE

Constipation and soiling is a relatively common condition in childhood and its course is often chronic. This study investigated long-term outcome of children with chronic constipation and soiling by following up a cohort of children 6 years after their presentation to a specialist paediatric gastroenterology clinic with chronic constipation and soiling.

DESIGN

Retrospective postal survey.

SETTING/SAMPLE

All children referred in 1991 to a specialist paediatric gastroenterology clinic accepting both secondary and tertiary referrals.

MEASURES

A semi-structured postal questionnaire was sent to all families, and the Strengths and Difficulties Questionnaire (SDQ) was sent to a random sample.

RESULTS

The response rate (of those who could be traced) was 89%. Of these, over a third (36%) still had a problem with constipation and soiling and 17% were using regular laxatives. Three people still having problems with constipation and soiling in the sample were aged over 18 years. No significant difference was found with regard to age, sex or age at referral between the group that improved and the group that did not. Both groups felt they had suffered a high degree of distress because of the problem, with parents highlighting their powerlessness to help their child and the child identifying the embarrassment caused by the problem.

CONCLUSIONS

A significant number of children presenting to a specialist paediatric clinic continue to have problems for several years. Further research is needed to identify these cases and to identify which factors promote resolution of the problem.

Risk factors for and sequelae of headaches in schoolchildren with clinical implications from a psychosocial perspective

Functional headache, by definition, is a headache not associated with organic diseases. It is a common symptom in school children and can cause potentially serious health problems, affecting their growth and development. Therefore, this report synthesizes the literature about functional headaches in schoolchildren from a psychosocial perspective. This report examines the research on risk factors and sequelae of headaches in children, presents a framework to guide the conceptualization of this phenomenon, and suggests an application of this framework for clinical practice.

Headache and associations with lifestyle among pupils in senior level elementary school

OBJECTIVE

To investigate the prevalence of headache and its association with lifestyle among schoolchildren and to test an intervention programme.

DESIGN

A cross-sectional survey of all pupils in the school who were asked to complete a questionnaire about headache and lifestyle factors.

SETTING

School health care at an elementary school in Sweden.

SUBJECTS

All 344 pupils aged 13-16 years, 170 girls and 174 boys, at senior level answered the questionnaire and were included in the study.

MAIN OUTCOME MEASURES

Headache occurring at least once a week.

RESULTS

Twenty-two percent had headache at least once a week. The problem was more common among girls than among boys; OR 1.6 (95%CI 1.3-2.1). In girls, headache was associated with smoking; OR 6.6 (CI 1.2-35.5), going to bed later than 11 p.m.; OR 4.4 (CI 1.1-18.0), headache in parents; OR 2.0 (CI 1.0-4.2), and few sports activities; OR 3.0 (CI 1.2-7.5). The only corresponding association in boys was with smoking; OR 12.0 (CI 1.5-101). Headache improved in pupils participating in the programme.

CONCLUSIONS

Headache is a common health problem in schoolchildren of both sexes at senior level and shows strong associations with lifestyle factors in girls. Intervention seems to be efficient.

Childhood headache, stress in adolescence, and primary headache in young adulthood: a longitudinal cohort study

OBJECTIVES

To determine the association between childhood history of headache, adolescent stress, and headache syndromes (determined by International Headache Society criteria) in young adulthood.

BACKGROUND

The association between stress and tension-type headache has recently been challenged. Little is known about stress and other headache subtypes, particularly among young people from the general population.

DESIGN

Members of the longitudinal Dunedin Multidisciplinary Health and Development Study participated in this study. Study members were asked about headache characteristics/symptoms at aged 26 (96% of the living cohort), and historical records were examined to ascertain headache history (younger than 12 years) and the reporting of stressful life events at aged 15 years.

RESULTS

Study members with childhood headache were significantly more likely to report adolescent stress than those without headache. High-intensity stress during mid adolescence increased the likelihood of migraine diagnosis. In those with combined headache (migraine as well as tension-type headache), this relation held only for those with a history of headache. Stress associated with bodily changes during mid adolescence was the only significant predictor of tension-type headache.

CONCLUSIONS

Childhood headaches are related to the appraisal of life events reported during mid adolescence. Childhood headaches also appear to confer a specific risk for the development of combined headache. There was little evidence for a prospective relation between stress in mid adolescence and tension-type headache in young adulthood, supporting claims that proximal (rather than distal) stress is associated with this disorder.

Paternal remarriage as a modifier of proneness to depression in young adulthood

BACKGROUND

The remarriage of a parent is a major event experienced by many children. Its role in children's depressive symptoms was examined in a follow-up study of a cohort from the age of 16 to 22 years.

METHODS

The study population consisted of young people who had experienced parental divorce in childhood (N=356). Associations between a parent's remarriage and potential modifying factors in adolescence (atmosphere at home, school performance, dating behavior, life-events, the importance of siblings, and socioeconomic status) and depressive symptoms at 22 years of age were studied.

RESULTS

A poor atmosphere at home at 16 years and father's remarriage (but not mother's) in childhood were associated with subsequent depression. Girls whose father had not remarried, but boys whose father had remarried, were more depressive than others. Dating behavior in adolescence modified proneness to depression in these groups.

CONCLUSION

The findings indicate the importance of the father in adolescent development after divorce and that the processes involved may differ by gender.

Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services

OBJECTIVE

To determine whether classification as pediatric "somatizers" identifies a group of children and adolescents at high risk for psychopathology, functional impairment, and frequent use of health services in a large, multisite study of pediatric primary care.

METHOD

Parental reports of frequent aches and pains and visits to the doctor for medically unexplained symptoms in children aged 4 to 15 years were used to construct a classification of somatization in pediatric primary care. Affected and unaffected children and adolescents were compared on measures of demographics, family functioning, psychopathology, functional status, and service use.

RESULTS

Classification as a somatizer was more common in adolescents, females, minority subjects, urban practices, nonintact families, and families with lower levels of parental education and was associated with heightened risk of clinician- and parent-identified psychopathology, family dysfunction, poor school performance and attendance, perceived health impairment, and more frequent use of health and mental health services.

CONCLUSIONS

Children classified as pediatric somatizers are at heightened risk for psychiatric disorder, family dysfunction, functional impairment, and frequent use of health services. Additional research is warranted, and clinicians should recognize the need for careful assessment and potential behavioral health referral in this population.

Independence of childhood life events and chronic adversities: a comparison of two patient groups and controls

OBJECTIVE

To examine the differences between independent and behavior-dependent stressful life events and chronic adversities in child psychiatric patients, community controls, and children with asthma.

METHOD

The Psychosocial Assessment of Childhood Experiences was used to assess recent severe events (life events with high long-term threat) and major adversities (long-term experiences with high negative impact on child) in children attending a psychiatric clinic (n = 99), community controls (n = 26), and children with chronic asthma (n = 94).

RESULTS

In the previous year, the psychiatric patients had, on average, experienced significantly more independent and behavior-dependent severe events and major adversities than either the controls or the asthmatic patients. The differences were most pronounced in relation to behavior-dependent high-threat life events and long-term-experiences. Among the psychiatric patients, one third of all severe events and one quarter of all major adversities were dependent on the child's behavior. The corresponding proportions in the controls and children with asthma were between one fifth and one twelfth.

CONCLUSIONS

Psychiatrically disturbed children have an increased risk of experiencing behavior-dependent life events and long-term adversities compared with their peers in the community at large and compared with children suffering from a chronic physical illness such as asthma. Future studies need to examine the possible contributions of such experiences to the development and maintenance of psychiatric and physical illness in children.

Psychosomatic problems and stress in adolescence

Psychosomatic problems are common in adolescents, and stress frequently plays a role in their development and maintenance. Armed with an understanding of the stressors experienced by adolescents, the individual's vulnerabilities and competencies and their level of social support, the physician can systematically assess each of these factors. Once the assessment is complete, a management plan can be formulated to address the particular psychosomatic problem. Symptom relief, stress reduction, and promotion of competence are important interventions that can be initiated by the primary care physician. When referrals are made for counseling and other stress management techniques, the primary care physician should maintain contact with the patient and family and remain an integral part of the management team. Incorporating brief discussions about the potential role of stress in health and illness into anticipatory guidance sessions may also help prevent the development of psychosomatic problems in adolescents.

Psychological distress and its correlates in secondary school students in Pavia, Italy

Adolescence is a time of social as well as biological transition; nevertheless, there are very few epidemiological studies in this field in Italy. Therefore, we felt it would be useful to conduct a cross-sectional study on a sample of 1346 adolescents aged 14-19 years attending high schools in the Health Authority Area of Pavia (northern Italy) through a multi-dimensional approach, taking into consideration physical and psychological health, life habits, family environment and social life of teen-agers. We used a structured self-administered questionnaire consisting of 264 question items to achieve the study aim, which was to find the variables (among personal data, scholastic, family, relational characteristics and habits) correlated with psychological distress. The results showed that in this sample psychological distress (evaluated by GHQ-30) was significatively (p < 0.005) associated with female sex, problems with school friends and teachers, having at least one immigrant parent (from a region different from that of residence), little love for parents and poor parental psycho-physical health status, staying at home on the weekend, smoking and using psychoactive medicines.

Life stress, social support and psychological distress in late adolescence

Psychological distress in high-school students was examined in relation to negative life events, long-lasting adversities and perceived social support from the family, friends and the school class. Academic problems increased the symptom levels of psychological distress, and social support from family and social support from friends reduced the symptoms among males and females. For females, social support from school class-mates and problems with parents and friends also had direct independent effects on symptom levels. An effect of the total number of long-lasting adversities was significantly stronger for females than males. The buffer hypothesis was supported: both an increase in social support from parents and social support from peers reduced the effect of negative life events.

Sex differences in coping and depression among young adults

The main purpose of the study was to evaluate the notion that the association between sex and depression is partly mediated by differences in coping styles. The study is based on questionnaire data from 890 female and 766 male Finnish 22-year-old young adults. Of the 12 ways of coping presented, self-blame, venting anger on others, seeking comfort in sweets and drinking beer were positively, and the others negatively, associated with depression; these were called dysfunctional and functional ways of coping, respectively. Women resorted much more often than men to dysfunctional ways of coping, except drinking. They also scored lower on personal resilience and showed more depressive symptoms. The sex difference in depressiveness was eliminated when dysfunctional coping was taken into account.

Physical symptoms and illness attitudes in adolescents: an epidemiological study

A secondary school population of 805 11-16-year-olds reported lifetime prevalence of 31 physical symptoms and illness attitudes. Girls had a median of six symptoms (range 0-22) and boys five (range 0-22); 67 (8.3%) had 13 or more. Older girls reported more symptoms than younger ones. The excess of symptoms in older girls was related to reporting painful periods rather than simply to age or the menarche. High symptom scorers of both sexes had significantly higher scores on seven Illness Attitude Sub-Scales (Kellner, 1987), with more distress about illness and more treatment experience. The implications of these findings are discussed.

Prevalence of headache in schoolchildren: relation to family and school factors

The purpose of the study was to determine the prevalence of recurrent headaches among schoolchildren in Göteborg and the relation of headache to school and family variables. A stratified sample of 1297 pupils was selected to be representative of the Göteborg population. Data were obtained by means of questionnaires. Twenty-six per cent had "headache once a month or more" and 6% had "headache several times a week or daily" (frequent headache). There was a gradual increase of headache with age. In the third grade there was a marked increase of frequent headache. In the highest school level (grades 7-9), girls had significantly more headache than boys. In the lower school level (grades 1-3), a greater number of pupils in the class increases the risk of frequent headache. Pupils in the intermediate school level (grades 4-6) reported more frequent headache in districts with high unemployment. It is concluded that headache among schoolchildren is a health problem which merits increased attention.

Somatisation in children

This review summarises recent work on somatisation in childhood. Minor physiological dysfunction may play a part in a number of cases and associated psychiatric disorders are commonly though not universally found. Contributory family factors include high rates of health problems and of parental psychological distress and there is some evidence for the role of family modelling and reinforcement of illness behaviour. There is suggestive evidence linking somatisation to emotional closeness in families, to family togetherness around health matters and to anomalies in children's social relationships. Somatisation in children can respond to treatments involving cognitive-behavioural and family techniques as well as to sensitive, psychologically sound advice from paediatricians.

Life events and behavioural deviances in childhood: a longitudinal study of a normal population

A semi-structured interview based upon Coddington's life event questionnaire was revised and modified to measure life changes in children of possible importance for the development of physical and mental illness. A normal population of 193 children was investigated in 1981-83 and followed up after six years. The life events during the intervening period are described and correlated to child behavioural symptom load and family function before and after. Both the life event load and the adjustment ability of the child make significant contributions to the prediction of child disturbance in the follow-up.

Somatization in children and adolescents

OBJECTIVE

To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment.

METHOD

One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization.

RESULTS

Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services.

CONCLUSION

Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.

Risk and protective factors in depression: a developmental perspective

The approach of developmental psychopathology is presented, and developmental research on the role of sex differences and protective factors in depression is reviewed. Results from our own study on family stress, protective factors and depression are presented as an example.

Elevated cholecystokinin concentrations in plasma in children with recurrent abdominal pain

The objective of the present study was to measure plasma concentrations of the gastrointestinal hormones gastrin, somatostatin and cholecystokinin in plasma of children with recurrent abdominal pain, since these hormones affect gastrointestinal function. Forty-four children (7-16 years old) with recurrent abdominal pain and 36 control children (matched for age and sex) participated in the study. In a blood sample collected after an overnight fast, gastrin, somatostatin and cholecystokinin concentrations were measured by radioimmunoassay. The children with recurrent abdominal pain had higher plasma cholecystokinin levels (p < 0.001) than the controls. Whether or not this aberration is related to the clinical symptoms of children with recurrent abdominal pain remains to be established.

Precipitant stressors in adolescent suicide

OBJECTIVE

Precipitant stressors in adolescent (aged 13 to 19 years) suicides (N = 53) were investigated in a nationwide psychological autopsy study in Finland.

METHOD

Data were collected through interviews with the victims' parents and health care personnel, and from official records.

RESULTS

Precipitants during the month preceding suicide were found in 70% of the cases. Almost half the precipitants occurred during the last 24 hours. Interpersonal separations and conflicts were the most common precipitants. Compared with other suicide victims, those with weakened parental support more often had interpersonal separation as a precipitant, a higher number of stressors during the final month, and had more often experienced major stress during the year before suicide.

CONCLUSION

The findings highlight the importance of stress (acute, chronic, or both) in adolescent suicide. Interpersonal problems were common precipitants in adolescent suicide. Among adolescents with weakened parental support, interpersonal separations were especially common precipitants. Additional research on precipitants in adolescent suicide is needed with proper control subjects.