Psychosocial predictors of somatic symptoms in adolescents of parents with HIV: a six-year longitudinal study

The association between parental chronic physical illness and adolescent functional somatic symptoms

BACKGROUND

Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems.

METHODS

In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects.

RESULTS

Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores.

LIMITATIONS

The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification.

CONCLUSION

Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.

Tweedie Compound Poisson Models with Covariate-Dependent Random Effects for Multilevel Semicontinuous Data

Multilevel semicontinuous data occur frequently in medical, environmental, insurance and financial studies. Such data are often measured with covariates at different levels; however, these data have traditionally been modelled with covariate-independent random effects. Ignoring dependence of cluster-specific random effects and cluster-specific covariates in these traditional approaches may lead to ecological fallacy and result in misleading results. In this paper, we propose Tweedie compound Poisson model with covariate-dependent random effects to analyze multilevel semicontinuous data where covariates at different levels are incorporated at relevant levels. The estimation of our models has been developed based on the orthodox best linear unbiased predictor of random effect. Explicit expressions of random effects predictors facilitate computation and interpretation of our models. Our approach is illustrated through the analysis of the basic symptoms inventory study data where 409 adolescents from 269 families were observed at varying number of times from 1 to 17 times. The performance of the proposed methodology was also examined through the simulation studies.

Coping strategies and mental health of adolescents impacted by parental HIV and AIDS in rural South Africa

Objective: The study explored whether orphanhood status as well as coping strategies predicted mental health outcomes in orphans and vulnerable adolescents who participated in an NGO-supported programme in rural South Africa.Method: Participants comprised 175 adolescents (aged 11-18 years) from a low-resource community, and included non-orphans (n = 57), orphans due to AIDS (n = 62) and orphans due to other causes (n = 56). All participants rated themselves on the age-appropriate Youth Self-Report scales and 95 completed the Children's Coping Strategies Checklist (CCSC). Little's test of data missing completely at random revealed that the CCSC missing data did not display a specific pattern.Results: Active coping negatively predicted internalising, externalising and general psychological problems, while avoidant coping predicted general psychological problems. Orphanhood group status, sex and age did not predict coping strategies used. A higher proportion of orphans by AIDS had elevated scores of internalising problems and all participants on somatic complaints.Conclusions: Active coping strategies minimise the risk for emotional and behavioural problems among the participants. Our findings suggest that agencies and non-governmental organisations that provide services to vulnerable adolescents can facilitate active coping skills to enhance their psychological well-being.

A Systematic Review of Somatic Symptoms in Children With a Chronically Ill Family Member

OBJECTIVE

Somatization and functional somatic symptoms reflect conditions in which physical symptoms are not sufficiently explained by medical conditions. Literature suggests that these somatic symptoms may be related to illness exposure in the family. Children with a parent or sibling with a chronic illness may be particularly vulnerable to developing somatic symptoms. This study provides a systematic review of the literature on somatic symptoms in children with a chronically ill family member.

METHODS

A systematic review (PROSPERO registry ID: CRD42018092344) was conducted using six databases (PubMed, EMBASE, PsychINFO, Scopus, CINAHL, and Cochrane) from articles published before April 5, 2018. All authors evaluated articles by title and abstract, and then by full-text review. Relevant data were extracted by the first author and reviewed by remaining authors.

RESULTS

Twenty-seven unique studies met the criteria. Seventeen examined somatic symptoms in children with a chronically ill parent, and seven evaluated somatic symptoms in children with a chronically ill sibling. Three studies examined somatic symptoms in children with an unspecified ill relative. The strongest relationship between child somatization and familial illness was found with children with a chronically ill parent (13/17 studies). Evidence for somatic symptoms in children with an ill sibling was mixed (4/7 studies found a positive association).

CONCLUSIONS

The literature on somatic symptoms in children suggests that parental illness is related to increased somatic symptoms in children. Research examining the effects of having a sibling with an illness on somatic symptoms is mixed. Several areas of future research are outlined to further clarify the relationship between familial chronic illness and somatic symptoms.

Sibling-Controlled Study of Parental Bonding, Coping, and Urgent Health-Care Use in Families With Children With Nonepileptic Seizures

Objectives

Pediatric psychogenic nonepileptic seizures (PNES) is a functional somatic symptom condition with significant health-care service burden. While both family and individual factors play an important role in the development and maintenance of PNES, little is known about what predicts urgent health-care use in families with children who have PNES. The aim of the current study was to explore whether child coping and parental bonding styles influence the decision to seek urgent medical care in these families.

Methods

Data were analyzed from youth of age 8-18 years, 47 with PNES, and their 25 sibling controls. Parents provided the number of youth emergency room visits and hospitalizations in the preceding year. Youth completed a questionnaire about their coping styles and a measure about their mothers' and fathers' bonding styles. Using a mixed model with family as a random effect, we regressed urgent health-care use on participant type (youth with PNES or sibling), parental bonding style, and youth coping style, controlling for number of child prescription medications.

Results

Higher urgent health-care use was associated with having PNES, coping via monitoring, and perceiving one's father to be rejecting and overprotective. Lower urgent health-care use was associated with coping via venting and with perceiving one's mother to be caring and overprotective.

Conclusions

This study provides preliminary empirical support for family-based clinical efforts to reduce child urgent health-care use by enhancing effective child coping skills and improving parental response to child impairment and distress in families with youth with PNES.

Family conflict and somatic symptoms over 10 years: a growth mixture model analysis

OBJECTIVE

While family conflict and somatic symptoms are mutually associated, few longitudinal studies have examined multiple (heterogeneous) trajectory subgroups for family conflict and somatic symptoms and their covariation over time. The aim of this study was to identify heterogeneous trajectory subgroups for family conflict and somatic symptoms and their joint trajectories.

METHODS

A representative sample of 424 community participants completed surveys at baseline and 1-, 4-, and 10-year follow-ups. Family conflict and somatic symptoms were assessed at each wave. Covariates (age, gender, marital status, education, and medical conditions) were assessed at baseline. Growth mixture modeling (GMM) was used to identify heterogeneous trajectory subgroups for family conflict and somatic symptoms. A parallel process GMM was used to examine joint trajectory subgroup membership between family conflict and somatic symptoms.

RESULTS

There were three trajectory subgroups for family conflict: stable low; worsening; and improving, and three somewhat similar trajectory subgroups for somatic symptoms: stable low; stable moderate; and improving. Family conflict and somatic symptom trajectory subgroup memberships were jointly associated. Individuals who had stable low family conflict were most likely to follow a stable low somatic symptom trajectory. Individuals who improved in family conflict were most likely to continue to have stable low somatic symptoms or improve in somatic symptoms. Moreover, individuals who had stable moderate somatic symptoms were most likely to show worsening family conflict.

CONCLUSION

This study demonstrates heterogeneous family conflict and somatic symptom trajectories and indicates that these trajectories covary over time.

Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children

Somatic symptoms are a common physical response to stress and illness in childhood. This study assessed 409, primarily African American (85.6 %), urban elementary school children to examine the association between: (1) somatic symptoms and potential external stressors (school and peer stress, family conflict, and community violence) and (2) parent and child agreement on children's self-report of somatic symptoms. The odds of self-report of somatic complaints were significantly associated with family conflict, school and peer stress, and community violence exposure (OR = 1.26, 95 % CI: 1.05-1.50; OR = 1.18, 95 % CI 1.08-1.28; and OR = 1.02, 95 % CI: 1.00-1.05, respectively). Identifying the associations between social, family, and community based stress and somatic symptoms may improve the quality of life for children living in urban environments through early identification and treatment.

Perception of association between normal development and environmental stimulation by mothers of children in the first three years of life

OBJECTIVE

To evaluate the perception of mothers with children aged zero to three years old on the association between environmental stimulation and normal development of these children assisted at a Health Unit in São Luís, Maranhão, Northeast Brazil, and to identify the level of maternal understanding on the stimulation of the family environment in which the child is inserted.

METHODS

Qualitative research that enrolled 15 mothers of children aged zero to three years old treated in the Health Unit Antonio Carlos Reis, Cidade Olímpica, in São Luís, Maranhão, Brazil, from October 2009 to March 2010. Data collection instruments were medical records, semi-structured interviews applied in household with parents, participant observations, and home visits.

RESULTS

Most mothers were teenagers, single, did not work outside the household, had incomplete primary education, and family income from 0 to 0.5 minimum wage. The main difficulties were: lack of preparation to raise their children, low level of resolution of everyday situations, and father absence on family life. It was identified how mothers associated environmental deprivation with normal child development.

CONCLUSIONS

The mothers presented perception on the environment in which their children lived and that the lack of stimulation in these places affected the children's development. Therefore, there is a need for improved levels of stimulation and of the links between child, family, and health professionals.

Approach to psychosomatic illness in adolescents

PURPOSE OF REVIEW

Due to the increased prevalence of psychosomatic presentations and the difficulty of managing such patients, this article summarizes the latest findings for identifying individual and family risk factors, and new trends in the evaluation and management of pediatric patients with psychosomatic illness.

RECENT FINDINGS

Up to 50% of patients in pediatric care will complain of medically unexplained symptoms with significant functional and emotional impairment. Such patients place heavy burdens on the healthcare system (frequent utilization of health resources and hospitalizations, specialist consultations, unnecessary investigations, and treatments). Somatoform disorders in pediatric care are associated with risks for psychiatric co-morbidity (anxiety and depressive disorders), family conflict, parent-perceived ill health, and school problems/absenteeism.

SUMMARY

Gaining expertise in addressing pediatric psychosomatic illness can make a great difference in patients' life and in physicians' professional satisfaction. Effective treatment approaches involve a multidisciplinary approach to consolidate care and facilitate communication, target the patient/family's understanding of the mind-body relationship and their acceptance of the bio-psycho-social formulation and treatment, and utilize functional rehabilitation and cognitive behavioral therapy for the individual and family and management guidance for schools.

Symptom experience in HIV-infected adults: a function of demographic and clinical characteristics

Personal characteristics that interact with both HIV diagnosis and its medical management can influence symptom experience. Little is known about how symptoms in populations with chronic illness vary by age, sex, or socioeconomic factors. As part of an ongoing prospective longitudinal study, this report describes symptoms experienced by 317 men and women living with HIV/AIDS. Participants were recruited at HIV clinics and community sites in the San Francisco Bay Area. Measures included the most recent CD4 cell count and viral load from the medical record, demographic and treatment variables, and the 32-item Memorial Symptom Assessment Scale to estimate prevalence, severity, and distress of each symptom and global symptom burden. The median number of symptoms was nine, and symptoms experienced by more than half the sample population included lack of energy (65%), drowsiness (57%), difficulty sleeping (56%), and pain (55%). Global symptom burden was unrelated to age or CD4 cell count. Those with an AIDS diagnosis had significantly higher symptom burden scores, as did those currently receiving antiretroviral therapy. African Americans reported fewer symptoms than Caucasians or Mixed/Other race, and women reported more symptom burden after controlling for AIDS diagnosis and race. Because high symptom burden is more likely to precipitate self-care strategies that may potentially be ineffective, strategies for symptom management would be better guided by tailored interventions from health care providers.