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Lim SI, Jeong S. The Relationship between the Frequency of Breakfast Consumption, Conversation with Parents, and Somatic Symptoms in Children: A Three-Wave Latent Growth Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12975. [PMID: 36232274 PMCID: PMC9564638 DOI: 10.3390/ijerph191912975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/14/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Breakfast consumption is essential for children to generate energy for the day. Parents play an important role in children's breakfast habits and spending time with parents during breakfast greatly influences children's emotional development. Therefore, this study investigated the relationship between the frequency of children's breakfast consumption, time spent in conversation with parents, and children's somatic symptoms. Data were obtained from the Korea Children and Youth Panel Survey 2018 and were initially collected from fourth-grade elementary school students and followed up for three years. SPSS 21.0 and AMOS 21.0 software were used for data analysis. Multivariate latent growth modeling was applied to analyze the effect of the breakfast consumption frequency on children's somatic symptoms and the mediating effect of parent-child conversation time on this relationship. Consequently, as children's frequency of breakfast consumption increased, their somatic symptoms decreased. Furthermore, parent-child conversation time mediated the relationship between these two variables. Therefore, students, parents, and teachers should be educated about the importance of having breakfast and communicating with parents for students' emotional health.
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Affiliation(s)
- Shin-Il Lim
- Department of Educational Psychology, College of Nursing, Jesus University, Jeonju 54989, Korea
| | - Sookyung Jeong
- Department of Nursing, College of Medicine, Wonkwang University, Iksan 54538, Korea
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Arnold JT, Franklin EV, Baker ZG, Abowd M, Santana JA. Association Between Fear of Pain and Sports-Related Concussion Recovery in a Pediatric Population. Clin J Sport Med 2022; 32:369-375. [PMID: 34173783 PMCID: PMC8692487 DOI: 10.1097/jsm.0000000000000951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether an association exists between fear of pain and recovery time from sports-related concussion in a pediatric population. DESIGN Prospective observational study. SETTING Primary outpatient sports medicine clinic of a large pediatric hospital. PATIENTS One hundred twenty-eight pediatric patients aged 8 to 18 years who presented to clinic with a primary diagnosis of concussion from September 2018 to March 2020. Inclusion criteria included presentation within 2 weeks of injury and symptomatic on initial visit. Patients who sustained a concussion because of motor vehicle collisions or assault were excluded. INDEPENDENT VARIABLES There was no intervention. Study participants who met inclusion criteria were administered the Fear of Pain Questionnaire (FOPQ) at their initial visit. MAIN OUTCOME MEASURES Time to clinical recovery was the main outcome measure and was determined by the fellowship-trained sports medicine physician based on resolution of concussion symptoms, resumption of normal physical and cognitive daily activities, no use of accommodations or medications, and normalization of physical exam. RESULTS There was a significant difference in FOPQ scores for those with prolonged recovery (M = 33.12, SD = 18.36) compared with those recovering in fewer than 28 days (M = 26.16, SD = 18.44; t [126] = -2.18, P = 0.036). CONCLUSIONS Consistent with the adult literature, we found that pediatric patients are more likely to have a prolonged recovery from concussion when they have higher fear of pain.
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Affiliation(s)
- Jennifer T Arnold
- Department of Sports Physical Therapy, Texas Children's Hospital, Houston, Texas
| | - Elizabeth V Franklin
- Department of Pediatrics, Section of Adolescent and Sports Medicine, Baylor College of Medicine, Houston, Texas
| | - Zachary G Baker
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota; and
| | - Marian Abowd
- Department of Orthopedics, Texas Children's Hospital, Houston, Texas
| | - Jonathan A Santana
- Department of Pediatrics, Section of Adolescent and Sports Medicine, Baylor College of Medicine, Houston, Texas
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Rappaport LG, VanderVennen MC, Monroe KK, McCaffery H, Stewart DA. Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay. Hosp Pediatr 2022; 12:79-85. [PMID: 34889353 DOI: 10.1542/hpeds.2021-006039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs). METHODS Data from 2012-2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions. We defined a weekend as 3 pm Friday to 3 pm Sunday. The Wilcoxon rank test was used for unadjusted analysis. Multiple logistic regression was used to estimate the odds of having LOS >1 day, >2 days, >3 days, and >4 days in weekend versus weekday groups. RESULTS Weekend admission significantly correlated with increased LOS (P < .001). Compared with weekdays, a weekend admission was associated with increased odds of having LOS >1, >2, and >3 days. This remained statistically significant while adjusting for the number of chronic conditions, procedures, and individuals with Black or Hispanic ethnicity compared with White ethnicity. LOS was not associated with sex or age of the patients. CONCLUSIONS Patients with SSRDs admitted on the weekend have an increased LOS compared with those admitted on a weekday. This may be due to a decrease in multidisciplinary care available during weekends. In future studies, researchers should aim to better understand the specific factors that contribute to this disparity and test interventions that may close the gap in care, including expanding to 7-day services, increasing mental health resources, and working to decrease the need for inpatient admissions.
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Affiliation(s)
- Leah G Rappaport
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Kimberly K Monroe
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - David A Stewart
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Quinn M, Caldwell B. A "Storm" of Somatic Symptoms: A Child's Reaction to a Natural Disaster Leads to Diagnostic Uncertainty. J Pediatr Health Care 2021; 35:542-547. [PMID: 33789796 DOI: 10.1016/j.pedhc.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
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Baro V, Garbin E, Sartori L, Caliri SL, Furlanis GM, Santoro L, Dal Pos S, Landi A, Denaro L. Metastatic osteosarcoma of craniovertebral junction with cervicalgia and torticollis an a pediatric patient. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cozzi G, Lucarelli A, Borrometi F, Corsini I, Passone E, Pusceddu S, Morabito G, Barbi E, Benini F. How to recognize and manage psychosomatic pain in the pediatric emergency department. Ital J Pediatr 2021; 47:74. [PMID: 33766115 PMCID: PMC7992953 DOI: 10.1186/s13052-021-01029-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Abstract
Aim Children and adolescents affected by somatization and somatic symptom disorder commonly refer to emergency services. Due to the absence of specific guidelines for the emergency setting and to a possible lack of knowledge, these patients are at risk of being unrecognized and mismanaged. This study aims at proposing a clinical practice to approach and manage these patients and their families in the emergency setting. Methods This manuscript derived from the work of a research group of italian pediatric emergency physicians and anesthesiologists, with an expertise in pain management, members of the PIPER group. The research group reviewed the literature about psychosomatic pain and somatic symptom disorder and developed a clinical practice specific for the pediatric emergency setting. Results The manuscript provides information about the main clinical features shared by patients with psychosomatic pain and about current diagnostic criteria and appropriate management in the emergency setting. Furthermore, it highlights the possible pitfalls in which the emergency physician may run into dealing with these patients. Conclusion This clinical practice should be seen as a starting point toward a better understanding of patients with psychosomatic pain and a standardization of care in the pediatric emergency setting.
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Affiliation(s)
- Giorgio Cozzi
- Pediatric Emergency Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137, Trieste, Italy.
| | - Annunziata Lucarelli
- Department of Paediatrics and Emergency, Giovanni XXIII Children's Hospital, University of Bari, Bari, Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care, Department of Oncology, Pausilipon Hospital, AORN Santobono Pausilipon, Naples, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eva Passone
- Pediatric Clinic, Department of Clinical and Experimental Sciences, DAME, ASUFC S. Maria Della Misericordia, University of Udine, Udine, Italy
| | - Sara Pusceddu
- Pediatric Department, Ospedale S. Maria della Scaletta AUSL, Imola, Italy
| | - Giuliana Morabito
- Pediatric and Neonatology Division, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137, Trieste, Italy.,Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Franca Benini
- Paediatric Palliative Care - Pain Service Department of Women's and Children's Health, University of Padua, Padua, Italy
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Morabito G, Cosentini D, Tornese G, Gortani G, Pastore S, Genovese MRL, Cozzi G. Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent. Front Pediatr 2021; 9:679004. [PMID: 34123974 PMCID: PMC8192849 DOI: 10.3389/fped.2021.679004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Somatic symptom disorder is common in children and adolescents; usually, it is an expression of a mental health problem or other conditions that lead to psychosocial impairment and suffering. Among these, in pubertal age, gender dysphoria should be considered. Case Presentation: We present the case of a 15-year-old girl admitted to the hospital because of a 2-month history of scattered arthralgia and myalgia, headache, and fatigue, with repeated visits to the emergency room. The physical exam was unremarkable, except for step walking and pain. Repeated diagnostic tests were normal, and consecutive psychological interviews disclosed intense suffering due to a gender incongruence. Referral to the hospital gender service was offered and refused by the parents. Conclusions: In pubertal age, gender dysphoria may be expressed through somatoform symptoms. Diagnosis is challenging to accept for the parents even in the presence of adequate multi-disciplinary hospital services.
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Affiliation(s)
- Giuliana Morabito
- Department of Pediatrics, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Dora Cosentini
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Gortani
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Serena Pastore
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Eliacik K, Bolat N, Kanik A, Malas N, Demircan T, Hortu H, Özyurt G, Orbatu D, Alaygut D, Guven B. Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning. Acta Paediatr 2020; 109:1642-1648. [PMID: 31860731 DOI: 10.1111/apa.15144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/24/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Chest pain is common in adolescence, but there are no established criteria for managing this problem, which is rarely associated with cardiac disease. This study addressed the gaps in the literature by evaluating psychosocial factors that could be associated with medically unexplained chest pain. METHODS We consecutively selected 100 patients (68% girls) aged 13-18 who were diagnosed with unexplained chest pain when they presented to the cardiology outpatient clinics of Tepecik Research Hospital, İzmir, Turkey, between 30 September 2015 and 30 June 2018. The controls were 76 age- and sex-matched adolescents (69% girls) aged 13-18 who were undergoing routine cardiology assessments before joining sports clubs. We assessed their health-related quality of life and any depression and physical symptoms. RESULTS Regression analysis showed some adolescents were a number of times more likely to report chest pain. These included those who reported boredom (4.1 times), felt stressed or anxious (2.2) and those who experienced sleep disturbance (2.6), co-morbid headaches (2.0), back pain (3.1) and impaired social functioning (1.2). CONCLUSION The results indicated a significant association between unexplained chest pain and physical symptoms, depression and impaired emotional and social functioning. These factors warrant further evaluation.
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Affiliation(s)
- Kayi Eliacik
- Division of Adolescent Medicine Tepecik Training and Research Hospital İzmir Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent Psychiatry Onsekiz Mart University School of Medicine Çanakkale Turkey
| | - Ali Kanik
- Department of Paediatrics Katip Çelebi University School of Medicine İzmir Turkey
| | - Nasuh Malas
- Department of Psychiatry and Department of Paediatrics University of Michigan Medical School Ann Arbor MI USA
| | - Tülay Demircan
- Department of Paediatric Cardiology Tepecik Training and Research Hospital İzmir Turkey
| | - Hacer Hortu
- Division of Adolescent Medicine Tepecik Training and Research Hospital İzmir Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry Katip Çelebi University School of Medicine İzmir Turkey
| | - Dilek Orbatu
- Department of Paediatrics Tepecik Training and Research Hospital İzmir Turkey
| | - Demet Alaygut
- Department of Paediatrics Tepecik Training and Research Hospital İzmir Turkey
| | - Baris Guven
- Department of Paediatric Cardiology Tepecik Training and Research Hospital İzmir Turkey
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Prevalence, Patterns, and Correlates of Pain in Medically Hospitalized Pediatric Patients With Somatic Symptom and Related Disorders. J Acad Consult Liaison Psychiatry 2020; 62:46-55. [PMID: 32641234 DOI: 10.1016/j.psym.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Somatic symptom and related disorders (SSRDs) and pain are highly comorbid in the pediatric population. Little is known about the prevalence of pain and factors that may predispose and perpetuate pain in hospitalized youth with SSRD. OBJECTIVE To describe the prevalence of pain and widespread pain symptoms in hospitalized youth with SSRD and describe differences between patients who endorsed limited (1-4 sites) versus widespread (5-8 sites) pain. METHODS Retrospective chart reviews were conducted of pediatric patients with SSRD seen over a 32-month period at a tertiary pediatric hospital and assessed by the psychiatry consultation service. During admission, patients completed the Childhood Somatization Inventory, which assessed pain and other physical symptoms. Descriptive statistics, one-way analysis of variances, Pearson's χ2, stepwise linear regressions, and internal consistency analyses were used. RESULTS Of the 219 patients (aged 8-18 y), 97% reported pain symptoms, and of those reporting pain (n = 213), 48% reported widespread pain. Patients with widespread pain had greater rates of comorbid depression (P = 0.012), neglect (P = 0.016), family psychiatric history (P = 0.013), diagnostic tests/procedures (P = 0.012), and prescribed opioid use (P = 0.016), when other medical and demographic factors were considered. When compared dichotomously to youth with limited pain, there was no difference in prevalence of medical conditions; however, patients with widespread pain had higher rates of trauma and stressor-related disorders (P = 0.017), sexual abuse (P = 0.031), emotional abuse (P = 0.041), and prior child protective service involvement (P = 0.011). CONCLUSIONS Pain symptoms and widespread pain are common in medically hospitalized youth with SSRD, with unique psychiatric and psychosocial factors associated with widespread pain.
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Saunders NR, Gandhi S, Chen S, Vigod S, Fung K, De Souza C, Saab H, Kurdyak P. Health Care Use and Costs of Children, Adolescents, and Young Adults With Somatic Symptom and Related Disorders. JAMA Netw Open 2020; 3:e2011295. [PMID: 32701161 PMCID: PMC7378752 DOI: 10.1001/jamanetworkopen.2020.11295] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Somatic symptom and related disorders are highly prevalent mental health disorders among young people. Presentation can be varied, and patients often face long delays and see multiple practitioners to receive a diagnosis. OBJECTIVE To evaluate the health care use and costs in a population-based sample of children and young people with somatic symptom and related disorders in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal single-payer health insurance plan. Participants included children aged 4 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 to 24 years residing in Ontario, Canada, during the period of April 1, 2008, to March 31, 2015. Included participants had a first health record diagnosis of somatic symptom and related disorders and were grouped based on the setting of their index somatic symptom and related disorders contact: outpatient, emergency department, or inpatient. Data were analyzed from August 1, 2017, to February 1, 2018. EXPOSURES One year before and 1 year after diagnosis of somatic symptom and related disorders. MAIN OUTCOMES AND MEASURES Outcome measures included overall and mental health-specific ambulatory and acute care visits and overall health system costs and sector-specific costs. RESULTS A total of 33 272 patients (median [interquartile range {IQR}] age, 20 [16-22] years; 17 387 female [52.3%]) were included in the analysis. Among these patients, 3875 (11.6%) were aged 4 to 12 years, 7273 (21.9%) were aged 13 to 17 years, and 22 124 (66.5%) were aged 18 to 24 years. A total of 17 893 (53.8%) had their index visit as outpatients, whereas 13 310 (40.0%) and 2069 (6.2%) were diagnosed in the emergency department and inpatient settings, respectively. Ambulatory physician visits were frequent and persisted 1 year after diagnosis within each setting (before vs after 1 year, median [IQR] visits, inpatient setting: 7 [3-13] vs 7 [3-13]; emergency department setting: 4 [2-8] vs 4 [2-9]; outpatient setting: 3 [1-7] vs 4 [2-7]; P < .001). After diagnosis, many did not receive physician-delivered mental health care (35.3% [730 of 2069] in an inpatient setting, 59.1% [7866 of 13 310] in an emergency department setting, 58.5% [10 467 of 17 893] in an outpatient setting; P < .001). Acute care use was frequent and remained so after diagnosis across settings. Of those hospitalized as inpatients at diagnosis, 37.7% (779 of 2069) were readmitted within 1 year. Mean (SD) 2-year patient costs were CAD$9845 ($39 725) (median [IQR], $2401 [$960-$7019]). Hospitalized patients had a 2-year mean (SD) cost of $51 424 ($100 416) (median [IQR], $21 997 [$12 510-$45 841]) per-patient expenditure. CONCLUSION AND RELEVANCE This study found that children and young people with somatic symptom and related disorders frequently used the health system with substantial health system costs before and after diagnosis. Many of these patients did not receive physician-delivered mental health care. These findings suggest that this population may be under-recognized, and initiatives for early recognition and engagement with mental health support may be warranted.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Claire De Souza
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hana Saab
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Kullgren KA, Shefler A, Malas N, Monroe K, Leber SM, Sroufe N, El Sakr A, Pomeranz E, O'Brien E, Mychaliska KP. Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hosp Pediatr 2020; 10:105-113. [PMID: 31896546 DOI: 10.1542/hpeds.2019-0141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care. Little literature exists to address SSRDs in the inpatient pediatric setting. The purpose of the study was to characterize current SSRD practice, identify problem areas in workflow, and develop a standardized approach to inpatient evaluation and management at a tertiary care academic children's hospital. METHODS A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014. A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice. Lean methodology was used to define current state practice and future state intervention. These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development. RESULTS Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review. Most patients presented with either neurologic or pain-related complaints. The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalization. Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis. Half of patients had comorbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up. CONCLUSIONS In this study, we describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of pediatric SSRDs. This study may serve as a model for similar standardization of SSRD care in other inpatient pediatric medical settings.
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Affiliation(s)
| | - Alanna Shefler
- Medical School, University of Michigan, Ann Arbor, Michigan
| | - Nasuh Malas
- Pediatrics
- Division of Child and Adolescent Psychiatry, Departments of Psychiatry
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12
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Cozzi G, Barbi E. Chronic school absenteeism as a diagnostic clue for paediatricians. J Paediatr Child Health 2020; 56:191-193. [PMID: 31705771 DOI: 10.1111/jpc.14689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 01/12/2023]
Abstract
Chronic school absenteeism is a relatively common problem in childhood and adolescence, and paediatricians should be aware of the causes, implications, and possible consequences of this behaviour. Most children, who consistently miss school, remain at home with the awareness of their parents, reporting some medical causes for their behaviour. Therefore, paediatricians should learn to use chronic school absenteeism as a diagnostic clue, to appropriately address children and adolescents with this behaviour and their families.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,University of Trieste, Trieste, Italy
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13
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Hirani K, Payne DN, Mutch R, Cherian S. Medical needs of adolescent refugees resettling in Western Australia. Arch Dis Child 2019; 104:880-883. [PMID: 29970582 DOI: 10.1136/archdischild-2018-315105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the medical needs and socioeconomic determinants of health among adolescent refugees resettling in Western Australia. DESIGN Comprehensive medical and socioeconomic health data of resettling adolescent refugees aged 12 years and above attending a Refugee Health Service over a 1-year period were analysed. RESULTS Medical records of 122 adolescents, median (range) age of 14 (12-17) years, were reviewed. Socioeconomic vulnerabilities included dependence on government financial support (50%), housing issues (27%) and child protection service involvement (11%). Medical concerns included non-communicable disorders (85%), infectious diseases (81%), nutrition/growth (71%) and physical symptoms of non-organic origin (43%). One quarter (27%) of female adolescents had sexual/reproductive health issues. A median (range) of 5 (2-12) health concerns were identified for each adolescent with 49% requiring referral to subspecialty services. CONCLUSION Resettling adolescent refugees are socioeconomically vulnerable with a range of medical issues that frequently require additional subspecialty health referrals.
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Affiliation(s)
- Kajal Hirani
- Department of Adolescent Medicine and Eating Disorders, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Donald N Payne
- Department of Adolescent Medicine and Eating Disorders, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Department of Adolescent Medicine and Eating Disorders, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia.,Refugee Health Service, Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Sarah Cherian
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Refugee Health Service, Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Ibeziako P, Brahmbhatt K, Chapman A, De Souza C, Giles L, Gooden S, Latif F, Malas N, Namerow L, Russell R, Steinbuchel P, Pao M, Plioplys S. Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings. Hosp Pediatr 2019; 9:147-155. [PMID: 30782623 PMCID: PMC11034856 DOI: 10.1542/hpeds.2018-0205] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.
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Affiliation(s)
- Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts;
| | - Khyati Brahmbhatt
- Langley Porter Psychiatric Institute
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Andrea Chapman
- Department of Psychiatry, British Columbia Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Claire De Souza
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lisa Giles
- Department of Psychiatry and Behavioral Health, Primary Children's Hospital and School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Shanti Gooden
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Finza Latif
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center and The George Washington University, Washington, District of Columbia
| | - Nasuh Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, C.S. Mott Children's Hospital, University of Michigan Hospital Systems, Ann Arbor, Michigan
| | - Lisa Namerow
- Department of Psychiatry, Connecticut Children's Medical Center and Institute of Living, School of Medicine, University of Connecticut, Hartford, Connecticut
| | - Ruth Russell
- Department of Psychiatry, Montreal Children's Hospital and McGill University, Montreal, Canada
| | - Petra Steinbuchel
- Department of Psychiatry, Weill Institute for Neurosciences, and Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Maryland Pao
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland; and
| | - Sigita Plioplys
- Department of Child and Adolescent Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Cozzi G, Barbi E. Facing somatic symptom disorder in the emergency department. J Paediatr Child Health 2019; 55:7-9. [PMID: 30288831 DOI: 10.1111/jpc.14246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
Somatic symptom disorder is a condition in which a patient's subjective report of physical symptoms is associated with distress; disruption of day-to-day functioning; or disproportionate thoughts, feelings and behaviours regarding the symptoms, whether or not they are associated with an identified medical condition. While somatic symptom disorder affects a considerable proportion of children and adolescents presenting to the emergency department (ED), it has not been well investigated in the ED literature, nor is there much formal training in, or guidelines for, how to care for affected patients in the ED. The aim of this paper is to highlight the historical clues commonly reported by these patients in order to try to help the emergency physicians recognise patients affected by a somatic symptom disorder. Adolescent age, the presence of daily subjective symptoms presenting daily for weeks or months, a long medical history record, an extensive diagnostic workup and, most of all, disproportionate functional impairment related to the symptoms are all features strongly suggestive of this disorder. Emergency physicians should become used to taking advantage of these clues to formulate a positive diagnosis of somatic symptom disorder according to the most recent diagnostic criteria. Emergency physicians have the unique opportunity to contribute to the correct diagnosis and treatment of these patients and to have a positive impact on their prognosis.
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Affiliation(s)
- Giorgio Cozzi
- Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- Emergency Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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16
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Bedard-Thomas KK, Bujoreanu S, Choi CH, Ibeziako PI. Perception and Impact of Life Events in Medically Hospitalized Patients With Somatic Symptom and Related Disorders. Hosp Pediatr 2018; 8:699-705. [PMID: 30327327 DOI: 10.1542/hpeds.2017-0197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We describe the prevalence and perceived impact of life events reported by medically hospitalized patients with somatic symptom and related disorders (SSRD) and highlight patient characteristics and outcomes associated with highly impactful life events. METHODS Retrospective chart reviews were conducted of patients with SSRD at a tertiary pediatric hospital who were seen by the psychiatry consultation service and completed various instruments while medically admitted, including a de novo life events checklist. Descriptive statistics, correlations, χ2 tests, and internal consistency analyses were used. RESULTS Charts of 70.2% of patients with SSRD who completed the life events checklist (N = 172; age range 8-25 years) were reviewed. Of those studied, 94% reported at least 1 life event in the last year, with academic events most prevalent, 81% reported life events across multiple domains, and 56% perceived the life event(s) as having a great impact on their lives. Patients who perceived more great impact life events were older, from households with lower median incomes, had higher self-reported somatization, greater functional disability, more comorbid psychiatric diagnoses, required more psychotropic medications, and had longer medical admissions. CONCLUSIONS Findings reveal that although the majority of medically hospitalized patients with SSRD reported at least 1 relevant life event, it was the patients' perception of the impact of the life event(s) that correlated with high levels of disability and health care use. An assessment of the perception of life events in patients with SSRD may help hospitalists and interdisciplinary providers identify high-risk patients for whom early psychiatry referrals can be made.
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Affiliation(s)
- Katherine K Bedard-Thomas
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; and
| | | | - Patricia I Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; and
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Canavera K, Allen J, Johnson LM. The Need for Improved Access to Mental Health Services for Youth With Medically Unexplained Symptoms. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:29-31. [PMID: 29697336 DOI: 10.1080/15265161.2018.1445316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Malas N, Donohue L, Cook RJ, Leber SM, Kullgren KA. Pediatric Somatic Symptom and Related Disorders: Primary Care Provider Perspectives. Clin Pediatr (Phila) 2018; 57:377-388. [PMID: 28840747 DOI: 10.1177/0009922817727467] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Somatization, or physical symptoms that are inconsistent with a physiological cause that may or may not involve an identified stressor, is common in outpatient pediatrics. When these symptoms persist, they can impair function and progress to a somatic symptom and related disorder (SSRD), resulting in increased health care use and increased demands on primary care providers (PCPs). We performed a needs assessment among PCPs to better understand how best to support providers caring for children with SSRDs. Pediatric PCPs (n = 77) were surveyed to better understand their training, experience, perceptions, and practices of SSRD care. Findings indicate that PCPs have limited training in SSRD care but express interest in learning more. Many barriers to effective care were reported. We hope to use these findings to develop training materials and support services for pediatric PCPs managing SSRDs.
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Affiliation(s)
- Nasuh Malas
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Robin J Cook
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven M Leber
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
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Sharma N, Daley M, Vente T. Pediatric Somatic Symptom Disorder: An Overview. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170831-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Nwokocha ARC, Chinawa JM, Onukwuli V, Ubesie A, Ndukuba A, Chinawa AT, Aniwada E, Uwaezuoke S. Somatization disorder among adolescents in southeast Nigeria: a neglected issue. Int J Ment Health Syst 2017; 11:57. [PMID: 28947913 PMCID: PMC5609071 DOI: 10.1186/s13033-017-0161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- A R C Nwokocha
- Department of Pediatrics, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - J M Chinawa
- Department of Pediatrics, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria.,Department of Pediatrics, UNTH, PMB 01129, Enugu, 400001 Enugu State Nigeria
| | - V Onukwuli
- Department of Pediatrics, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - A Ubesie
- Department of Pediatrics, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - Appolos Ndukuba
- Department of Psychological Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - A T Chinawa
- Department of Community Medicine, ESUT Teaching Hospital, Enugu, Enugu State Nigeria
| | - Elias Aniwada
- Department Community Medicine, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
| | - Samuel Uwaezuoke
- Department of Pediatrics, College of Medicine, University of Nigeria, University of Nigeria/Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State Nigeria
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Abstract
Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.
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22
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Pop-Jordanova N, Zorcec T. Somatoform Disorders - A Pediatric Experience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2016; 37:55-62. [PMID: 27883317 DOI: 10.1515/prilozi-2016-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. Working at the Psychophysiological Department at the University Clinic we are dealing with more than 100 children per year manifesting this kind of disorders. The aim of this article is to summarize some specific characteristics of the somatoform disorder in a group of 243 children, mean age 10.31 (± 2.75) years for both genders, selected randomly. The used psychometric instruments are: CBCL, EPQ for children, and MMPI-201 for mothers. The obtained results showed high scores for somatization, extroversion and accentuated anxiety for children; as well as a typical Hs-Hy personality profile for mothers. The treatment with cognitive-behavior therapy and biofeedback showed very positive outcome.
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Abstract
Functional neurological symptom disorder (FNSD) is characterized by motor or sensory impairments inconsistent with recognized neurologic conditions. Usually emerging in adolescence, somatic symptoms remain challenging for the physician to assess and treat. Also termed "conversion disorder," FNSD has been recently reconceptualized with greater diagnostic emphasis on positive neurologic findings while eliminating the requirement for a precipitating stressor. This has broadened the initial treatment emphasis from mandating psychotherapeutic engagement to a more collaborative model that requires open communication of neurologic findings and strives to align with families' perspectives. Severe disorders necessitate a unified treatment approach from several clinical specialties, including behavioral approaches, and pediatricians may play a central role in the management of youth with FNSD as well as their families. Treatment engagement can be facilitated by validating the distress of the patient, providing resources to address diagnostic questions and parental concerns, and implementing shared goals toward rapid return to self-efficacy. [Pediatr Ann. 2016;45(10):e356-e361.].
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Ibeziako P, Choi C, Randall E, Bujoreanu S. Bullying Victimization in Medically Hospitalized Patients With Somatic Symptom and Related Disorders: Prevalence and Associated Factors. Hosp Pediatr 2016; 6:290-6. [PMID: 27073256 DOI: 10.1542/hpeds.2015-0207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study is to describe the prevalence of bullying victimization among medically admitted patients with somatic symptom and related disorders (SSDs) and to compare demographic, diagnostic, and psychosocial characteristics of bullied versus nonbullied patients. METHODS Medically admitted patients at a tertiary pediatric facility referred to the Psychiatry Consultation Service with somatic concerns were assessed via a quality improvement (QI) initiative, the SSD Standardized Clinical Assessment and Management Plan (SSD-SCAMP). Retrospective chart and QI data on adolescent and young adult patients assessed via SSD-SCAMP from May 2012 - December 2014 were reviewed. RESULTS Medical records of 282 patients (aged 12-22 years) diagnosed with SSDs were reviewed. Approximately 37% had a history of bullying victimization. Compared with nonbullied patients, bullied patients had higher somatization scores, more functional neurologic symptoms, and longer admissions. Bullied patients also had higher rates of comorbid anxiety, suicidal histories, and family psychiatric histories. Furthermore, bullied patients also had higher rates of learning disabilities and school accommodations and endorsed more significant life events within the year before hospitalization. CONCLUSIONS This study describes the unique health and psychosocial challenges experienced by medically hospitalized bullied adolescents and young adults with SSDs. The findings highlight the importance of a multidisciplinary approach to assessment and management. By implementing QI initiatives such as the SSD-SCAMP, providers can bridge the gap between the clinical needs and long-term management of patients with SSDs.
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Affiliation(s)
- Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Christine Choi
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Edin Randall
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
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25
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Hinton D, Kirk S. Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:12-26. [PMID: 25684117 DOI: 10.1111/hsc.12184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well-being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under-represented, and multi-site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high-quality, evidence-based practice.
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Affiliation(s)
- Denise Hinton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Susan Kirk
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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26
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A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived? J Adolesc 2015; 45:317-26. [DOI: 10.1016/j.adolescence.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
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Bujoreanu S, White MT, Gerber B, Ibeziako P. Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges. Hosp Pediatr 2015; 5:269-275. [PMID: 25934811 DOI: 10.1542/hpeds.2014-0079] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. METHODS The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. RESULTS Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. CONCLUSIONS Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals.
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Affiliation(s)
- Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Matthew T White
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
| | - Bradley Gerber
- Department of Psychology, Austin State Hospital, Austin, Texas
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and
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28
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Guerriero RM, Pier DB, de Gusmão CM, Bernson-Leung ME, Maski KP, Urion DK, Waugh JL. Increased pediatric functional neurological symptom disorders after the Boston marathon bombings: a case series. Pediatr Neurol 2014; 51:619-23. [PMID: 25152961 DOI: 10.1016/j.pediatrneurol.2014.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional neurological symptom disorders are frequently the basis for acute neurological consultation. In children, they are often precipitated by high-frequency everyday stressors. The extent to which a severe traumatic experience may also precipitate functional neurological abnormalities is unknown. METHODS For the 2-week period after the Boston Marathon bombings, we prospectively collected data on patients whose presentation suggested a functional neurological symptom disorder. We assessed clinical and demographic variables, duration of symptoms, extent of educational impact, and degree of connection to the Marathon bombing. We contacted all patients at 6 months after presentation to determine the outcome and accuracy of the diagnosis. RESULTS In a parallel study, we reported a baseline of 2.6 functional neurological presentations per week in our emergency room. In the week after the Marathon bombings, this frequency tripled. Ninety-one percent of presentations were delayed by 1 week, with onset around the first school day after a city-wide lockdown. Seventy-three percent had a history of a prior psychiatric diagnosis. At the 6 months follow-up, no functional neurological symptom disorder diagnoses were overturned and no new organic diagnosis was made. CONCLUSIONS Pediatric functional neurological symptom disorder may be precipitated by both casual and high-intensity stressors. The 3.4-fold increase in incidence after the Boston Marathon bombings and city-wide lockdown demonstrates the marked effect that a community-wide tragedy can have on the mental health of children. Care providers must be aware of functional neurological symptom disorders after stressful community events in vulnerable patient populations, particularly those with prior psychiatric diagnoses.
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Affiliation(s)
- Réjean M Guerriero
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Danielle B Pier
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Kiran P Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - David K Urion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeff L Waugh
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts.
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29
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Thomson K, Randall E, Ibeziako P, Bujoreanu IS. Somatoform Disorders and Trauma in Medically-Admitted Children, Adolescents, and Young Adults: Prevalence Rates and Psychosocial Characteristics. PSYCHOSOMATICS 2014; 55:630-9. [DOI: 10.1016/j.psym.2014.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 11/24/2022]
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Bujoreanu S, Randall E, Thomson K, Ibeziako P. Characteristics of medically hospitalized pediatric patients with somatoform diagnoses. Hosp Pediatr 2014; 4:283-290. [PMID: 25318110 DOI: 10.1542/hpeds.2014-0023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe demographic, diagnostic, and psychosocial characteristics of medically admitted patients diagnosed with somatoform disorders. METHODS Retrospective chart reviews were performed for pediatric patients (ages 3-18 years) seen by the Psychiatry Consultation Service in 2010 and 2011 on inpatient medical/surgical units and diagnosed with somatoform disorders. Data included demographic information; patient medical history, physical symptom characteristics, and service utilization; psychiatric diagnoses, history, and comorbidities, patient temperament, and coping style; family characteristics; and academic and social characteristics. RESULTS Mean age for the 161 identified patients was 14.4 years. The majority of patients were female (75%) and white (73%). Chief physical symptoms were pain (58%) and neurologic symptoms (40%); 73% of patients had medical diagnoses, and 66% had a history of prior psychiatric treatment. The most common somatoform diagnoses, using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, were pain (50%) and conversion disorders (28%). Psychiatric comorbidities were predominantly mood and anxiety disorders (42% and 29%, respectively). Mean hospitalization length was 4.9 days, with 14% of patients readmitted with psychiatric reinvolvement during the study period. Patients had sensitive temperaments (80%) and internalizing coping styles (76%) and were described as "good children" (72%). School absences (55%), academic pressures (51%), and learning difficulties (36%) were reported. CONCLUSIONS Clarifying the prevalence and nature of such characteristics can help pediatric providers improve patient care and minimize unnecessary medical interventions with early detection of risk for somatoform processes, provision of psychoeducation for patients and families, and early referral to mental health clinicians.
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Affiliation(s)
- Simona Bujoreanu
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edin Randall
- Boston Children's Hospital and Harvard Medical School, Boston, MA
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de Gusmão CM, Guerriero RM, Bernson-Leung ME, Pier D, Ibeziako PI, Bujoreanu S, Maski KP, Urion DK, Waugh JL. Functional neurological symptom disorders in a pediatric emergency room: diagnostic accuracy, features, and outcome. Pediatr Neurol 2014; 51:233-8. [PMID: 25079572 DOI: 10.1016/j.pediatrneurol.2014.04.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND In children, functional neurological symptom disorders are frequently the basis for presentation for emergency care. Pediatric epidemiological and outcome data remain scarce. OBJECTIVE Assess diagnostic accuracy of trainee's first impression in our pediatric emergency room; describe manner of presentation, demographic data, socioeconomic impact, and clinical outcomes, including parental satisfaction. METHODS (1) More than 1 year, psychiatry consultations for neurology patients with a functional neurological symptom disorder were retrospectively reviewed. (2) For 3 months, all children whose emergency room presentation suggested the diagnosis were prospectively collected. (3) Three to six months after prospective collection, families completed a structured telephone interview on outcome measures. RESULTS Twenty-seven patients were retrospectively assessed; 31 patients were prospectively collected. Trainees' accurately predicted the diagnosis in 93% (retrospective) and 94% (prospective) cohorts. Mixed presentations were most common (usually sensory-motor changes, e.g. weakness and/or paresthesias). Associated stressors were mundane and ubiquitous, rarely severe. Families were substantially affected, reporting mean symptom duration 7.4 (standard error of the mean ± 1.33) weeks, missing 22.4 (standard error of the mean ± 5.47) days of school, and 8.3 (standard error of the mean ± 2.88) of parental workdays (prospective cohort). At follow-up, 78% were symptom free. Parental dissatisfaction was rare, attributed to poor rapport and/or insufficient information conveyed. CONCLUSIONS Trainees' clinical impression was accurate in predicting a later diagnosis of functional neurological symptom disorder. Extraordinary life stressors are not required to trigger the disorder in children. Although prognosis is favorable, families incur substantial economic burden and negative educational impact. Improving recognition and appropriately communicating the diagnosis may speed access to treatment and potentially reduce the disability and cost of this disorder.
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Affiliation(s)
- Claudio M de Gusmão
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts.
| | - Réjean M Guerriero
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Danielle Pier
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - Kiran P Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - David K Urion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeff L Waugh
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts
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Petanidou D, Mihas C, Dimitrakaki C, Kolaitis G, Tountas Y. Selected family characteristics are associated with adolescents' subjective health complaints. Acta Paediatr 2014; 103:201-6. [PMID: 24127814 DOI: 10.1111/apa.12466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/10/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Abstract
AIM This national study of schoolchildren in Greece investigated the association between adolescents' subjective health complaints (SHC) and a number of family characteristics. METHODS Questionnaires were completed by a random, school-based sample of children from 12 to 18 years of age, and one of their parents (76.6% mothers), in 2003. Data from 1041 adolescent-parent pairs were analysed. Multiple linear regression analysis was used to assess the associations between the adolescent's SHC and the following characteristics: parent's marital status, parent's physical and mental health status, parent's worries about their child's SHC, the parent-child relationship, family cohesion, family socio-economic status and the adolescent's sex and age. RESULTS The analysis showed that the adolescents' SHC were independently and significantly correlated with poor parental subjective mental health status, poor quality parent-child relationships and parental worry. There were also associations between levels of SHC and female and older adolescents. CONCLUSION Certain family features can be seen as potential contributing factors to SHC in adolescence and should therefore constitute complementary targets for prevention and treatment planning.
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Affiliation(s)
- Dimitra Petanidou
- Centre for Health Services Research; Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens Greece
| | - Constantinos Mihas
- General Hospital - Health Centre of Kimi ‘G. Papanikolaou’; Kimi Evia Greece
| | - Christine Dimitrakaki
- Centre for Health Services Research; Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry; Athens University Medical School; ‘Aghia Sophia’ Children's Hospital; Athens Greece
| | - Yannis Tountas
- Centre for Health Services Research; Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens Greece
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Psychosomatic conditions of the children and adolescents exposed to 5.12 Wenchuan earthquake. Int J Behav Med 2013; 21:730-5. [PMID: 24337952 DOI: 10.1007/s12529-013-9377-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A devastating earthquake registering 8.0 on the Richter Scale struck Wenchuan County in Northwest Sichuan Province in China on May 12, 2008, claiming over 69,200 lives, seriously wounding more than 374,600 people, and rendering more than 18,400 people missing. The epicenter was close to Yingxiu Township in Wenchuan County. PURPOSE This study aimed to investigate the psychosomatic conditions of the children and adolescents exposed to the devastating earthquake and explore the risk factors for psychosomatic symptoms. METHOD A total of 1,828 participants aged 6 to 16 years, of whom 842 from the affected area and 986 from non-affected area, were administered a Psychosomatic Conditions Scale. RESULTS Each factor score, total somatic score, total psychological score, and total psychosomatic score of the experimental group were significantly higher than those of the control group (P < 0.001). Positive correlation was found between the psychological state and somatic symptoms in the experimental group(r = 0.157 ~ 0.489, P < 0.01). Respiratory system, cardiovascular system, nervous system, digestive system, urogenital system, emotion, behavior, and language, combined as a panel, were significantly differentiated between the two groups, accounting for 73.4% of the total difference. In the experimental group, the factor scores of anxiety, behavior, total psychological score, and total psychosomatic score of the girls were obviously higher than those of the boys (P < 0.01 ~ 0.05); most somatic factors and psychological factors, total somatic score, total psychological score, and total psychosomatic score of the elder adolescents were significantly higher than those of the younger children (P < 0.01 ~ 0.05). CONCLUSION The children and adolescents exposed to 5.12 earthquake greatly suffered from terrible psychosomatic conditions, among whom the elder girls had more severe symptoms, particularly in terms of anxiety and behavior.
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Petanidou D, Daskagianni E, Dimitrakaki C, Kolaitis G, Tountas Y. The role of perceived well-being in the family, school and peer context in adolescents' subjective health complaints: evidence from a Greek cross-sectional study. Biopsychosoc Med 2013; 7:17. [PMID: 24283390 PMCID: PMC4175490 DOI: 10.1186/1751-0759-7-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 11/21/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents' perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints. METHODS Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12-18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored. RESULTS As hypothesized, adolescents' perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints. CONCLUSIONS Our study delineated the unique and cumulative contributions of adolescents' perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents' Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health.
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Affiliation(s)
- Dimitra Petanidou
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., Athens 11527, Greece
| | - Evangelie Daskagianni
- Institute of Social and Preventive Medicine, 25 Alexandroupoleos str., Athens 11527, Greece
| | - Christine Dimitrakaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., Athens 11527, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, Athens University Medical School, "Aghia Sophia" Children's Hospital, Greece. Thivon and Papadiamantopoulou, Athens 11527, Greece
| | - Yannis Tountas
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, 25 Alexandroupoleos str., Athens 11527, Greece
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