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Münker L, Rimvall MK, Frostholm L, Ørnbøl E, Wellnitz KB, Jeppesen P, Maria Rosmalen JG, Rask CU. Exploring the course of functional somatic symptoms (FSS) from pre- to late adolescence and associated internalizing psychopathology - an observational cohort-study. BMC Psychiatry 2024; 24:495. [PMID: 38977964 PMCID: PMC11232134 DOI: 10.1186/s12888-024-05937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Functional somatic symptoms (FSS), which commonly cannot be attributed to well-defined organic pathology, often co-occur with internalizing psychopathology and fluctuate throughout different life stages. We examined FSS courses throughout adolescence, and the association between preadolescent FSS, FSS severity and internalizing psychopathology at late adolescence. METHODS Data from the Copenhagen Child Cohort (CCC2000) were utilized from assessments at ages 11-12 years (preadolescence; T0) and 16-17 years (late adolescence; T1). Self-report questionnaire and interview data on FSS, internalizing psychopathology, chronic medical conditions, and sociodemographic data from Danish national registers were available for 1285 youths. FSS courses were categorized into persistent (high FSS at T0 & T1), remission (high FSS only at T0), incident (high FSS only at T1) or no FSS (no FSS at T0 & T1). Multiple linear and multinomial logistic regressions were conducted to investigate the FSS/psychopathology association. RESULTS 1.8% of adolescents fell into the persistent FSS course group throughout adolescence. Higher preadolescent FSS predicted FSS (b = 0.07, p < .001), anxiety (b = 0.05, p < .001) and depression (b = 0.06, p < .001) at age 16/17, even after controlling for sex, parental education, a chronic medical condition and internalizing psychopathology in preadolescence. Persistent, incident, and remittent FSS courses were associated with significantly higher mean levels of anxiety and depression compared to the reference group (no FSS). CONCLUSIONS FSS during pre- and late adolescence might increase and co-occur with anxiety and depression throughout adolescence, potentially due to shared underlying risk factors and processes.
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Affiliation(s)
- Lina Münker
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark.
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Judith Gerarda Maria Rosmalen
- Departments of Psychiatry and Internal medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Allemand M, Fend HA, Hill PL. Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood. J Youth Adolesc 2024; 53:1513-1528. [PMID: 38282066 PMCID: PMC11136711 DOI: 10.1007/s10964-024-01940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.
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Affiliation(s)
- Mathias Allemand
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.
| | - Helmut A Fend
- Institute of Education, University of Zurich, Zurich, Switzerland
| | - Patrick L Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, USA
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Yap AU, Sultana R, Natu VP. Somatic and temporomandibular disorder symptoms - Idioms of psychological distress in Southeast Asian youths. Cranio 2024; 42:364-371. [PMID: 34569454 DOI: 10.1080/08869634.2021.1982496] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the prevalence/severity of somatic and temporomandibular disorder (TMD) symptoms in Southeast Asian youths and determine their associations with psychological distress. METHODS Demographic information, Patient Health Questionnaire-15 (PHQ-15), Fonseca Anamnestic Index (FAI), and Depression, Anxiety, Stress Scale-21 (DASS-21) responses were gathered electronically and analyzed using non-parametric statistical and logistic regression analysis (p < 0.05). RESULTS Of 400 youths (mean age 18.7 ± 1.7 years; 52.3% females), 65.0%/47.0% reported somatic/TMD symptoms, and 10.5% had TMDs. Significant differences in psychological distress were observed among the varying severity of somatic/TMD symptoms. Correlations between PHQ-15/FAI and DASS-21 scores were weak to moderately strong (rs = 0.30-0.61). Stepwise logistic regression indicated that female gender, TMD symptoms, and stress were risk factors for somatic symptoms, while somatic symptoms and stress were probable factors for TMDs. CONCLUSION Somatic and TMD symptoms are common in Southeast Asian youths and may be a manifestation of psychological distress.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, Jurong East, Singapore, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Dental Research Institute, National Dental Centre Singapore, Singapore
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | | | - Vaishali Prakash Natu
- Faculty of Dentistry, National University of Singapore, Singapore
- School of Health and Social Sciences, Nanyang Polytechnic, Singapore, Singapore
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Wardenaar KJ, Jörg F, Oldehinkel AJ. Explanatory and modifying factors of the association between sex and depression onset during adolescence: An exploratory study. J Affect Disord 2024; 354:424-433. [PMID: 38479503 DOI: 10.1016/j.jad.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The prevalence of Major Depressive Disorder (MDD) is twice as high in women as in men and this difference already emerges during adolescence. Because the mechanisms underlying this sex-difference remain poorly understood, we took a bottom-up approach to identify factors explaining the sex-MDD relationship. METHODS Data came from the TRacking Adolescents' Individual Lives Survey (TRAILS), a population study investigating youths' development from age 11 into adulthood. We assessed multiple baseline covariates (e.g., demographic, social and psychological) at ages 11-13 years and MDD onset at ages 19 and 25 years. In regression analyses, each covariate's role in the sex-MDD association as an effect modifier or confounder/explanatory variable was investigated. Replicability was evaluated in an independent sample. RESULTS The analyses identified no effect-modifiers. Baseline internalizing problems, behavioral inhibition, dizziness, comfort in classroom, physical complaints, attention problems, cooperation, self/effortful control, interpersonal life events and computer use partially explained the association between sex and MDD at age 19. The association between sex and MDD at age 25 was explained by largely the same variables, but also by shyness, acne, antisocial behavior, aggression, affection from peers and time spent shopping. The explanatory roles of internalizing problems, behavioral inhibition, negative events involving gossip/rumors and leisure-time spending (computer-use/shopping) were replicated. LIMITATIONS Potentially important baseline variables were not included or had low response rates. Gender roles or identification were not considered. Baseline MDD was not adjusted for. CONCLUSION The sex-MDD association is partially explained by sex differences in symptoms and vulnerability factors already present in early adolescence.
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Affiliation(s)
- Klaas J Wardenaar
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Child and Family Welfare, Groningen, the Netherlands.
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Emotion Regulation (ICPE), Groningen, the Netherlands; Research Department, GGZ Friesland, Leeuwarden, the Netherlands
| | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Emotion Regulation (ICPE), Groningen, the Netherlands
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Kiekens WJ, Baams L, Stevens GWJM. Sexual Attraction Disparities in Adolescent Mental Health: The Role of School Norms. LGBT Health 2024; 11:28-37. [PMID: 37590484 DOI: 10.1089/lgbt.2022.0314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: Few studies examine whether and how heterosexist norms in schools might influence disparities in mental health between sexual minority and heterosexual adolescents. Addressing this gap, we study disparities in life satisfaction, psychosomatic complaints, and emotional problems between same/both-sex attracted and other-sex attracted adolescents and examine the moderating role of heterosexist norms on the classroom- and school-level. Methods: We used data from the 2013 and 2017 Dutch Health and Behavior in School-Aged Children study (N = 12,756; mean age = 14.02; standard deviation = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results: Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints, and more emotional problems than their other-sex attracted peers. On average, stronger school-level heterosexist norms were associated with higher life satisfaction, fewer psychosomatic complaints, and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with fewer emotional problems. One moderating effect of sexual attraction and school-level heterosexist norms was found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents were smaller when classroom-level heterosexist norms were stronger. Standardized regression coefficients showed that the associations were small. Conclusion: Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school and classroom level were weakly associated with these health disparities.
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Affiliation(s)
- Wouter J Kiekens
- Department of Sociology, Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
| | - Laura Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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Koen LW, Ravensbergen SJ, Schoormans D, Hoogendijk WJG, Grootendorst-van Mil NH. The association between parental chronic physical illness and adolescent functional somatic symptoms. J Affect Disord 2023; 338:262-269. [PMID: 37308000 DOI: 10.1016/j.jad.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/23/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Lotte W Koen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Susan J Ravensbergen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dounya Schoormans
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Lugo-Candelas C, Chang L, Dworkin JD, Aw N, Fields A, Reed H, Spann M, Gilchrist MA, Hinds W, Marsh R, Fifer WP, Weissman M, Foerster BU, Manin MG, Silva I, Peterson B, Coelho Milani AC, Gingrich J, Monk C, Duarte CS, Jackowski A, Posner J. Maternal childhood maltreatment: associations to offspring brain volume and white matter connectivity. J Dev Orig Health Dis 2023; 14:591-601. [PMID: 37732425 PMCID: PMC10840844 DOI: 10.1017/s2040174423000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The deleterious effects of adversity are likely intergenerational, such that one generation's adverse experiences can affect the next. Epidemiological studies link maternal adversity to offspring depression and anxiety, possibly via transmission mechanisms that influence offspring fronto-limbic connectivity. However, studies have not thoroughly disassociated postnatal exposure effects nor considered the role of offspring sex. We utilized infant neuroimaging to test the hypothesis that maternal childhood maltreatment (CM) would be associated with increased fronto-limbic connectivity in infancy and tested brain-behavior associations in childhood. Ninety-two dyads participated (32 mothers with CM, 60 without; 52 infant females, 40 infant males). Women reported on their experiences of CM and non-sedated sleeping infants underwent MRIs at 2.44 ± 2.74 weeks. Brain volumes were estimated via structural MRI and white matter structural connectivity (fiber counts) via diffusion MRI with probabilistic tractography. A subset of parents (n = 36) reported on children's behaviors at age 5.17 ± 1.73 years. Males in the maltreatment group demonstrated greater intra-hemispheric fronto-limbic connectivity (b = 0.96, p= 0.008, [95%CI 0.25, 1.66]), no differences emerged for females. Fronto-limbic connectivity was related to somatic complaints in childhood only for males (r = 0.673, p = 0.006). Our findings suggest that CM could have intergenerational associations to offspring brain development, yet mechanistic studies are needed.
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Affiliation(s)
- Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Le Chang
- Department of Statistics, University of South Carolina, Columbia, USA
| | | | - Natalie Aw
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA
| | - Andrea Fields
- Department of Psychology, Columbia University, New York, USA
| | - Hannah Reed
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Marisa Spann
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | | | - Walter Hinds
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Myrna Weissman
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Bernd Uwe Foerster
- Department of Psychiatry, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Marina Giorgi Manin
- Department of Pediatrics, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Ivaldo Silva
- Department of Gynecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Bradley Peterson
- Department of Psychiatry, University of Southern California, Los Angeles, CA, USA
| | | | - Jay Gingrich
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, USA
| | - Andrea Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo, Sao Paulo, Brazil
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Sætren SS, Augusti EM, Myhre MC, Hafstad GS. The regulatory role of affective inhibitory control in somatic symptoms among adolescents exposed to child maltreatment: a population-based study. Eur Child Adolesc Psychiatry 2023; 32:1701-1710. [PMID: 35441902 PMCID: PMC10460330 DOI: 10.1007/s00787-022-01988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
Adolescents exposed to child maltreatment are at increased risk for various somatic symptoms, but which psychological factors that contribute to this relationship need to be further investigated. Emotion dysregulation is suggested to serve as a proximal link between child maltreatment and somatic complaints. The purpose of the present study was to investigate whether individual differences in affective inhibitory control, a central component in implicit emotion regulation, contribute to the risk of somatic symptoms in adolescents exposed to child maltreatment. Data were drawn from the UEVO study, a national population-based survey of adolescents between 12 and 16 years of age (N = 9240). For this study, we included participants who completed the emotional go/no-go task measuring affective inhibitory control (N = 7241; Mage/SD = 14 years/.87; 52% girls, 47% boys), of which N = 3349 reported at least one incident of maltreatment exposure (57% girls, 41% boys). Exposure to psychological abuse and sexual abuse were associated with somatic symptoms. Affective inhibitory control was related to somatic symptoms, both in the total sample and in adolescents exposed to child maltreatment. The strength of relationships between exposure to psychological abuse and somatic symptoms, as well as sexual abuse and somatic symptoms, were moderated by individual differences in affective inhibitory control problems. Our study suggests that psychological abuse and sexual abuse increase the risk for somatic symptoms in adolescence. Affective inhibitory control, a central component in implicit emotion regulation, was related to somatic symptoms and moderated the relationships between psychological abuse and somatic symptoms, and sexual abuse and somatic symptoms. Revealing these associations in a population-based sample indicates that treatment targeting affective inhibitory control may be beneficial and should be explored further in clinical settings.
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Affiliation(s)
- Sjur Skjørshammer Sætren
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Jan Johnsens gate 12, 4011, Stavanger, Norway.
| | - Else-Marie Augusti
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Mia Cathrine Myhre
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Gertrud Sofie Hafstad
- Department for Child and Adolescent Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Raemen L, Claes L, Buelens T, Vankerckhoven L, Van Oudenhove L, Luyckx K. Personal identity, somatic symptoms, and symptom-related thoughts, feelings, and behaviors in adolescence: Examining between- and within-person associations and the role of depressive symptoms. J Youth Adolesc 2023:10.1007/s10964-023-01811-9. [PMID: 37329388 DOI: 10.1007/s10964-023-01811-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
Recent literature highlights the complex relationship between personal identity and body-related pathology, yet there is a lack of integrative longitudinal research on the relationship between identity and somatic symptoms. The present study investigated the longitudinal associations between identity functioning and (psychological characteristics of) somatic symptoms, and examined the role of depressive symptoms in this relationship. A total of 599 community adolescents (Time 1: 41.3% female; Mage = 14.93, SD = 1.77, range = 12-18 years) participated in three annual assessments. Using cross-lagged panel models, a bidirectional relationship between identity and (psychological characteristics of) somatic symptoms, mediated by depressive symptoms, emerged at the between-person level; whereas only a unidirectional relationship from psychological characteristics of somatic symptoms to identity functioning, mediated by depressive symptoms, emerged at the within-person level. Identity and depressive symptoms were bidirectionally related at both levels. The present study suggests that adolescent identity development is closely related to somatic and emotional distress.
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Affiliation(s)
- Leni Raemen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
- Child & Youth Institute, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lore Vankerckhoven
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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10
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Lee WC, Lai JY, Pan CH, Su SS, Yang TW, Tsai SY, Chen CC, Kuo CJ. Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan. Psychol Med 2023; 53:2885-2894. [PMID: 36104840 DOI: 10.1017/s0033291721004864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls. METHODS From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10-19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case-control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls. RESULTS Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls. CONCLUSIONS The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.
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Affiliation(s)
- Wan-Chen Lee
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Jou-Yin Lai
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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11
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Kiekens WJ, Baams L, Feinstein BA, Veenstra R. Development and Validation of the Sexual Minority Adolescent Rejection Sensitivity Scale. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:971-989. [PMID: 36454435 PMCID: PMC10102110 DOI: 10.1007/s10508-022-02474-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 05/11/2023]
Abstract
Because no measure for sexual orientation-related rejection sensitivity (RS) for adolescents exists, we aimed to develop and validate the Sexual Minority Adolescent Rejection Sensitivity Scale (SMA-RSS). In Study 1, interviews with 22 sexual minority youth were conducted (M age = 18.86, SD = 3.03). Based on these interviews, 29 scenarios were developed as potential items for the SMA-RSS. In Study 2, exploratory factor analyses were conducted on these 29 scenarios in a sample of 397 sexual minority adolescents (M age = 16.63, SD = 1.07). The 14 best performing items were selected and a two-factor structure best fit the data. In Study 3, a confirmatory factor analysis was conducted and the test-retest reliability, criterion validity, convergent validity, and incremental validity of the SMA-RSS were assessed in a sample of 499 sexual minority adolescents (M age = 16.61, SD = 1.34). A bifactor model best fit the data and evidence was provided for a strong enough general factor to justify unidimensionality. For criterion validity, the SMA-RSS evidenced small to moderate correlations with minority stressors and mental health indicators. For convergent validity, we found a moderate correlation with general RS. For incremental validity, the SMA-RSS was associated with mental health indicators over and above minority stressors and general RS. Participants were moderately stable in their scores on the SMA-RSS over a one-month period. Taken together, the SMA-RSS captured unique situations in which sexual minority adolescents anxiously expect rejection and can aid in better understanding health disparities among sexual minority adolescents.
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Affiliation(s)
- Wouter J Kiekens
- Department of Sociology/Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Laura Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - René Veenstra
- Department of Sociology/Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
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12
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Kanine RM, Bush ML, Davis M, Jones JD, Sbrilli MD, Young JF. Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training. Child Psychiatry Hum Dev 2023; 54:96-108. [PMID: 34379228 DOI: 10.1007/s10578-021-01222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/27/2023]
Abstract
This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.
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Affiliation(s)
- Rebecca M Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.
| | - Morgan L Bush
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa D Sbrilli
- Clinical-Community Psychology PhD Program, Department of Psychology, University of Illinois - Urbana Champaign, Champaign, IL, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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13
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Among the swedish generation of adolescents who experience an increased trend of psychosomatic symptoms. Do they develop depression and/or anxiety disorders as they grow older? BMC Psychiatry 2022; 22:779. [PMID: 36503425 PMCID: PMC9743552 DOI: 10.1186/s12888-022-04432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite an increase in mental health problems, with psychosomatic symptoms having been observed in new generations of Swedish youth, the extent to which these problems correspond to an increase in adult mental problems is unknown. The present study investigates whether Swedish adolescents with high levels of psychosomatic symptoms are at risk of developing depression and anxiety problems in adulthood and whether sex moderates any association. Moreover, we aim to understand whether different clusters of youth psychosomatic symptoms - somatic, psychological and musculoskeletal - have different impacts on adult mental health. METHODS One thousand five hundred forty-five Swedish adolescents - aged 13 (49%) and 15 (51%) - completed surveys at baseline (T1) and 3 years later (T2); of them, 1174 (61% females) also participated after 6 years (T3). Multivariate logistic models were run. RESULTS Youth with high levels of psychosomatic symptoms had higher odds of high levels of depressive symptoms at T2 and T3. Moreover, psychosomatic symptoms at T1 predicted a high level of anxiety symptoms and diagnoses of anxiety disorders at T3. When analyzed separately, musculoskeletal symptoms predicted higher odds of having high levels of depressive symptoms at T2 and T3 while somatic symptoms predicted high levels of anxiety symptoms at T2. Moreover, somatic symptoms at T1 predicted diagnoses of depression and anxiety disorders at T3. Sex did not moderate any of the relationships. CONCLUSIONS The study supports the idea that an increase in mental health problems, such as psychosomatic symptoms, can seriously impact the psychological health of new generations of young adults.
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14
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Can the bodily distress syndrome (BDS) concept be used to assess functional somatic symptoms in adolescence? J Psychosom Res 2022; 163:111064. [PMID: 36372006 DOI: 10.1016/j.jpsychores.2022.111064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Bodily Distress Syndrome (BDS) represents a new research concept for adult patients with various functional somatic syndromes. We evaluated the utility of the BDS research concept and the associated BDS-25-checklist as a screening tool for diverse functional somatic symptoms (FSS) in adolescence by investigating: 1) the psychometric and factorial structures of the checklist, 2) symptom cluster patterns and 3) illness classification and associations with emotional psychopathology and sociodemographic factors. METHODS This cross-sectional study obtained data from the 16/17-year follow-up (N = 2542) of the general population Copenhagen Child Cohort 2000 (CCC2000). We used self-reported questionnaires to assess physical symptoms (the BDS-25 checklist), overall health (KidScreen), emotional psychopathology (Spence Children's Anxiety Scale; The Mood and Feelings Questionnaire), and illness worry (Whiteley-6 Index), and utilized data from Danish national registers to assess sociodemographic factors. RESULTS The BDS-25 checklist items displayed satisfactory psychometric data quality. Factor analyses revealed a similar four-factor model as reported in adults (factor loadings λ ≥0.5), representing distinct BDS symptom clusters: cardio-pulmonary, gastro-intestinal, musculoskeletal and general symptoms. Latent class analyses revealed a model with three latent classes, i.e. probable no to mild BDS, probable moderate, single-organ BDS and probable severe, multi-organ BDS, displaying acceptable class quality (Entropy = 0.904). Trend analyses revealed sociodemographic group differences across latent classes. Increased emotional psychopathology was associated with more pronounced BDS symptoms. CONCLUSION Our findings support the BDS concept with four symptom clusters and three illness severity groups (no BDS, single- organ and multi-organ BDS) to screen for FSS in adolescence.
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15
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Kolaitis G, van der Ende J, Zaravinos-Tsakos F, White T, Derks I, Verhulst F, Tiemeier H. The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first? Eur Child Adolesc Psychiatry 2022; 31:1933-1941. [PMID: 34137940 DOI: 10.1007/s00787-021-01821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/03/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child's experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.
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Affiliation(s)
- Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
| | - Jan van der Ende
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Foivos Zaravinos-Tsakos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece
| | - Tonya White
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ivonne Derks
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, The Netherlands
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
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16
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Bae EJ, Kim DE, Sagong H, Yoon JY. Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender. Arch Psychiatr Nurs 2022; 40:25-31. [PMID: 36064242 DOI: 10.1016/j.apnu.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/27/2022] [Accepted: 04/09/2022] [Indexed: 11/25/2022]
Abstract
This study explored the relationship between problematic smartphone use and depressive symptoms, peer relationships, and functional somatic symptoms with a representative sample of Korean male and female adolescents using serial multiple mediation models. The results identified the mediating effect of depressive symptoms and peer relationships for males in the association between problematic smartphone use and FSS. The serial mediating effect of the two mediators was also verified in the model for males. However, in the model for females, only depressive symptoms mediated the relationship between problematic smartphone use and FSS. The findings suggest that parents and professionals should assess adolescents with problematic smartphone use for the risk of FSS when depressive symptoms develop. Schools should also provide programs to build positive peer relationships to reduce FSS.
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Affiliation(s)
- Eun Jung Bae
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Da Eun Kim
- College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Hae Sagong
- Auburn University School of Nursing, Auburn, AL, USA
| | - Ju Young Yoon
- College of Nursing, Seoul National University, Seoul, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea; Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Republic of Korea.
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17
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Amendola S, Hengartner MP, Spensieri V, Grillo L, Cerutti R. Patterns of internalizing symptoms and disability functioning in children and adolescents. Eur Child Adolesc Psychiatry 2022; 31:1455-1464. [PMID: 33909142 DOI: 10.1007/s00787-021-01789-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 12/19/2022]
Abstract
Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8-16 years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: "High somatic symptoms and average depression/anxiety"; cluster 2: "High somatic symptoms and high depression/anxiety"; cluster 3: "Average somatic symptoms and above average depression/anxiety"; and cluster 4: "Low somatic symptoms and low depression/anxiety". Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, Zurich, 8005, Switzerland
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Luciano Grillo
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza, University of Rome, Via degli Apuli 1, 00185, Rome, Italy.
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18
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Berg N, Nummi T, Bean CG, Westerlund H, Virtanen P, Hammarström A. Risk factors in adolescence as predictors of trajectories of somatic symptoms over 27 years. Eur J Public Health 2022; 32:696-702. [PMID: 35904464 PMCID: PMC9527955 DOI: 10.1093/eurpub/ckac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Somatic symptoms among adolescents are common, yet little is known about long-term trajectories of somatic symptoms and the factors in adolescence that shape them. We examined individual, family and school-based factors at age 16 as predictors of trajectories of somatic symptoms over 27 years. METHODS Participants from the Northern Swedish Cohort (n = 1001) responded to questions about individual factors (e.g. health behaviours), family factors (e.g. contact with parents, social and material adversity) and school satisfaction at age 16; as well as 10 somatic symptoms at ages 16, 18, 21, 30 and 43. Teacher assessments at age 16 included overall ability at school and peer relations. Age 16 predictors of somatic symptom trajectory group membership were analysed using multinomial logistic regression. RESULTS Poor contact with mother and poor school satisfaction were significant predictors of adverse symptom trajectories among both men and women. Low birth weight and low parental academic involvement were contributing factors for women, while smoking and social adversity were more relevant factors for men. CONCLUSIONS Our findings emphasize the importance of a holistic approach that considers the unique contributions of individual, family and school-based factors in the development of trajectories of somatic symptoms from adolescence to middle age.
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Affiliation(s)
- Noora Berg
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tapio Nummi
- Faculty of Information Technology and Communication Sciences/Statistics, Tampere University, Tampere, Finland
| | - Christopher G Bean
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Hugo Westerlund
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anne Hammarström
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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20
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Shaver N, Michaelson V, Pickett W. Do Spiritual Health Connections Protect Adolescents When They Are Bullied: A National Study of 12,593 Young Canadians. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11034-NP11065. [PMID: 33533268 PMCID: PMC9251749 DOI: 10.1177/0886260521989853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health-the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11-15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of "connections to self" (i.e., a sense of meaning/purpose or joy and happiness in one's life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26-2.12] and 1.25 [1.06-1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered.
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Affiliation(s)
- Nicole Shaver
- Queen's University, Kingston, Ontario, Canada
- University of Ottawa, Ontario, Canada
| | | | - William Pickett
- Queen's University, Kingston, Ontario, Canada
- Brock University, St. Catharines, Ontario, Canada
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21
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Grishkevich NY, Evert LS, Bakhshieva SA, Kostyuchenko YR. Gender Differences In Functional Somatic Disorders Of Indigenous Adolescents In Khakassia. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rationale — The goal of the study was to investigate gender characteristics of functional somatic disorders in adolescents of the indigenous population of Khakassia (using the case study of the Abakan city). Material and methods — The object of the study was 215 (46.8%) boys and 244 (53.2%) girls of four secondary schools in Abakan. Their average age was 14.5±1.3 years. Data collection was conducted by means of an original screening questionnaire developed by Professor S.Yu. Tereshchenko. Results — The incidence of recurrent pain in the total sample of the surveyed youths was 184 (40.1%) for cephalalgia, 225 (49.0%) for abdominal pain, and 269 (58.7%) for back pain. The prevalence and structure of functional somatic disorders in Khakas adolescents depended on their gender. Asthenic syndrome was more common among girls – 42 (17.2%) vs. 14 (6.5%) in boys. In girls, the percentage of frequent headaches was higher than in boys: 22 (9.0%) vs. 8 (3.7%), respectively. Similar trend was observed in case of rare headaches: 100 (41.0%) vs. 54 (25.1%). Also, girls, compared with boys, were characterized by a higher incidence of both frequent and rare abdominal pains: 38 (15.6%) vs. 9 (4.2%) and 106 (43.4%) vs. 72 (33.5%), correspondingly. Conclusion — The case study of surveyed ethnic sample of Abakan school students revealed a high prevalence of recurrent pain syndromes in the indigenous youths of Khakassia. We have also established that incidence, structure and severity of recurrent pain, as well as its negative impact on well-being and daily activities, were associated with gender.
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Affiliation(s)
| | - Lidia S. Evert
- Krasnoyarsk Scientific Center, Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | | | - Yuliya R. Kostyuchenko
- Krasnoyarsk Scientific Center, Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
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22
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Raemen L, Claes L, Verschueren M, Van Oudenhove L, Vandekerkhof S, Triangle I, Luyckx K. Personal identity, somatic symptoms, and symptom-related thoughts, feelings, and behaviors: Exploring associations and mechanisms in adolescents and emerging adults. SELF AND IDENTITY 2022. [DOI: 10.1080/15298868.2022.2063371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Leni Raemen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Sarah Vandekerkhof
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Resilient People, Ucll Research and Expertise, Diepenbeek, Belgium
| | - Ine Triangle
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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23
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Lee RY, Oxford ML, Sonney J, Enquobahrie DA, Cato KD. The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents. J Adolesc 2022; 94:133-147. [PMID: 35353421 PMCID: PMC9511877 DOI: 10.1002/jad.12012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms. METHODS Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted. RESULTS The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms. CONCLUSION The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.
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Affiliation(s)
- Rachel Y. Lee
- School of Nursing, Columbia University, New York City, New York, USA
| | - Monica L. Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Jennifer Sonney
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | | | - Kenrick D. Cato
- School of Nursing, Columbia University, New York City, New York, USA
- Department of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York City, New York, USA
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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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Kliem S, Krieg Y, Beller J, Brähler E, Baier D. Psychometric properties of the Somatic Symptom Scale 8 (SSS-8) in a representative sample of German adolescents. J Psychosom Res 2021; 149:110593. [PMID: 34371255 DOI: 10.1016/j.jpsychores.2021.110593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The psychometric properties of the Somatic Symptom Scale 8 (SSS-8) have been investigated in different studies. However, there is no study examining its psychometric properties on representative data of adolescents. The study at hand will present results from a large representative sample of German adolescents (13 to 18 years). METHODS The following analyses draw on cross-sectional data from German ninth-grade students collected in 2015. Altogether, 10,638 individuals were surveyed with a return rate of 68.5% as part of a periodic representative survey in the German federal state of Lower Saxony. RESULTS For the SSS-8, coefficient omega for the full sample was ω = 0.90, and ω = 0.77 and 0.79 for males and females, respectively. In addition, a convergent validity was determined with the Patient Health Questionnaire 2 (PHQ-2), Generalized Anxiety Disorder 2 (GAD-2), and the brief form of Perceived Social Support Questionnaire (FSozU-K6). Based on a confirmatory factor analysis and measurement invariance analysis (for gender and migration background), the initially determined factor structure by Gierk et al. of the SSS-8 could be confirmed. CONCLUSION The results support the reliability and validity of the SSS-8 for use with adolescents. The use of the SSS-8 seems to be meaningful within different frameworks, especially when, due to a lack of time or for reasons of cost, no face-to-face interviews can be conducted.
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Affiliation(s)
- Sören Kliem
- Ernst-Abbe-Hochschule Jena, University of Applied Sciences, Jena, Germany.
| | - Yvonne Krieg
- Criminological Research Institute of Lower Saxony, Hannover, Germany
| | - Johannes Beller
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Dirk Baier
- Zürcher Hochschule für Angewandte Wissenschaften, Zürich, Switzerland
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26
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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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Pilkionienė I, Širvinskienė G, Žemaitienė N, Jonynienė J. Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health. CHILDREN (BASEL, SWITZERLAND) 2021; 8:737. [PMID: 34572169 PMCID: PMC8468452 DOI: 10.3390/children8090737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years. METHODS The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis. RESULTS Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety. CONCLUSIONS High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.
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Affiliation(s)
- Ingrida Pilkionienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania; (G.Š.); (N.Ž.); (J.J.)
| | - Giedrė Širvinskienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania; (G.Š.); (N.Ž.); (J.J.)
- Health Research Institute, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania
| | - Nida Žemaitienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania; (G.Š.); (N.Ž.); (J.J.)
| | - Jolita Jonynienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Tilžės 18, LT-47181 Kaunas, Lithuania; (G.Š.); (N.Ž.); (J.J.)
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Groen RN, van Gils A, Emerencia AC, Bos EH, Rosmalen JGM. Exploring temporal relationships among worrying, anxiety, and somatic symptoms. J Psychosom Res 2021; 146:110293. [PMID: 33228967 DOI: 10.1016/j.jpsychores.2020.110293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 08/27/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The role of anxiety symptoms in the development of functional somatic symptoms (FSS) is unknown. Somatic symptoms may be triggered by or give rise to anxiety symptoms. This study aimed to 1) explore interrelationships among within-day worrying, feeling anxious, and somatic symptoms, and 2) investigate the association between these interrelationships and overall level of FSS. METHODS This study included 767 participants (83% females, mean age 39 years), who were recruited through an online crowdsourcing study in the Dutch general population. Somatic, and anxiety symptoms were reported thrice daily (6-h intervals) for 30 days using electronic diaries. FSS were assessed at baseline (PHQ-15). Temporal relationships among worrying, feeling anxious, and somatic symptoms were modeled using a multilevel vector autoregressive model. RESULTS We observed large heterogeneity in the within-person interrelationships among worrying, feeling anxious and somatic symptoms. Averaged over participants, higher-than-usual somatic symptoms were associated with increases in levels of worrying six hours later (B = 0.017, 95% CI [0.006, 0.027]). At the between-person level, FSS levels predicted the persistence of feeling anxious (B = 0.230 95% CI [0.105, 0.350]) and the carry-over of worrying to feeling anxious over six-hours (B = 0.159, 95% CI [0.031, 0.283]). CONCLUSIONS In contrast to what we expected, higher levels of somatic symptoms over multiple weeks were associated with the persistence and carry-over of within-day anxiety-related symptoms. One within-person association between psychological and somatic symptoms during the day was observed, suggesting that, over a time span of 6-h, anxiety symptoms relate to somatic symptoms only in a minority of people from the general population.
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Affiliation(s)
- R N Groen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - A van Gils
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - A C Emerencia
- University of Groningen, Behavioural and Social Sciences, Department of Developmental Psychology, Groningen, The Netherlands
| | - E H Bos
- University of Groningen, Behavioural and Social Sciences, Department of Developmental Psychology, Groningen, The Netherlands
| | - J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
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Stein K, Warne N, Heron J, Zucker N, Bould H. Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population-based cohort. Int J Eat Disord 2021; 54:915-924. [PMID: 33939186 PMCID: PMC8344098 DOI: 10.1002/eat.23513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. METHOD The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. RESULTS After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre-existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002). DISCUSSION Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long-term outcomes than functional impairment.
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Affiliation(s)
- K. Stein
- Academic Clinical Fellow in Child and Adolescent Psychiatry, University of Oxford; Warneford Hospital, Oxford OX3 7JX
| | - N. Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN
| | - J. Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN
| | - N. Zucker
- Associate Professor of Clinical Psychology, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - H. Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN & Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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30
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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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31
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Zargar F, Rahafrouz L, Tarrahi MJ. Effect of Mindfulness-Based Stress Reduction Program on Psychological Symptoms, Quality of Life, and Symptom Severity in Patients with Somatic Symptom Disorder. Adv Biomed Res 2021; 10:9. [PMID: 33959566 PMCID: PMC8095256 DOI: 10.4103/abr.abr_111_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/11/2019] [Accepted: 10/13/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Patients with somatic symptom disorder (SSD) had a poor quality of life and suffered from depression, anxiety, and stress. Mindfulness-based stress reduction (MBSR) is a psychological treatment with remarkable effects on several psychological disorders. This study aimed to evaluate the effect of the MBSR program on psychological symptoms, quality of life, and symptom severity in patients with SSD. Materials and Methods: The patients with SSD were randomly divided into two groups of receiving venlafaxine alone and venlafaxine with an 8-week MBSR program. Depression, anxiety, and stress with their severities were assessed along with the quality of life, the number of physical symptoms and their severities, as well as SSD severity before and after the intervention. Subsequently, the results were compared between the two groups. Results: This study included 37 patients with SSD who referred to Shariati Psychosomatic Clinic, Isfahan, Iran, with a mean age of 37.08 ± 8.26 years. It should be noted that 37.8% of the participants were male. The intervention group obtained significantly lower scores in depression, anxiety, stress, and their severities, compared to the control group. Moreover, the number of physical symptoms, their severity, and the severity of SSD were significantly decreased more in the intervention group rather than the controls. Conclusion: The MBSR accompanied by prescribing venlafaxine can significantly reduce the severity of SSD, as well as the number and severity of physical symptoms. Moreover, it can reduce depression, anxiety, stress, and their severity. The MBSR can be used as complementary medicine for the treatment of patients with SSD.
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Affiliation(s)
- Fatemeh Zargar
- Department of Health Psychology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Rahafrouz
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Tarrahi
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Casanovas M, Kramer T, Clarke V, Goddard A, M Elena G, Khadr S. Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study. PSYCHOL HEALTH MED 2021; 27:546-558. [PMID: 33573390 DOI: 10.1080/13548506.2021.1874437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.
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Affiliation(s)
- Marta Casanovas
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Tami Kramer
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Venetia Clarke
- The Havens. King's College Hospital NHS Foundation Trust, London, UK
| | - Andrea Goddard
- The Havens. King's College Hospital NHS Foundation Trust, London, UK.,Department of Paediatrics. Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Garralda M Elena
- Department of Child and Adolescent Psychiatry, Imperial College London, London, UK
| | - Sophie Khadr
- The Havens. King's College Hospital NHS Foundation Trust, London, UK.,Institute of Child Health(ICH), Population, Policy and Practice. University College London (UCL), London, UK
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de Jonge-Heesen KWJ, Rasing SPA, Vermulst AA, Scholte RHJ, van Ettekoven KM, Engels RCME, Creemers DHM. Secondary Outcomes of Implemented Depression Prevention in Adolescents: A Randomized Controlled Trial. Front Psychiatry 2021; 12:643632. [PMID: 33708150 PMCID: PMC7940696 DOI: 10.3389/fpsyt.2021.643632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Our most recent RCT provides evidence that indicated depression prevention is effective in reducing depressive symptoms in adolescents when implemented in the school community. In the present study we further test the potential effects of this prevention approach on symptoms related to depression: anxiety, suicidality, somatic symptoms, and perfectionism. We conducted exploratory analyses in 130 adolescents with elevated depressive symptoms aged between 12 and 16 years old (M = 13.59; SD = 0.68; 63.8% girls) who were randomly assigned to the experimental (OVK 2.0) or active control condition (psycho-education). Self-reported anxiety, suicidality, somatic symptoms, and perfectionism were assessed at pretest, post intervention, as well as 6- and 12-months follow-up. Latent growth curve analyses revealed that there was a significant decrease in anxiety in both conditions and that this decrease was significantly larger in the intervention condition than in the control condition. Somatic symptoms and socially prescribed perfectionism decreased significantly in the intervention condition and suicidality decreased significantly in the control condition. Yet there was no difference in decrease in suicidality, somatic symptoms, and perfectionism between the two conditions. This study suggest that screening on depressive symptoms and providing a CBT depression prevention program for adolescents with elevated depressive symptoms, can decrease comorbid symptoms of anxiety and therefore ensure better outcomes. We discuss the clinical implications as well suggestions for future research. Clinical Trial Registration: The study is registered in the Dutch Trial Register for RCTs (NTR5725). Date registered: 11th of March 2016.
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Affiliation(s)
- Karlijn W J de Jonge-Heesen
- GGZ Oost Brabant, Boekel, Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Sanne P A Rasing
- GGZ Oost Brabant, Boekel, Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Ron H J Scholte
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Praktikon, Nijmegen, Netherlands
| | - Kim M van Ettekoven
- GGZ Oost Brabant, Boekel, Netherlands.,Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Daan H M Creemers
- GGZ Oost Brabant, Boekel, Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
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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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Kempert H. Clinical overlap of functional neurologic symptom disorder and complex regional pain syndrome in pediatrics: A case report. J Pediatr Rehabil Med 2021; 14:113-120. [PMID: 33720859 DOI: 10.3233/prm-200700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case study documents a 13-year-old female who presented to our intensive inpatient chronic pain rehabilitation program with complex regional pain syndrome (CRPS) of her left leg, which was significantly interfering with her normal daily functioning. She participated in a full day of traditional interdisciplinary therapies, including physical and occupational therapy for 3 hours daily. As assistive equipment was altered or weaned her physical mobility, balance, and tremors worsened and/or increased. As she began advancing her legs more independently (versus requiring physical assist), she demonstrated more variable functional strength and stability, inconsistent balance reactions, and a more unsteady gait pattern. The team was treating her according to her incoming CRPS diagnosis; however, as treatment progressed, her physical and psychological presentation seemed more aligned with diagnostic criteria of functional neurologic symptom disorder (FND). Staff then treated according to the FND diagnosis resulting in successful long-term outcomes. The clinical impact from this case study includes highlighting the commonalities between CPRS and FND clinically, discussing treatment suggestions depending on the diagnosis, and emphasizing key components of family/patient education.
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Barone R, Gulisano M, Cannata E, Padalino S, Saia F, Maugeri N, Pettinato F, Lo Nigro L, Casabona A, Russo G, Di Cataldo A, Rizzo R. Self- and Parent-Reported Psychological Symptoms in Young Cancer Survivors and Control Peers: Results from a Clinical Center. J Clin Med 2020; 9:jcm9113444. [PMID: 33120900 PMCID: PMC7693519 DOI: 10.3390/jcm9113444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/16/2022] Open
Abstract
Pediatric cancer survivors are at increased risk for psychological distress. We sought to understand the severity and symptoms' co-occurrence among pediatric survivors compared to controls by rating both self- and parent-reported symptomatology. Forty survivors (22 males; mean age at study time: 12.9 years) participated in the study. Most survivors (85%) had a diagnosis of acute lymphoblastic leukemia. Seventy-nine healthy controls with the same age and gender distribution as the patients were included. A standardized assessment of psychological functioning was conducted by self- and parent-reported symptoms evaluations. The self-reported anxious symptom severity was significantly higher in survivors. A significantly higher proportion of survivors compared to controls had clinically significant anxiety, depression, and combined anxiety symptoms (i.e., social anxiety, separation anxiety, or physical symptoms). In both study groups, the self-reported emotional and somatic symptoms were significantly associated. The multi-informant assessments of the psychological symptoms revealed distinct associations between the child- and parent-reported symptoms in the survivors' group: the survivors' self-reports of depressive symptoms, somatic symptoms, and functional impairment were significantly correlated with the parent reports of child behavioral concerns, somatic complaints, and functional impairment, respectively. Conclusion: Self-reported symptoms showed similar comorbidity profiles in survivors and control peers. The multi-informant assessments detected differences in the association of self- and parent-reported symptoms between the survivor and control groups. The present study showed that multi-informant assessment is critical to understanding symptom profiles and to informing intervention with particular regard to parental participation and support.
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Affiliation(s)
- Rita Barone
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
- Correspondence: ; Tel.: +39-095-378-2898
| | - Mariangela Gulisano
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
| | - Emanuela Cannata
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (E.C.); (L.L.N.); (G.R.); (A.D.C.)
| | - Sara Padalino
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
| | - Federica Saia
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
| | - Nicoletta Maugeri
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
| | - Fabio Pettinato
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
| | - Luca Lo Nigro
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (E.C.); (L.L.N.); (G.R.); (A.D.C.)
| | - Antonino Casabona
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, School of Medicine, University of Catania, 95123 Catania, Italy;
| | - Giovanna Russo
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (E.C.); (L.L.N.); (G.R.); (A.D.C.)
| | - Andrea Di Cataldo
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (E.C.); (L.L.N.); (G.R.); (A.D.C.)
| | - Renata Rizzo
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, 95123 Catania, Italy; (M.G.); (S.P.); (F.S.); (N.M.); (F.P.); (R.R.)
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The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance. Clin J Pain 2020; 35:633-643. [PMID: 31094934 DOI: 10.1097/ajp.0000000000000723] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research. METHODS The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area. RESULTS Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors. DISCUSSION Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.
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Abstract
OBJECTIVE To assess pediatric primary care providers' (PCPs) knowledge, perceived barriers, and needs related to child and adolescent anxiety in their practice. METHODS Primary care providers licensed and practicing in the state of Colorado were invited to complete an online knowledge and needs assessment. The survey queried their knowledge of pediatric anxiety, experience in assessing and treating anxiety, perceived barriers in their practice setting to adequately addressing youth anxiety, and interest in additional training on this topic. RESULTS Survey completers included 115 PCPs (51 medical doctors and 64 nurses/nurse practitioners). PCPs had been practicing with their current medical license with pediatric patients for an average of 14 years (SD = 10.45), and 70% reported that they regularly discuss anxiety with patients and parents. Although PCPs had a basic knowledge of youth anxiety, there appeared to be significant gaps in PCP knowledge. Specifically, knowledge gaps included evidence-based assessment and treatment, how to differentiate between developmentally appropriate, transient episodes of anxiety versus anxiety disorders, and where and how to refer youth for specialty services. Nearly all (80%) PCPs indicated that they would be "extremely interested" in additional training in pediatric anxiety, particularly if it occurred in their organizational setting, at a nearby community setting, or online. CONCLUSION Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety. PCPs also reported a growing need for training in how to assess, treat, and refer anxious youth. This needs assessment supports a need for the development of easily accessible training and resources for PCPs to better support their pediatric patients.
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BUTEAN I, MONE I, VISU-PETRA L, OPRE A. Predictors of Individual Differences in Lie Acceptability in Adolescence: Exploring the Influence of Social Desirability, Callous Unemotional Traits and Somatization. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Lie acceptability is defined as an attitude toward lying that can vary along a continuum, from considering that lying is completely unacceptable, to a most lenient view upon deception. The present research focused on identifying factors associated with individual differences in lie acceptability in a sample of Romanian adolescents (N =167, 14-19 years). We investigated associations between variables with a preliminary documented theoretical and/or empirical association with lie acceptability (callous-unemotional traits or social desirability), along with exploratory age-specific measures of somatization. Our results revealed that male adolescents who displayed high callousness, uncaring, or somatization tended to view lying as more acceptable. Social desirability did not predict lie acceptability above and beyond these individual predictors. The implications of these findings for attempts to reduce problematic deceptive behavior in adolescence are discussed."
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Affiliation(s)
- Iulia BUTEAN
- "Department of Psychology, Babeș-Bolyai University, Republicii Str. 37, 400015, Cluj-Napoca, Romania. Regional Centre for Resources and Educational Assistance, Cluj-Napoca"
| | - Ionuț MONE
- Department of Psychology, Babeș-Bolyai University, Republicii Str. 37, 400015, Cluj-Napoca,
| | - Laura VISU-PETRA
- "Research in Individual Differences and Legal Psychology (RIDDLE) Lab, Department of Psychology, Babeș-Bolyai University, Republicii Str. 37, 400015, Cluj-Napoca, Romania"
| | - Adrian OPRE
- Department of Psychology, Babeș-Bolyai University, Republicii Str. 37, 400015, Cluj-Napoca, Romania
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Pathways to quality of life in adolescents with genetic generalized epilepsy: The role of seizure features and affective symptoms. Epilepsy Behav 2020; 109:107115. [PMID: 32438120 DOI: 10.1016/j.yebeh.2020.107115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
Both clinical features of seizures and affective problems (i.e., depressive and/or anxious symptoms) affect quality of life perception in patients with epilepsy. Although genetic generalized epilepsies (GGEs) represent one-third of all epilepsies, very few studies focused on the association among seizures, affective problems, and perceived quality of life in pediatric patients with GGE. Here, we assessed the relative contributions of seizure characteristics and affective symptoms on quality of life in patients with adolescence-onset GGE. Forty pediatric outpatients completed self-report questionnaires on affective symptoms and quality of life. Sociodemographic and clinical variables were obtained from medical charts. Affective symptoms were present in 40% of patients. Higher scores emerged in patients who were seizure-free at the time of the survey for both the physical and mental components of quality of life. Higher seizure frequency was significantly associated with lower quality of life scores in the mental component, whereas the presence of depressive and/or anxious symptoms was significantly associated with lower scores in the physical component. These associations were confirmed after controlling for sociodemographic confounders. These findings suggest that adolescents with GGE are at increased risk for affective symptoms. Moreover, both GGE-related clinical features (i.e., seizure frequency) and the presence of affective symptoms (i.e., depression, anxiety) are relevant and independent contributors to quality of life. The investigation of affective problems is warranted to be included in routine assessments of GGE in pediatric populations.
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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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Implementation and effectiveness of adolescent life skills programs in low- and middle-income countries: A critical review and meta-analysis. Behav Res Ther 2020; 130:103402. [DOI: 10.1016/j.brat.2019.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 04/25/2019] [Indexed: 01/05/2023]
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Kangas M, Kallesoe KH, Rask CU. Functional Somatic Syndromes (FSS) in Children and Adolescents. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Unspecific somatic health complaints and symptoms are common in children and adolescents, varying on a continuum of severity. When persistent and impairing, they are often referred to as functional somatic syndromes (FSS). The overarching objective of this paper is to provide an overview of the pediatric literature in relation to conceptual, assessment, and treatment issues for youth presenting with FSS. Clinical recommendations are outlined including addressing potential feasibility and barrier issues for families presenting to medical and mental health services. Assessment and treatment issues are further discussed in context of two recent psychotherapy trials conducted with children and older age adolescents (aged from 7 to 19 years). Finally, we address ongoing research gaps in this field with view to strengthen the evidence base in the assessment and treatment of youth presenting with FSS.
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Affiliation(s)
- Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Karen Hansen Kallesoe
- Research Clinic for Functional Disorders and Psychosomatic, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Saito E, Eng S, Grosso C, Ozinci Z, Van Meter A. Pro Re Nata Medication Use in Acute Care Adolescent Psychiatric Unit. J Child Adolesc Psychopharmacol 2020; 30:250-260. [PMID: 31800304 DOI: 10.1089/cap.2019.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Evidence to support the use of pro re nata (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. Methods: A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Results: Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Conclusion: Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.
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Affiliation(s)
- Ema Saito
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Stephanie Eng
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christine Grosso
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Zeynep Ozinci
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anna Van Meter
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Feinstein Institutes of Medical Research, Glen Oaks, New York, USA
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Herskovic V, Matamala M. Somatización, ansiedad y depresión en niños y adolescentes. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Finning K, Ford T, Moore DA, Ukoumunne OC. Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey. Eur Child Adolesc Psychiatry 2020; 29:187-198. [PMID: 31054124 PMCID: PMC7024694 DOI: 10.1007/s00787-019-01342-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
Abstract
Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.
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Affiliation(s)
- Katie Finning
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Tamsin Ford
- University of Exeter School of Medicine and Health, College House, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Darren A Moore
- Graduate School of Education, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- School of Medicine and Health, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
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Raffagnato A, Angelico C, Valentini P, Miscioscia M, Gatta M. Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents. Front Psychiatry 2020; 11:262. [PMID: 32322222 PMCID: PMC7158949 DOI: 10.3389/fpsyt.2020.00262] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11-18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.
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Affiliation(s)
- Alessia Raffagnato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Caterina Angelico
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Perla Valentini
- Department of Communication Sciences, Humanistic and International Studies: History, Culture, Languages, Literature, Arts, Media, University of Urbino 'Carlo Bo', Urbino, Italy
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy.,Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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ANXIETY AND ITS SIGNIFICANCE IN THE STRUCTURE OF SOMATOFORM DISORDERS IN CHILDREN AND THE ROLE OF SEROTONINE AND TRIPTOPHAN IN THEIR NASCENCE. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-1-71-94-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Positive affect and functional somatic symptoms in young adults. J Psychosom Res 2019; 127:109847. [PMID: 31706069 DOI: 10.1016/j.jpsychores.2019.109847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Functional Somatic Symptoms (FSS) are symptoms for which an underlying pathology cannot be found. High negative affect (NA) has been linked to the etiology of FSS, but little is known about the role of Positive Affect (PA). OBJECTIVE The aim of this study was to test if PA is related to current and future lower levels of FSS. We also examined the interactions between PA and NA, and PA and sex on FSS. METHOD Data from the Dutch Tracking Adolescents' Individual Lives Survey (TRAILS) cohort were used (N = 1247 cases, 60% females, mean age T5 = 22.2, T6 = 25.6). PA was measured with the PANAS schedule and FSS with the Adult Self Report questionnaire (ASR). A Principal Component Analysis (PCA) was performed on the physical complaints subscale of the ASR. Regression analyses with bootstrapping were performed to assess the associations and interactions. RESULTS PA had a significant negative association with current FSS when adjusted for NA, age, sex and socioeconomic status (B = -0.004; BCa 95% CI = [-0.006; -0.002]), but the association was not significant longitudinally. No interactions were found. In secondary analysis, PA was significantly related to the component "General Physical Symptoms" (B = -0.019; BCa 95% CI = [-0.0028; -0.011]) but not to the component "Gastrointestinal Symptoms" (B = -0.008; BCa 95% CI = [-0.016;0.001]) in the cross-sectional analysis. CONCLUSION In conclusion, high PA was significantly related to current lower levels of FSS, but the effect was small. Further research on individual variations in affect is needed to obtain more insight in their contribution to FSS.
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von Werthern M, Grigorakis G, Vizard E. The mental health and wellbeing of Unaccompanied Refugee Minors (URMs). CHILD ABUSE & NEGLECT 2019; 98:104146. [PMID: 31521903 DOI: 10.1016/j.chiabu.2019.104146] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Today, almost half of all refugees worldwide are children and adolescents, nearly a quarter of whom arrive in Europe as Unaccompanied Refugee Minors (URM). Many URMs have experienced the cumulative stress of being exposed both to the adverse environmental conditions which drive forced migration, and to the traumatic experience of displacement and resettlement. These experiences, coupled with other developmental stressors, may impede their overall development and increase their likelihood of mental health problems. Despite the evident vulnerability of URMs, much controversy currently surrounds the legitimacy of their arrival in host countries and their mental health is given little consideration. OBJECTIVE This review synthesises and examines the limited published literature on the impact of traumatic refugee experiences on the mental health and development of URMs. METHODS Academic databases and other sources were searched using key terms relating to URMs and mental health. RESULTS The findings confirm in large part that being a URM negatively influences mental health development, and that adolescence and being female are particular indicators of increased risk of psychiatric disorders. However, cultural differences in measurement and assessment of mental health are important confounding factors. CONCLUSIONS The current literature on youth in transit consistently paints a picture of how experiences URMs face can place a great burden on their mental health - clearly depicting an urgent need to consider their mental health within the current climate. The pressing need for improved care based on best practice is discussed.
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Affiliation(s)
- Martha von Werthern
- Child and Adolescent Mental Health, UCL Great Ormond Street Institue for Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.
| | - Georgios Grigorakis
- Child and Adolescent Mental Health, UCL Great Ormond Street Institute for Child Heatlh, 30 Guilford Street, London, WC1N 1EH, United Kingdon.
| | - Eileen Vizard
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
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