Illness-related parenting in mothers with functional gastrointestinal symptoms

Family healthcare patterns as a proxy for transgenerational transmission of functional somatic symptoms in early childhood - A longitudinal cohort study

OBJECTIVE

Functional somatic symptoms (FSS) accumulate within families. Exposure to family patterns of high healthcare use may induce maladaptive symptom coping and thereby potentially contribute to the transgenerational transmission of FSS. This study aimed to uncover associations between parental and child healthcare use during the child's first years of life (age 0-4) and childhood FSS at age 5-7.

METHODS

We utilized data from the Copenhagen Child Cohort (CCC2000), a population-based birth cohort. Parent-reported FSS of their 5-7-year-old children were linked to Danish national registry data on parental and child healthcare use (including general practitioner [GP] consultations and hospital contacts) during child age 0-4 years. Logistic regression analyses were performed to investigate longitudinal associations between family healthcare use and child FSS.

RESULTS

We found an association between prior parental healthcare use and child FSS at age 5-7 (OR = 1.02, 95% CI [1.01-1.04]). Key sensitivity analyses specifically focusing on GP consultations, revealed modest but statistically significant associations between parental (OR = 1.03, 95% CI [1.02-1.05]) and child (OR = 1.18, 95% CI [1.04-1.34]) GP consultations and impairing FSS at age 5-7.

CONCLUSION

Family healthcare use, especially within the general practice, may play a role in the transgenerational transmission of FSS. Early-stage FSS identification and care might be improved through training aimed at GPs. Future research may identify vulnerable families at whom parent-focused interventions for symptom-coping could be targeted. This could potentially contribute to the prevention of transgenerational transmission of FSS.

Psychosocial mechanisms for the transmission of somatic symptoms from parents to children

AIM

To examine familial aggregation of irritable bowel syndrome (IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to stress.

METHODS

Mothers of children between the ages of 8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget Sound. Mothers completed questionnaires, including the Child Behavior Checklist (child psychological distress), the Family Inventory of Life Events (family exposure to stress), SCL-90R (mother psychological distress), and the Pain Response Inventory (beliefs about pain). Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire (beliefs about pain), Pain Response Inventory (coping) and Child Symptom Checklist [gastrointestinal (GI) symptoms]. In addition, health care utilization data was obtained from the automated database of Group Health Cooperative. Mothers with IBS (n = 207) and their 296 children were compared to 240 control mothers and their 335 children, while controlling for age and education.

RESULTS

Hypothesis 1: reinforcement of expression of GI problems is only related to GI symptoms, but not others (cold symptoms) in children. There was no significant correlation between parental reinforcement of symptoms and child expression of GI or other symptoms. Hypothesis 2: modeling of GI symptoms is related to GI but not non-GI symptom reporting in children. Children of parents with IBS reported more non-GI (8.97 vs 6.70, P < 0.01) as well as more GI (3.24 vs 2.27, P < 0.01) symptoms. Total health care visits made by the mother correlated with visits made by the child (rho = 0.35, P < 0.001 for cases, rho = 0.26, P < 0.001 for controls). Hypothesis 3: children learn to share the methods of coping with illness that their mothers exhibit. Methods used by children to cope with stomachaches differed from methods used by their mothers. Only 2/16 scales showed weak but significant correlations (stoicism rho = 0.13, P < 0.05; acceptance rho = 0.13, P < 0.05). Hypothesis 4: mothers and children share psychological traits such as anxiety, depression, and somatization. Child psychological distress correlated with mother's psychological distress (rho = 0.41, P < 0.001 for cases, rho= 0.38, P < 0.001 for controls). Hypothesis 5: stress that affects the whole family might explain the similarities between mothers and their children. Family exposure to stress was not a significant predictor of children's symptom reports. Hypothesis 6: the intergenerational transmission of GI illness behavior may be due to multiple mechanisms. Regression analysis identified multiple independent predictors of the child's GI complaints, which were similar to the predictors of the child's non-GI symptoms (mother's IBS status, child psychological symptoms, child catastrophizing, and child age).

CONCLUSION

Multiple factors influence the reporting of children's gastrointestinal and non-gastrointestinal symptoms. The clustering of illness within families is best understood using a model that incorporates all these factors.

A questionnaire study of cervical cancer screening beliefs and practices of Chinese and Caucasian mother-daughter pairs living in Canada

OBJECTIVE

Papanicolaou (Pap) testing rates among Chinese women remain low compared with their Caucasian counterparts despite extensive efforts to raise awareness of the importance of regular screening. We examined three potential predictors of Pap testing behaviour in Chinese women: acculturation, cervical cancer screening belief accuracy, and intergenerational transmission.

METHODS

Caucasian (n = 78) and Chinese (n = 93) female university students and their mothers completed questionnaires concerning acculturation, Pap testing beliefs, and behaviours.

RESULTS

Ethnic group comparisons revealed that Chinese daughters and mothers had lower Pap testing rates and less accurate beliefs regarding cervical cancer screening. Among women who had had at least one Pap test, there was no ethnic difference in the proportion of women who adhered to the recommended screening frequency. Among the Chinese women, lower heritage acculturation was correlated with higher cancer screening belief accuracy in both the daughters and their mothers. Maternal Pap testing behaviour was predicted by level of cancer screening belief accuracy, whereas daughters' Pap testing behaviour was predicted by previous experience of sexual intercourse and heritage acculturation. No intergenerational transmission of Pap testing beliefs or behaviours was found.

CONCLUSION

The accuracy of cancer screening beliefs, level of acculturation and experience of sexual intercourse may be predictors of Pap testing behaviour in Chinese women. Contrary to our prediction, we found no support for intergenerational transmission, suggesting that Pap testing beliefs and behaviours of Chinese women are independent of the beliefs and behaviours of their mothers.

Familial aggregation in children affected by functional gastrointestinal disorders

BACKGROUND AND AIMS

Adults with irritable bowel syndrome may often have a first-degree relative with abdominal pain and bowel problems. The aims of this study were to evaluate the prevalence of functional gastrointestinal disorders (FGIDs) in parents and siblings of children affected by FGIDs, the psychological profile of both children and parents affected by FGIDs, and whether independent factors could influence the prevalence of FGIDs in parents of children with and without FGIDs.

SUBJECTS AND METHODS

One hundred three patients affected by FGIDs according to Rome III criteria and/or their parents and siblings filled out validated questionnaires for gastrointestinal (GI) symptoms, depression, and anxiety. These patients were compared with 65 age- and sex-matched controls referred to the Primary Care Center of the Department of Paediatrics at the University of Naples "Federico II" for non-GI symptoms.

RESULTS

The parents of children with FGIDs showed a significantly (P < 0.0001) higher prevalence of FGIDs compared with the parents of children without FGIDs. No significant differences between the groups were observed for marital status, parental occupation, education level, standard of living, and presence of anxiety and/or depression. An association between the children's and their parents' type of GI disorders was found in 33.9% (35/103) of patients. In particular, an association between the children's and mother's type of GI disorders was found in 25.2% (26/103) of patients.

CONCLUSIONS

To our knowledge, our study is the first to demonstrate that a large number of mothers of children with FGIDs have the same FGIDs as their children.

Genes and irritable bowel syndrome: is there a link?

Advances in genetics and genomics during the past decade, including sequencing of the human genome and DNA sequencing technologies, have made it possible to discover the genetic basis for many diseases. With the discovery of multiple genetic loci for gastrointestinal diseases such as Crohn's disease, some have begun to wonder-Could there be a genetic basis for irritable bowel syndrome (IBS)? This article summarizes the evidence for and against a link between genes and IBS. In addition, a gene-environment paradigm is presented to combine the two opposing hypotheses, as IBS may represent a complex genetic disorder that results from the interaction of several genes and environmental risk factors.

Intergenerational transmission of health beliefs in somatoform disorders: exploratory study

Children of parents with a range of psychiatric disorders are at increased risk of developing psychological disturbance themselves. There is growing evidence that this includes children who have parents with a chronic somatoform disorder. The health beliefs of children with a parent with a somatoform disorder were compared with those of children with a parent with an organic physical disorder. Children of parents with somatoform disorder scored higher on bodily preoccupation and disease phobia scales and their health beliefs showed similarities to the beliefs of their parents.

Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study

OBJECTIVE

To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6(3/4) years.

METHOD

A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6(3/4) years. Parental reports of child and parent functioning were gathered. Associations between parental and child functioning assessed at 6 to 8 months postpartum, and RAP measured at age 6(3/4) years were investigated.

RESULTS

The prevalence of RAP in this sample was 11.8%. Both maternal anxiety (adjusted odds ratio = 1.53; 95% confidence interval 1.24-1.89) and paternal anxiety (adjusted odds ratio = 1.38; 95% confidence interval 1.12-1.71) in the first year of a child's life were associated with later childhood RAP. Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP.

CONCLUSIONS

This is the first evidence from a prospective study that anxiety in both mothers and fathers and child temperament features predate the occurrence of RAP in children. These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP, although some caution should be exercised in their interpretation because of possible reporting bias.

Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress

PURPOSE OF REVIEW

Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour.

RECENT FINDINGS

Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services.

SUMMARY

Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.

Psychiatric and psychological dysfunction in irritable bowel syndrome and the role of psychological treatments

Psychosocial variables play a substantial role in the IBS condition of many patients. Evaluating and addressing adverse psychosocial factors is important to achieve satisfactory clinical outcomes with those patients. This can be achieved efficiently through psychosocial interviewing, establishing a solid therapeutic relationship, and judicious and tactful application of psychotropic medications and psychological treatments. Success in address-ing psychosocial factors in clinical encounters benefits not only patients, but also the gastroenterologist through increased work satisfaction because of reduced difficulty and frustration in working with IBS patients.

Irritable bowel syndrome: a syndrome in evolution

As a group, functional gastrointestinal disorders are the most common gastrointestinal disorder seen by both generalists and specialists. These disorders can be frustrating to both patients and physicians as they are usually chronic in nature and difficult to treat. These disorders are associated with frequent healthcare visits, the scheduling of multiple, expensive diagnostic tests, and the use of both over-the-counter and prescription medications. All of these factors lead to a significant economic burden to society. In addition, functional gastrointestinal disorders are associated with a reduction in quality of life for the patient. Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders. This syndrome has been the focus of a large number of research studies over the past two decades. These studies have resulted in a number of significant changes in our definition of IBS. In addition, these research studies have produced considerable changes in our understanding of the etiology and pathogenesis of IBS. In this section, we will review some of the evolutionary changes that have occurred in IBS. We will discuss how the definition of IBS has changed, consider our evolving strategies to evaluate and diagnose IBS, and finally, provide a brief overview of treatment options for this common disorder.