Somatic Problems in Children Disclosing Sexual Abuse: The Mediating Role of Alexithymia and Dissociation.

Child sexual abuse (CSA) is linked to heightened levels of medically unexplained symptoms. Research indicates that victims of CSA display alexithymia and dissociation symptoms. Alexithymia and dissociation may potentially contribute to developing somatic complaints in CSA victims. They represent mechanisms through which psychological distress is avoided and could then manifest as physical symptoms like somatic problems (e.g. headaches, nausea, stomachache, etc.). This study aimed to investigate if alexithymia and dissociation are mechanisms explaining the link between CSA and somatic complaints. The sample included 245 children who had disclosed child sexual abuse and 100 non-abused children aged 6-12 years old. Results of a sequential mediation model revealed that the CSA-somatic complaints relationship was mediated by alexithymia and dissociation. This study suggests that intense negative emotion leads children to focus on external stimuli to reduce psychological suffering. To mitigate somatic problems in victims of CSA, treatment should target overregulation of affect, namely alexithymia, and dissociation. In the long term, this could prevent unnecessary diagnostic testing and delay in appropriate interventions.

The influence of excessive stress on medical students in the Czech Republic - national sample.

PURPOSE: The Czech Republic has been dealing with a long-term shortage of doctors, which, according to demographic forecasts, will continue to worsen due to the retirement of stronger generations of doctors in contrast to the gradual aging of the population, which will require more health care over time. The country´s political set is trying to respond to this shortage and demographic forecasts by gradually increasing financial funding of medical faculties with the aim of increasing the number of graduates of the program in the field of general medicine. METHODS: Anonymous questionnaire survey was conducted among students and graduates of general medicine at all eight Czech medical faculties. A total of 3183 respondents participated in the survey. There were 2843 medical students, which represents approximately 28% of all medical students in the Czech Republic. The distribution of respondents within the study years was approximately even and approximately corresponded to the real distribution of students between individual faculties in country, which makes survey a national sample. The statistical processing was performed in the statistical software R. Apart from the basic comparison using percentage relative frequencies and Pearson´s chi-squared test, in this study we used Odds ratios (OR) with CI 0,95 from logistic regression model for a better interpretation of some outputs. RESULTS: The results show that the vast majority of Czech medical students experience excessive stress during their studies, which increases the risk of students´ somatic problems (OR = 4.89, CI 0.95 = (4.11;5.83), p < 0.001)., targeted alcohol use (OR = 2.29, CI 0.95 = (1.73;3.04), p < 0,001) and the use of anxiolytic or antidepressant medication to reduce it (OR = 2.99, CI 0.95 = (2.24;4.01), p < 0.001). Students experiencing higher levels of excessive stress are more likely to leave their studies based on their own decision (4.20 (CI 0.95 (3.39;5.19), p < 0.001) and not to enter clinical practice after graduation (OR = 2.62, CI 0.95 = (2.06;3.33), p < 0.001). CONCLUSIONS: The survey shows the need for an open discussion at the highest level about the possibilities of reasonable reduction of unnecessary stress during medical studies. Medical students in the Czech Republic are exposed to excessive stress with all the consequences described above. All that remains is to state the existence of unnecessary components of stress, which represent an opportunity to reduce it, thereby achieving better conditions for studying, improvement in the staff situation in the Czech healthcare system and a reduction in inefficiently spent financial resources for the education of young doctors. TRIAL REGISTRATION: No registration.

Immediate impact of child maltreatment on mental, developmental, and physical health trajectories.

OBJECTIVE: The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. METHOD: We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. RESULTS: Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. CONCLUSION: The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.

Executive function and somatic problems in adolescents with above target glycemic control.

Adolescents with type 1 diabetes may be at elevated risk for somatic problems. This study used cross-sectional, baseline data from an intervention to examine if problems with executive function (EF) were associated with greater somatic problems independent of poor adherence and disease severity in adolescents with type 1 diabetes and above target glycemic control. In addition, it examined whether certain types of EF skills, that is, metacognitive and behavior regulation, accounted for variance in somatic problems. Ninety-three adolescents completed a glycated hemoglobin (HbA1c) blood test and parents completed adherence, somatic problems, and EF questionnaires, which measured metacognitive, behavior regulation, and global EF. Greater somatic problems had significant bivariate associations with greater global (r = 0.42, P < 0.01), metacognitive (r = 0.43, P < 0.01), and behavior regulation EF problems (r = 0.31, P < 0.01), worse adherence (r = -0.39, P < 0.01), and poorer metabolic control (r = 0.26, P < 0.05). However, when adherence, metabolic control, and EF subscales were examined together in the same model, only greater global EF problems (b = 0.15, P < 0.01) and metacognitive EF problems (b = 0.16, P < 0.01) were independently associated with greater somatic problems; behavior regulation EF problems were not independently associated with greater somatic problems when controlling for adherence. Metacognitive EF problems may predict somatic problems in adolescents with above target glycemic control above and beyond physical symptoms related to disease management, underscoring the importance of proper assessment and treatment of these distinct somatic problems.

The Role of Metacognitions and Thinking Styles in the Negative Outcomes of Adolescents' Peer Victimization.

Psychological mechanisms that may explain the link between peer victimization and its adverse outcomes are still understudied. The current study aimed to apply the Self-Regulatory Executive Function (S-REF) model of psychopathology (Wells & Matthews, 1994, 1996) to help explain this link in a sample of adolescents. A total of 1,169 Italian adolescents (47.7% females; Mage = 15.79, SD = 1.07) completed self-report measures of peer victimization, metacognitions, thinking styles (worry and rumination), and adjustment indices (somatic symptoms, anxiety, depression). The hypothesized model based on the S-REF model was tested through path analysis. Results confirmed that peer victimization was positively associated with both positive and negative metacognitions that, in turn, were linked to worry and rumination, which were associated with higher psychological and somatic problems. The strongest indirect links were found between peer victimization and anxiety via negative metacognitions and worry, and between victimization and depression via negative metacognitions and rumination. Overall, the results support to the application of the S-REF model to peer victimization experiences during adolescence. The clinical implications of these findings are discussed.

Displaced Syrian children's reported physical and mental wellbeing.

BACKGROUND: Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan. METHODS: A cross-sectional explorative design was applied. Structured questionnaires were used to collect data through face-to-face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used. RESULTS: Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = -.14, p = .034); gender differences were found in anger expression and anger trait (p < .05). CONCLUSIONS: The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them.

Fears during the Covid-19 pandemics and their influence on physical health: A cross-sectional study on the general population in Spain.

Background/objective: This study examines the paths through which Covid-19 can negatively impact health and lead to somatic symptoms. Based on the dual process theory, fears can impair health in two ways: through psychological distress, which is an automatic reaction to fear, and through a more conscious and deliberative rumination process. Method: Data from a representative sample of the Spanish population (N = 3083 subjects,18 years or older) were obtained from a Survey by the Sociological Research Center (CIS). The dual path model was tested, and a longer sequence was included where the two mediators act sequentially to produce an impact on somatic symptoms. Results: The results showed how Covid-19 fears translate into somatic problems. Beyond the direct relations, and after comparing with other possible alternative models, our findings support a process where rumination mediates between fears and psychological distress, and psychological distress in turn leads to somatic problems. Conclusions: This process reveals a plausible mechanism that explains the somatization of health problems during the Covid-19 pandemic, and it provides theoretical and practical inputs to better understand the role of fears in health in crisis contexts.

Relative Frequency of Psychiatric, Neurodevelopmental, and Somatic Symptoms as Reported by Mothers of Children with Autism Compared with ADHD and Typical Samples.

No study has analyzed the relative occurrence of a broad range of symptoms reported by mothers of children with autism, ADHD-Combined, and ADHD-Inattentive and typical controls. Mothers rated 1436 children with autism, 1056 with ADHD without autism, and 186 controls, 2-17 years, on 41 internalizing, externalizing, neurodevelopmental, and somatic problems. Most children with autism had symptoms of ADHD, oppositional defiant disorder, disruptive mood dysregulation disorder, and expressive language disorder and almost half had dysgraphia and receptive language disorder. Symptom overlap between autism and ADHD-Combined was high. Clinicians specializing in autism and ADHD must have expertise in evaluating and treating these comorbidities identified as most problematic by mothers in order to relieve family concerns and develop treatment plans relevant to families.

Complex PTSD symptoms mediate the association between childhood trauma and physical health problems.

The ICD-11 reconceptualized Posttraumatic Stress Disorder (PTSD) as a narrowly defined fear-based disorder, and introduced Complex PTSD (CPTSD) as a new diagnosis comprised of PTSD symptoms and symptoms of 'Disturbances in Self-Organization' (DSO) that are more reflective of general dysphoria. Previous research suggests that PTSD symptoms mediate the association between childhood trauma and physical health problems, including cardiovascular disease. No study has yet assessed how posttraumatic stress symptoms, as outlined in the ICD-11, influence the association between childhood trauma and somatic problems in adulthood. OBJECTIVE: This cross-sectional descriptive study examined whether PTSD and DSO symptoms mediated the associations between childhood physical and sexual abuse and childhood emotional abuse and neglect and somatic problems and cardiovascular diseases (CVD) load in adulthood. METHODS: General adult population samples from Ireland (N = 1020) and the United Kingdom (N = 1051) completed self-report questionnaires online. RESULTS: Structural equation modelling results indicated that PTSD and DSO symptoms fully mediated the association between both forms of childhood trauma and somatic problems, and that PTSD symptoms but not DSO symptoms fully mediated the association between childhood trauma and CVD load. CONCLUSION: Psychological interventions that effectively treat CPTSD symptoms may have the added benefit of reducing risk of physical health problems.

Victimization and Somatic Problems: The Role of Class Victimization Levels.

BACKGROUND: The link between peer victimization and somatic problems is well-established. What is currently understudied is under what contextual conditions victims' health might be most likely to be compromised. Studies demonstrate that victims suffer from poorer adjustment when they belong to a group in which victimization is less normative (social misfit hypothesis). We examined whether the association between individual victimization and somatic problems was stronger in classrooms with lower class victimization. METHODS: A sample of 1906 adolescents (65% girls; Mage  = 14.4, SD = 1.2) completed a survey about school life quality, peer victimization, and health problems. RESULTS: Multilevel modeling with Bayes estimator indicated modest variation in somatic problems between classrooms. At the individual level, peer victimization was associated with higher reports of somatic problems. This association varied across classroom as a function of class victimization level. Simple slope computation confirmed that the association between peer victimization and somatic complaints became stronger as class victimization levels decreased. CONCLUSIONS: Victims in classrooms with lower levels of victimization are more likely to report somatic problems. Anti-bullying programs should consider the effects of class norms on victims' adjustment and address the possible risks for those who continue to be victimized.

ICD-11 Adjustment Disorder among Organ Transplant Patients and Their Relatives.

Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients' demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies.

Fears during the Covid-19 pandemics and their influence on physical health: A cross-sectional study on the general population in Spain

Background/objective: This study examines the paths through which Covid-19 can negatively impact health and lead to somatic symptoms. Based on the dual process theory, fears can impair health in two ways: through psychological distress, which is an automatic reaction to fear, and through a more conscious and deliberative rumination process. Method: Data from a representative sample of the Spanish population (N = 3083 subjects,18 years or older) were obtained from a Survey by the Sociological Research Center (CIS). The dual path model was tested, and a longer sequence was included where the two mediators act sequentially to produce an impact on somatic symptoms. Results: The results showed how Covid-19 fears translate into somatic problems. Beyond the direct relations, and after comparing with other possible alternative models, our findings support a process where rumination mediates between fears and psychological distress, and psychological distress in turn leads to somatic problems. Conclusions: This process reveals a plausible mechanism that explains the somatization of health problems during the Covid-19 pandemic, and it provides theoretical and practical inputs to better understand the role of fears in health in crisis contexts. (AU)

Long-term effects of internet-supported cognitive behaviour therapy.

INTRODUCTION: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer. Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). The pre-to follow-up effect size was Hedge's g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects. Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

Adolescents' Daily Perception of Internalizing Emotional States by Means of Smartphone-based Ecological Momentary Assessment.

This study uses ecological momentary assessment (EMA) with smartphone devices to examine community adolescents' perceptions regarding both the intensity of and variability in their daily sadness/depression, anxiety, and somatic problems over the period of one week. Participants were 90 high-school students (M age = 14.61, SD = 1.64; range 12-18). The sample was divided according to gender (61.1% girls), migratory status (68.5% Spanish nationals and 31.5% Latin American immigrants), and level of psychological symptoms (17% risk group). Sadness/depression, anxiety, and somatic problems were examined using a smartphone app, five times per day, semi-randomly, for seven days (35 possible moments). A high proportion of adolescents did not report feelings of sadness (80.0%) or worry (79.3%) or physical symptoms on a daily basis (84.9%). Girls and the risk group reported greater intensity levels for the three analyzed problems than did boys and the normal group, respectively (p .05 in all cases). Day-to-day fluctuations in mood during the week were statistically significant but not meaningful (b = 0.0004, 95% CI [0.0001, 0.0008], p = .001).