Impact of Sleep Disturbance on Fatigue, Nausea, and Pain: Mediating Role of Depressive Symptoms Among Youth With Disorders of Gut-Brain Interaction.

OBJECTIVES: A high degree of sleep disturbance is reported among youth with disorders of gut-brain interaction (DGBIs). Given that sleep quality impacts a range of pediatric health outcomes including somatic sensations (eg, pain) and depressive mood occurs relatively frequently among youth with DGBIs, there is a dire need to disentangle the unique contributions of sleep and depressive mood on the somatic sensations experienced by youth with DGBIs. We aimed to examine whether depressive mood mediates the relations among sleep disturbance and pain intensity, nausea, and fatigue among youth with DGBIs. METHODS: One hundred eighteen patients aged 8-17 years ( Mage = 14.05, SD = 2.88; 70.34% female), 83.05% White/non-Hispanic recruited at a pediatric neurogastroenterology clinic completed measures of sleep disturbance, nausea, fatigue, pain intensity, and depressive mood. Three mediation models examined the effect of sleep disturbance on nausea, fatigue, and pain, with depressive mood as a mediator. RESULTS: Participants reported moderate sleep disturbance. Depressive mood partially mediated the significant, respective relations between greater sleep disturbance and more severe nausea and fatigue. Sleep disturbance was significantly associated with higher pain intensity; however, depressive mood was not a significant mediator of this relation. CONCLUSIONS: Sleep quality is a major concern among youth with DGBIs. Low sleep quality may worsen nausea and fatigue via co-occurring increases in depressive mood symptoms. In contrast, sleep disturbance may directly increase pain, regardless of youths' depressive mood symptoms. Future research should explore these relations through prospective studies leveraging a combination of subjective and objective assessment approaches.

Little Bayesians or little Einsteins? Probability and explanatory virtue in children's inferences.

Like scientists, children seek ways to explain causal systems in the world. But are children scientists in the strict Bayesian tradition of maximizing posterior probability? Or do they attend to other explanatory considerations, as laypeople and scientists - such as Einstein - do? Four experiments support the latter possibility. In particular, we demonstrate in four experiments that 4- to 8-year-old children, like adults, have a robust latent scope bias that leads to inferences that do not maximize posterior probability. When faced with two explanations equally consistent with observed data, where one explanation makes an unverified prediction, children consistently preferred the explanation that does not make this prediction (Experiment 1), even if the prior probabilities are identical (Experiment 3). Additional evidence suggests that this latent scope bias may result from the same explanatory strategies used by adults (Experiments 1 and 2), and can be attenuated by strong prior odds (Experiment 4). We argue that children, like adults, rely on 'explanatory virtues' in inference - a strategy that often leads to normative responses, but can also lead to systematic error.

Hassles predict physical health complaints in undergraduate students: a dynamic structural equation model analysis of daily diary data.

OBJECTIVE: Daily hassles and physical health complaints are common among undergraduate students, and both are related to negative academic and psychosocial outcomes. However, the extent to which hassles or health complaints persist from day to day is underexplored, and studies examining whether hassles predict health complaints or vice versa, are lacking. This study aimed to examine the temporal stability and to define the temporal relationship between daily hassles and health symptoms in undergraduate students. DESIGN: Participants (n = 255, mean age = 19.2 years, 69% female, 53% White) completed 14 consecutive daily diaries of hassles and health complaints. MAIN OUTCOME MEASURES: Daily reports of the Brief College Students Hassles Scale and the Patient Health Questionnaire-15. RESULTS: Hassles and health complaints demonstrated stability through autocorrelations. Hassles significantly predicted subsequent health complaints, but health complaints did not significantly predict subsequent hassles. However, the two paths did not differ significantly. CONCLUSION: Students reporting elevations in one or both domains may benefit from interventions aimed at reducing daily hassles, in order to promote better perceived health and well-being.

Symptom complaints and impact on functioning in youth with hypermobile Ehlers-Danlos syndrome.

Hypermobile Ehlers-Danlos syndrome (hEDS), a genetic connective tissue disorder, involves several body systems which makes symptom management and functioning difficult. The aim of this study was to understand pediatric hEDS patients' symptoms and primary complaints. Additionally, we examined the cumulative impact of symptoms on physical and psychological functioning. Thirty-four youth with hEDS were recruited from a genetics clinic and reported the hardest thing about having hEDS, their pain, fatigue, physical symptoms, functional disability, anxiety, and depression. Physical symptoms (pain and fatigue) and limitations (keeping up with friends) were reported as the most difficult parts of having hEDS. A higher number of somatic symptoms was the strongest predictor of disability, anxiety, and depression. Physical symptoms are subjectively distressing and significantly related to impairments in physical and psychological functioning. Thus, addressing these varied symptoms in treatment may yield better functioning in youth with hEDS.

Sociodemographic and Environmental Factors are Associated with Adolescents' Pain and Longitudinal Health Outcomes.

Research in adult populations indicates that several sociodemographic and environmental variables increase risk for pain and poor outcomes. There is little research exploring the impact of household income, health insurance coverage, barriers to health care, neighborhood and school safety, violence experienced, and neighborhood isolation on pediatric chronic pain. Data from the Add Health Study, a longitudinal examination of a nationally-representative adolescent sample were analyzed. The relationships between demographic variables, risk factors, chronic pain, and long-term health outcomes were examined. Adolescents with chronic pain had lower income, more health care barriers, greater safety concerns, and experienced more violence compared to those without pain. In a model together, female sex, White race/ethnicity, and greater health care barriers, safety concerns, and violence exposure conferred significant risk for chronic pain. Additional analyses revealed nuances in the strength of risk factors between racial/ethnic groups. Systemic health care barriers were significantly associated with chronic pain and may delay symptom alleviation and return to functioning. Considering access to care is necessary in prevention efforts. Among adolescents with chronic pain, greater safety concerns predicted poor mental health outcomes, particularly for White females. The cumulative stress of environmental concerns, such as safety, and managing chronic pain may worsen functioning. PERSPECTIVE: Adolescents with chronic pain had lower income, and more health care barriers, safety concerns, and violence exposure compared to those without chronic pain. Access to care is a significant problem in youth with chronic pain. The relationships between race/ethnicity, risk factors, and health outcomes are complex and require additional research.