The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression.

The objective of this study was to examine if emotion awareness in children and adolescents (age 7-18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N = 617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.

Do parents maintain or exacerbate pediatric functional abdominal pain? A systematic review and meta-analysis.

Parents may maintain or exacerbate functional abdominal pain (FAP) in children through modeling of physical symptoms and solicitous responses to the child's complaints. This systematic review and meta-analysis aimed to examine these relationships. Parents of children with FAP reported more physical symptoms than parents of healthy children (effect size d = .36). As all studies were cross-sectional or retrospective, the causal direction was unclear. For parental responses to child complaints, not enough studies were available to perform a meta-analysis. We conclude that the present literature is unfit to establish whether parents maintain or exacerbate pediatric FAP through the processes investigated.

Emotion awareness and coping in children with functional abdominal pain: a controlled study.

Literature on somatization suggests that patients suffering from medically unexplained symptoms are less aware of their emotions and use maladaptive coping strategies when coping with everyday problems. In addition, coping is hypothesized to mediate between emotion awareness and medically unexplained symptoms. Scientific evidence for the relevance of this hypothesis for children with functional abdominal pain (FAP) is, however, lacking. Therefore, the purpose of the present study was to investigate this hypothesis in Dutch children with functional abdominal pain (FAP), aged 7-18 years. Between April 2007 and April 2010, a total of 114 referred children with FAP, 235 schoolchildren without abdominal pain and 407 schoolchildren with some abdominal pain (AP) of diverse etiology filled out questionnaires concerning their pain, emotion awareness and coping. MANOVA was used to investigate group differences in emotional awareness and coping. Structural equation modeling was used to investigate the mediational role of coping. The results showed that children with FAP scored significantly lower on most aspects of emotion awareness than children without AP, although these differences were small. Contrary to expectations, children with FAP were more aware of a link between emotions and bodily sensations than children without AP. As for coping, we found that children with FAP used avoidant coping more often than children without AP. Overall, children with FAP mostly did not differ in their emotional awareness and coping compared to children with some AP. Problem focused coping had a small mediating effect for two aspects of emotion awareness. We conclude that children with FAP show only small differences in emotion awareness and coping compared to children without AP, and are practically no different from children with some AP. Contrary to common belief, it can be questioned whether emotion awareness and general coping are useful targets for psychological treatments of FAP to focus on.

Abdominal pain in Dutch schoolchildren: relations with physical and psychological comorbid complaints in children and their parents.

OBJECTIVES: Children with functional abdominal pain (FAP) frequently report comorbid complaints such as anxiety and activity limitations. Their parents often experience heightened levels of anxiety, depression, and somatization. The aim of the present study was to investigate whether these comorbid complaints in children and their parents are specific for FAP or can also be found in a community sample. PATIENTS AND METHODS: Six hundred sixty-five schoolchildren (ages 7-18 years) filled out questionnaires concerning AP, activity limitations, somatic complaints, quality of life, and symptoms of anxiety and depression. A total of 391 of their parents filled out questionnaires concerning parental anxiety, depression, and somatization. Pearson correlations and multiple regression analyses were performed. RESULTS: A total of 56.5% of the children reported AP at least once in a 2-week period. Univariate relations with AP were found for activity limitations (r = 0.392), somatic complaints (r = 0.408), 3 of 5 domains of quality of life (r ranging from -0.120 to -0.209), and symptoms of anxiety and depression (r, respectively, 0.329 and 0.361). Multivariate analyses showed only significant relations for female sex (ß = 0.230), younger age (ß = -0.077), activity limitations (ß = 0.247), somatic complaints (ß = 0.170), and depressive symptoms (ß = 0.093). CONCLUSIONS: Activity limitations, somatic complaints, and depressive symptoms are related to AP in the general population, whereas a reduced quality of life, anxiety, and parental internalizing problems seem specific comorbid complaints for FAP. Future research on parental internalizing problems, quality of life, and anxiety as risk factors for FAP is warranted.

Coping strategies and quality of life of adolescents with inflammatory bowel disease.

OBJECTIVE: This study aims to compare generic coping styles adopted by adolescents suffering from inflammatory bowel disease (IBD) to styles used by their healthy peers, and to assess the association between coping styles and health-related quality of life (HRQoL). METHODS: A generic coping style instrument, a disease-related coping style instrument and a disease-specific HRQoL instrument were administered to 65 adolescents (12-18 years old) with IBD. Normative data from the generic instrument were available. Mean domain scores of IBD patients were compared to normative scores. Multivariate linear regression analyses were performed on models with HRQoL domains as dependent, and preselected demographic and disease-related characteristics and coping styles as independent variables. RESULTS: Adolescents with IBD use more avoidant coping styles than their healthy peers. HRQoL is associated with disease-related coping styles and with disease activity. More use of a predictive coping style (having positive expectations about the disease) and less use of a depressive reaction pattern are associated with better HRQoL in three out of six HRQoL domains. CONCLUSION: This study suggests an association between coping styles and HRQoL.

The incidence of pediatric inflammatory bowel disease in the Netherlands: 1999-2001.

BACKGROUND: The incidence of inflammatory bowel disease (IBD) seems to be rising. Incidence studies could provide more insight into geographical differences and thereby lead to the identification of etiological factors. The aim of this study was to prospectively assess the incidence of pediatric IBD in the Netherlands from 1999 to 2001, using both an active physician case-reporting registry and a nationwide pathology database. METHODS: All pediatricians in the Netherlands were sent monthly identification cards to be returned if they had diagnosed a new case of IBD in a pediatric patient. Follow-up questionnaires were sent to physicians reporting new cases of IBD. The pathology database contains reports from all cytologic and histologic diagnoses made in the Netherlands. Two independent raters searched the database for new IBD cases. Cases identified from the pathology database were labeled as "probable IBD" and "possible IBD." Cases were cross-checked across databases on the basis of gender, date of birth, date of biopsy, and place of residence. Age-specific incidence rates were calculated for the Dutch population for the year 2000. RESULTS: Five hundred forty-six probable cases of IBD were identified; 217 cases were labeled as possible. The incidence rate was 5.2 new cases per 100000 children (<18 years) per year. An increase in incidence with age was observed. Only 24% of the cases were ascertained through the clinical registry. CONCLUSION: The incidence of IBD cases in the Netherlands is comparable with that reported in other European countries. Epidemiological studies using case reporting by physicians may be underestimates of true incidence rates.

A critical assessment of items on the Pediatric Crohn's Disease Activity Index.

OBJECTIVES: Questions have been raised about the discriminative value of the three laboratory items (hematocrit, erythrocyte sedimentation rate, and albumin) and three physical items (height, perirectal disease, and extraintestinal manifestations) included in the Pediatric Crohn's Disease Activity Index (PCDAI). The aim of this study was to analyze the value of these six "criticized" items to the discriminative properties of the PCDAI. METHODS: Data from 71 children with Crohn's disease visiting an outpatient clinic were analyzed. Physician global assessment of disease activity was used as the gold standard. A "basic index" was calculated by subtracting the score of the six criticized items from the score of the PCDAI calculated in the standard fashion. Multivariate logistic regression procedures identified which items significantly contributed to the "basic index". Receiver operating characteristic curves were produced comparing the standard PCDAI score to the "basic index" and a new "clinical index" which included only the criticized items truly contributing to the discriminatory ability of the "basic index". RESULTS: Logistic regression models identified only perirectal disease as contributing to the discriminative abilities of the basic index. The clinical index therefore consists of the three history items (abdominal pain, number of liquid stools, and general well-being), three physical examination items (weight loss, abdominal examination, and perirectal disease) and no laboratory tests. The clinical index had an area under the curve not significantly inferior to that of the original PCDAI (0.93 [95% confidence interval, 0.89-0.99] vs. 0.96 [95% confidence interval, 0.92-0.99]). CONCLUSIONS: A clinical index consisting of three history items and three physical examination items has an accuracy equal to the standard PCDAI in distinguishing children with disease in remission from those with a relapse.

Quality of life in paediatric inflammatory bowel disease measured by a generic and a disease-specific questionnaire.

UNLABELLED: This study assessed the impact of inflammatory bowel disease (IBD) on the health-related quality of life (HRQoL) of children and adolescents, using both a generic and a disease-specific instrument. Three questionnaires were sent to all patients (8-18 y old) from the database of two large secondary/tertiary hospitals in the western part of The Netherlands. In total, 83 (66%) children responded, 18 were between 8 and 12 y old and the remaining 65 were older. HRQoL was measured using a generic instrument, the TNO-AZL Children's Quality of Life questionnaire (TACQOL), assessing seven domains, and the Impact-II (NL), a disease-specific instrument assessing six domains. Disease activity was measured by a five-item symptom card. Compared with scores from a large reference population (n= 1810), younger children with IBD had a comparable HRQoL (measured by the TACQOL) on six domains, and better cognitive functioning, although they did not have severely active disease. Adolescent patients with IBD had a significantly impaired HRQoL on four domains (body complaints, motor functioning, autonomy and negative emotions). The Impact-II discriminated well between patients with varying disease activity states on all domains. CONCLUSION: Adolescents with IBD have a severely affected HRQoL. Impairment on motor functioning and autonomy is a threat to gaining independence from caregivers, and a high occurrence of negative emotions places patients at risk for depressive and behavioural disorders. The Impact-II is recommended for clinical use because of its high discriminative validity.