A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children

Rita Cerutti, Valentina Spensieri, Carmela Valastro, Fabio Presaghi, Roberto Canitano, Vincenzo Guidetti, Rita Cerutti, Valentina Spensieri, Carmela Valastro, Fabio Presaghi, Roberto Canitano, Vincenzo Guidetti

Abstract

Introduction: Somatic symptoms are frequently reported by children with significant impairment in functioning. Despite studies on adult populations that suggest somatic symptoms often co-occur with difficulties in identifying and describing feelings, little research has been done in childhood. This study aimed to investigate the prevalence and frequency of somatic symptoms as well as to investigate the functional impairment in children with high number of self reported somatic symptoms versus those with fewer somatic symptoms. Additionally the parental perception of their children's somatic symptoms and functioning was explored. Finally, we explored the direct and indirect effects of difficulties in identifying feelings in predicting somatic symptoms and functional disability among school-aged children.

Methods: 356 Italian school-aged children and their mothers participated in this study. Children (mean age = 11.43; SD = 2.41) completed the Children's Somatization Inventory (CSI-24) to assess somatic symptoms, the Functional Disability Inventory (FDI) to assess physical and psychosocial functioning and the Alexithymia Questionnaire for Children (AQC) to evaluate alexithymic features. Mothers completed the parental forms of the CSI and the FDI.

Results: Among children, 66.3% did not declare somatic symptoms and 33.7% reported one or more somatic symptoms in the last two weeks. A significant positive correlation emerged between children's and mothers' CSI total scores. Both children's and mothers' FDI total scores were significantly correlated with CSI scores. A significant correlation was observed between somatic symptoms and alexithymic features. Furthermore, the data showed that somatic symptoms mediated the relationship between difficulties in identifying feelings and functional impairment. Finally, it was showed that alexithymia facet of difficulty in identifying feelings contributed in large part to the prediction of the somatic symptomatology (b = 0.978, p < 0.001; R2 = 0.164, F(5, 350) = 10.32, p < 0.001).

Conclusions: Findings from this study provide evidence that a higher frequency of somatic symptoms is associated with functional disabilities and alexithymic facets in school-aged children.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Cerutti R, Presaghi F, Spensieri V, Valastro C, Guidetti V. The Potential Impact of Internet and Mobile Use on Headache and Other Somatic Symptoms in Adolescence. A Population-Based Cross-Sectional Study. Headache 2016; 56(7): 1161–70. 10.1111/head.12840
    1. Escobar JI, Hoyos-Nervi C, Gara M. Medically Unexplained Physical Symptoms in Medical Practice: A Psychiatric Perspective. Environ Health Perspect 2002; 110(4): 631–6.
    1. Geist R, Weinstein M, Walker L, Campo JV. Medically unexplained symptoms in young people: The doctor's dilemma. Paediatr Child Health 2008; 13(6): 487–91.
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing; 2013.
    1. Schulte IE, Petermann F. Somatoform disorders: 30 years of debate about criteria! What about children and adolescents? J Psychosom Res 2011; 70: 218–28. 10.1016/j.jpsychores.2010.08.005
    1. Arruda MA, Guidetti V, Galli F, Albuquerque RC, Bigal ME Primary headaches in childhood-a population-based study. Cephalalgia 2010; 30(9): 1056–64. 10.1177/0333102409361214
    1. Klineberg E, Rushworth A, Bibby H, Bennett D, Steinbeck K, Towns S. Adolescent chronic fatigue syndrome and somatoform disorders: a prospective clinical study. J Paediatr Child Health 2014; 50(10): 775–81. 10.1111/jpc.12653
    1. Cerutti R, Presaghi F, Spensieri V, Valastro C, Guidetti V. The Potential Impact of Internet and Mobile Use on Headache and Other Somatic Symptoms in Adolescence. A Population-Based Cross-Sectional Study. Headache 2016; 56(7): 1161–70. 10.1111/head.12840
    1. Bisht J, Sankhyan N, Krishan Kaushal R, Sharmi RC, Grover N. Clinical profile of pediatric somatoform disorders. Indian Pediatr 2007; 45: 111–5.
    1. Imran N, Ani C, Mahmood Z, Hassan KA, Bhatti MR. Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: a case-control study. J Psychosom Res 2014; 76(2): 105–12. 10.1016/j.jpsychores.2013.11.016
    1. Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, et al. Headache and comorbidity in children and adolescents. J Headache Pain 2013; 14: 1–11.
    1. Modestin J, Furrer R, Malti T. Study on alexithymia in adult non-patients. J Psychosom Res 2004; 56(6): 707–9. 10.1016/S0022-3999(03)00125-9
    1. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia. J Psychosom Res 2004; 57: 239–47. 10.1016/S0022-3999(03)00613-5
    1. Kooiman CG, Bolk JH, Brand R, Trijsburg RW, Rooijmans HGM. Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients? Psychosom Med 2000; 62: 768–78.
    1. Sifneos PE. The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom 1973; 22: 255–62.
    1. Jellesma F, Rieffe C, Meerum Terwogt M, Westenberg P. Do I feel sadness, fear or both? Comparing self-reported alexithymia and emotional task-performance in children with many or few somatic complaints. Psychol Health 2009; 24: 881–93. 10.1080/08870440801998970
    1. Nemzer E. Somatoform disorders. Child and Adolescent Psychiatry: A Comprehensive Textbook. 2nd Ed. Lippincott Williams and Wilkins, Baltimore, MD; 1996.
    1. Garber J, Walker LS, Zeman J. Somatization symptoms in a community sample of children and adolescents: Further validation of the Children’s Somatization Inventory. Psychol Assess 1991; 3(4): 588–95.
    1. Garber J, Van Slyke DA, Walker LS. Concordance between mothers’ and children’s reports of somatic and emotional symptoms in patients with recurrent abdominal pain or emotional disorders. J Abnorm Child Psychol 1998; 26: 381–91.
    1. Litcher L, Bromet E, Carlson G, Gilbert T, Panina N, Golovakha E, et al. Ukrainian application of the Children’s Somatization Inventory: Psychometric properties and associations with internalizing symptoms. J Abnorm Child Psychol 2001; 29: 165–75.
    1. Meesters C, Muris P, Ghys A, Reumerman T, Rooijmans M. The Children’s Somatization Inventory: Further evidence for its reliability and validity in a pediatric and a community sample of Dutch children and adolescents. J Pediatr Psychol 2003; 28: 413–22.
    1. Pirinen T, Kolho KL, Simola P, Ashorn M, Aronen ET. Parent–adolescent agreement on psychosocial symptoms and somatic complaints among adolescents with inflammatory bowel disease. Acta Paediatr 2011; 101(4): 433–7. 10.1111/j.1651-2227.2011.02541.x
    1. Walker LS, Greene JW. Children with recurrent abdominal pain and their parents: More somatic complaints, anxiety, and depression than other patient families? J Pediatr Psychol 1989; 14: 231–43.
    1. Eisenberg N, Valiente C, Morris AS, Fabes RA, Cumberland A, Reiser M, et al. Longitudinal relations among parental emotional expressivity, children's regulation, and quality of socioemotional functioning. Dev Psychol 2003; 39(1): 3–19.
    1. Walker LS, Garber J, Greene JW. Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization. J Abnorm Child Psychol 1991; 19: 379–94.
    1. Walker LS, Garber J. Children’s somatization inventory: preliminary manual. Vanderbilt University Medical Center, Nashville; 1992.
    1. Walker LS, Beck JE, Garber J, Lambert W. Children's Somatization Inventory: psychometric properties of the revised form (CSI-24). J Pediatr Psychol 2009; 34(4): 430–40. 10.1093/jpepsy/jsn093
    1. Allen LB, Lu Q, Tsao JCI, Hayes LP, Zeltzer LK. Depression partially mediates the relationship between alexithymia and somatization in a sample of healthy children. J Health Psychol 2011; 16(8): 1177–86. 10.1177/1359105311402407
    1. Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991; 16: 39–58.
    1. Rieffe C, Oosterveld P, Terwogt MM. An alexithymia questionnaire for children: Factorial and concurrent validation results. Personality Individ Differ 2006; 40(1): 123–33.
    1. Di Trani M, Tomassetti N, Bonadies M, Capozzi F, De Gennaro L, Presaghi F, et al. Un Questionario Italiano per l’Alessitimia in Età Evolutiva: struttura fattoriale e attendibilità. Psicologia della Salute 2009; 2: 131–43.
    1. Bagby RM, Taylor GJ, Parker JD. The Twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994; 38(1): 33–40.
    1. Kashikar-Zuck S, Flowers SR, Lewis Claar R, Guite JW, Logan DE, Lynch-Jordan AM, et al. Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain. Pain 2011; 152: 1600–7. 10.1016/j.pain.2011.02.050
    1. Campo JV. Annual Research Review: Functional somatic symptoms and associated anxiety and depression–developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53(5): 575–92. 10.1111/j.1469-7610.2012.02535.x
    1. Zolog TC, Jane-Ballabriga MC, Bonillo-Martin A, Canals-Sans J, Hernandez-Martinez C, Romero-Acosta K. Somatic complaints and symptoms of anxiety and depression in a school-based sample of preadolescents and early adolescents. functional impairment and implications for treatment. Journal of Evidence-Based Psychotherapies 2011; 11(2): 191–08.
    1. Konijnenberg A.Y., Uiterwaal C., Kimpen J., van der Hoeven J., Buitelaar J., de Graeff-Meeder E. Children with unexplained chronic pain: Substantial impairment in everyday life. Archives of Disease in Childhood 2005, 90(7): 680–686. 10.1136/adc.2004.056820
    1. van de Putte E. M., Engelbert R. H., Kuis W., Kimpen J. L., Uiterwaal C. How fatigue is related to other symptoms. Archives of Disease in Childhood 2006, 91:824–827. 10.1136/adc.2006.094623
    1. Claar RL, Walker LS. Functional assessment of pediatric pain patients: Psychometric properties of the Functional Disability Inventory. Pain 2006; 121: 77–84. 10.1016/j.pain.2005.12.002
    1. Andresen JM, Woolfolk RL, Allen LA, Fragoso MA, Younggerman NL, Patrick-Miller TJ, et al. Physical Symptoms and Psychosocial Correlates of Somatization in Pediatric Primary Care. Pedriat 2011; 50: 904–9.
    1. Moreno MA, Furtner F, Rivara FP. Functional Abdominal Pain in Children and Adolescents. JAMA Pediatr 2013; 167 (2): 204 10.1001/jamapediatrics.2013.1665
    1. Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S et al. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PLoS One 2014; 9(3): e90984 10.1371/journal.pone.0090984
    1. Picardi A, Porcelli P, Mazzotti E, Fassonea G, Lega I, Ramieri L, et al. Alexithymia and global psychosocial functioning: A study on patients with skin disease. J Psychosom Res 2007; 62: 223–9. 10.1016/j.jpsychores.2006.09.002
    1. Helmers KF, Mente A. Alexithymia and health behaviors in healthy male volunteers. J Psychosom Res 1999; 47(6): 635–45.
    1. Conrad R, Wegener I, Imbierowicz K, Liedtke R, Geiser F. Alexithymia, temperament and character as predictors of psychopathology in patients with major depression. Psychiatry Res 2009; 165(1–2): 137–44. 10.1016/j.psychres.2007.10.013
    1. Grabe HJ, Spitzer C, Freyberger HJ. Alexithymia and personality in relation to dimensions of psychopathology. Am J Psychiatry 2004; 161: 1299–301. 10.1176/appi.ajp.161.7.1299

Source: PubMed

3
Abonnere