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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders. World J Clin Pediatr 2025; 14:103323. [DOI: 10.5409/wjcp.v14.i2.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/14/2024] [Accepted: 01/02/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.
AIM To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.
METHODS A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.
RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children’s vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.
CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin K Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 26671, Bahrain
- Medical Microbiology Section, Department of Pathology, The Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel S Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Gaylord-Harden NK, Gilreath T, Burnside A, Mintah P, Lindsey MA. Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:878-892. [PMID: 37418319 DOI: 10.1080/15374416.2023.2222395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms. METHOD A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms. RESULTS Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another. CONCLUSIONS The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.
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Affiliation(s)
| | - Tamika Gilreath
- Center for Health Equity and Evaluation Research, Texas A&M University
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Nilsen M, Weider S, Halse MK, Fiskum C, Wichstrøm L. Association of anxiety and depression to headache, abdominal- and musculoskeletal pain in children. FRONTIERS IN PAIN RESEARCH 2023; 4:1136145. [PMID: 37122816 PMCID: PMC10132025 DOI: 10.3389/fpain.2023.1136145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
The comorbidity between recurrent pain, anxiety, and depression among children is frequent and well documented. However, only a few studies of the predictive effect of anxiety and depression on pain have adjusted for symptoms of the other disorder when examining the respective relations to different pain locations, rendering the unique contribution from anxiety and depression undetermined. In the current investigation we explore the strength of associations between pain at different locations with symptoms of anxiety and depression in a community sample of 10-year-old children (n = 703). The children were interviewed about the frequency of pain during the last 3 months. Parents and children were interviewed separately about symptoms of anxiety and depression using a semi-structured diagnostic interview. Results of three multivariate regression models for each of headache, abdominal and musculoskeletal pain revealed that depression was associated with musculoskeletal pain and headache, whereas anxiety was not. The associations for depression were not significantly stronger compared to anxiety. Gender-specific models found that depression was related to headache only among girls, but the association was not statistically different compared to boys. These results may, in turn, influence our interpretation of different forms of pain in children, with less weight given to abdominal symptoms viewed as a strong correlate with psychological problems, compared to for instance headache. The results provided no clear support for neither a differential relationship between anxiety and pain and depression and pain nor gender differences.
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Affiliation(s)
- Marianne Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Correspondence: Marianne Nilsen
| | - Siri Weider
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Kathrine Halse
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Fiskum
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Mental Health, St. Olav’s Hospital, Trondheim, Norway
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Rejer I, Wacewicz D, Schab M, Romanowski B, Łukasiewicz K, Maciaszczyk M. Stressors Length and the Habituation Effect-An EEG Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:6862. [PMID: 36146211 PMCID: PMC9505843 DOI: 10.3390/s22186862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
The research described in this paper aimed to determine whether people respond differently to short and long stimuli and whether stress stimuli repeated over time evoke a habituation effect. To meet this goal, we performed a cognitive experiment with eight subjects. During this experiment, the subjects were presented with two trays of stress-inducing stimuli (different in length) interlaced with the main tasks. The mean beta power calculated from the EEG signal recorded from the two prefrontal electrodes (Fp1 and Fp2) was used as a stress index. The main results are as follows: (i) we confirmed the previous finding that beta power assessed from the EEG signal recorded from prefrontal electrodes is significantly higher for the STRESS condition compared to NON-STRESS condition; (ii) we found a significant difference in beta power between STRESS conditions that differed in length-the beta power was four times higher for short, compared to long, stress-inducing stimuli; (iii) we did not find enough evidence to confirm (or reject) the hypothesis that stress stimuli repeated over time evoke the habituation effect; although the general trends aggregated over subjects and stressors were negative, their slopes were not statistically significant; moreover, there was no agreement among subjects with respect to the slope of individual trends.
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Ivaki P, Schulz S, Jeitler M, Kessler CS, Michalsen A, Kandil FI, Nitzschke SM, Stritter W, Voss A, Seifert G. Effects of yoga and mindfulness practices on the autonomous nervous system in primary school children: A non-randomised controlled study. Complement Ther Med 2021; 61:102771. [PMID: 34450257 DOI: 10.1016/j.ctim.2021.102771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 05/31/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The present study examined the effects of a yoga and mindfulness-based programme on the autonomic nervous system of primary school children by using heart rate variability parameters. DESIGN A two-arm non-randomised controlled trial compared an integrated yoga and mindfulness-based programme (16 weeks) to conventional primary school lessons. SETTING Primary school classrooms and conference rooms. INTERVENTIONS Participants were allocated to a 16-week integrated yoga-based programme or conventional school lessons. A subgroup was randomised to receive 24h electrocardiogram-recordings. MAIN OUTCOME MEASURES Heart rate variability indices were measured, both linear (time and frequency domain) and non-linear (symbolic dynamics, compression entropy), calculated from 30-minute extracts of Holter-electrocardiogram-recordings. Assessments were conducted at baseline and at the end of intervention. RESULTS 40 participants (42.5% female) were included into the analysis of HRV. No significant changes in heart rate variability parameters were observed between the groups after 16 weeks. In the intervention group, a trend towards increased parasympathetic activity could be seen over time, although not significantly enhanced compared to the control group. CONCLUSION Results obtained here do not clearly show that children in German primary school settings benefit from an integrated yoga-based intervention. However, exploratory post-hoc analyses point interestingly to an increased nocturnal parasympathetic activity in the intervention group. Further studies are required with high-quality study designs, larger sample sizes and longer-term follow-ups.
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Affiliation(s)
- Pune Ivaki
- Department of Paediatrics, Division of Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Steffen Schulz
- Department of Paediatrics, Division of Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital, Königstraße 63, 14109 Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital, Königstraße 63, 14109 Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Internal and Integrative Medicine, Immanuel Hospital, Königstraße 63, 14109 Berlin, Germany
| | - Farid I Kandil
- Department of Paediatrics, Division of Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Saskia-Marie Nitzschke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wiebke Stritter
- Department of Paediatrics, Division of Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Voss
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, Jena, Germany
| | - Georg Seifert
- Department of Paediatrics, Division of Oncology and Haematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Instituto de Tratamento do Câncer Infantil (ITACI), São Paulo, São Paulo, Brazil.
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Nelson S, Burns M, Logan D. The Clinical Utility of a Brief Psychological Stress Measure (Patient-Reported Outcomes Measurement Information System) in Youth with Chronic Pain. PAIN MEDICINE 2021; 22:91-99. [PMID: 32914177 DOI: 10.1093/pm/pnaa263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To preliminarily examine the psychometric properties (i.e., internal consistency reliability, construct validity) and clinical utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) psychological stress experiences scale in a sample of youth with chronic pain. METHODS Participant data were gathered from an institutional review board (IRB) approved clinical data registry. One hundred sixty-eight children and adolescents (age: mean = 14.97, SD = 2.78) with chronic pain presenting to a tertiary pain treatment clinic were included in the data set. Internal consistency estimates (i.e., Cronbach's alpha), bivariate correlations, and confirmatory factor analyses were performed to preliminarily examine reliability and validity. Multivariate regression analyses were performed to examine the associations between PROMIS psychological stress and pain-related and psychosocial outcomes. RESULTS Confirmatory factor analysis and correlational results indicated that the PROMIS psychological stress experiences scale shows promising reliability and validity in the current sample of youth with chronic pain. Additionally, the results indicated that almost 50% of youth with chronic pain report "high" or "very high" stress (T ≥ 60) and significantly higher rates of stress when compared with national validation samples (P < 0.001). The results also indicated that the PROMIS psychological stress experiences scale was significantly associated with both pain-related and psychosocial outcomes (all P <0.01). CONCLUSIONS The PROMIS psychological stress experiences scale shows promising psychometric properties in youth with pediatric pain and may be useful in assessing for psychological impairment. Future research should further examine the use of this brief measure to assess psychological stress in medical clinics as a way to enhance intervention and prevention efforts in these youth.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen Burns
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Fenelon A. Does Public Housing Increase the Risk of Child Health Problems? Evidence from Linked Survey-Administrative Data. HOUSING POLICY DEBATE 2021; 32:491-505. [PMID: 35832732 PMCID: PMC9272982 DOI: 10.1080/10511482.2021.1905027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/15/2021] [Indexed: 06/15/2023]
Abstract
Research on the effects of major federal housing assistance programs on children's outcomes has produced mixed results. Although housing assistance programs provide one of the few sources of affordable and stable housing for low-income families, there remains concern that living in public housing developments increases the risk of poor health for children. This paper uses a unique survey-administrative linked dataset to examine the effect of living in public housing on children's risk of health problems, including frequent diarrhea, frequent headaches, skin allergies, asthma, and fair/poor health status. Children living in public housing have substantially more health problems than children who do not live in public housing. However, the analysis develops several additional comparison groups to demonstrate that the excess health problems reflect unobserved selection into public housing. The main selection adjustment compares children living in public housing to children who enter public housing in the near future. Results indicate that public housing does not increase the risk of child health problems, and it is important to consider the substantial selection into public housing on factors that are likely to be correlated with children's outcomes. The broad effects of public housing may be mixed, but policymakers should not confuse the economic and health challenges of public housing residents for the effects of the program itself.
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Affiliation(s)
- Andrew Fenelon
- School of Public Policy and Department of Sociology and Criminology, Penn State University, University Park, 331 Pond Lab, University Park, PA 16801
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Maier T, Kugelmann M, Rhee DS, Brill S, Gündel H, Friemert B, Becker HP, Waller C, Rappel M. Structural Equation Modeling of a Global Stress Index in Healthy Soldiers. J Clin Med 2021; 10:jcm10081799. [PMID: 33924268 PMCID: PMC8074902 DOI: 10.3390/jcm10081799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of acute and chronic stress from childhood to adult life. One-hundred and ninety-two female and male soldiers completed the Perceived Stress Scale (PSS4), Trier Inventory for Chronic Stress (TICS), Hospital Anxiety and Depression Scale (HADS), Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale Checklist (PDS), and the Deployment Risk and Resilience Inventory (DRRI-2). The underlying structure for the GSI was examined through structural equation modeling. The final hierarchical multilevel model revealed fair fit by taking modification indices into account. The highest order had a g-factor called the GSI. On a second level the latent variables stress, HADS and CTQ were directly loading on the GSI. A third level with the six CTQ subscales was implemented. On the lowest hierarchical level all manifest variables and the DRRI-2/PDS sum scores were located. The presented GSI serves as a valuable and individual stress profile for soldiers and could potentially complement classical cardiovascular risk factors.
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Affiliation(s)
- Tanja Maier
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Correspondence:
| | - Melanie Kugelmann
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | - Dae-Sup Rhee
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | - Harald Gündel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | | | - Christiane Waller
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University of Nueremberg, 90419 Nueremberg, Germany
| | - Manuela Rappel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
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Gulewitsch MD, Jusyte A, Weimer K, Schönenberg M. Does Social Exclusion Alter Sensory and Pain Thresholds in Children and Adolescents with Functional Abdominal Pain? - Results from a Preliminary Study. PAIN MEDICINE 2020; 20:1472-1478. [PMID: 30544137 DOI: 10.1093/pm/pny266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Functional abdominal pain (AP) is a prevalent issue in childhood and adolescence. The contribution of psychosocial factors in the development and maintenance of this health problem is rather unclear, and experimental studies about underlying mechanisms are lacking. This study investigates whether experimentally induced social exclusion decreases sensory and pain thresholds in children suffering from AP. SUBJECTS Twenty children/adolescents with AP and 22 healthy controls. METHODS Children/adolescents participated in the Cyberball paradigm, which affects an experience of social exclusion. Thermal sensory and pain thresholds were measured before and after Cyberball. RESULTS Children/adolescents with AP showed a divergent reaction regarding their sensory threshold after social exclusion: The control group exhibited a tendency toward a decreased sensory threshold whereas the AP group remained stable. Concerning the pain threshold, no effect of social exclusion could be identified. The increase of both thresholds ("numbing") after Cyberball was positively correlated with symptoms of mental health issues. CONCLUSIONS This is the first study to investigate changes in sensory and pain thresholds following painful social interactions in a sample of children/adolescents with a chronic pain condition. Results suggest that AP and control children differ in their reaction of sensory thresholds, which might indicate an altered processing of social exclusion. Replication and further methodological improvements are needed.
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Affiliation(s)
| | - Aiste Jusyte
- LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Burnside AN, Gaylord-Harden NK. Hopelessness and Delinquent Behavior as Predictors of Community Violence Exposure in Ethnic Minority Male Adolescent Offenders. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:801-810. [PMID: 30294761 DOI: 10.1007/s10802-018-0484-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Justice-involved boys from urban communities are disproportionately impacted by community violence exposure (ECV) and despite decades of research, rates of ECV in youth continue to increase particularly for youth involved in the juvenile justice system. Despite the increased risk of exposure, the majority of research focuses on what may protect youth from the deleterious outcomes associated with violence exposure, rather than strategies that may prevent the violence exposure from occurring. The current study seeks to shift the focus of research in this area to examining factors that may predict future violence exposure. Specifically, the purpose of the current study is to examine the role of hopelessness as a predictor of the risk for violence exposure in a sample of 831 justice-involved, urban boys ages 14-18 (52.2% African American, 42.1% Hispanic, 5.7% other). Results revealed that baseline levels of low aspirations and hopelessness towards the future indirectly predicted violence exposure 1 year later through engagement in delinquent behavior. Clinical implications for targeting youth with elevated risk and preventing future violence exposure are discussed.
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Affiliation(s)
- Amanda N Burnside
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL, 60660, USA.
| | - Noni K Gaylord-Harden
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL, 60660, USA
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Nelson S, Burns M, McEwen B, Borsook D. Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain. Brain Behav Immun Health 2020; 5:100095. [PMID: 34589863 PMCID: PMC8474662 DOI: 10.1016/j.bbih.2020.100095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen's model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.
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Affiliation(s)
- Sarah Nelson
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Maureen Burns
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
| | | | - David Borsook
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Anesthesia, Harvard Medical School, USA
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12
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Black’s Coping Responses to Racial Stress. J Racial Ethn Health Disparities 2020; 7:609-618. [DOI: 10.1007/s40615-019-00690-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/27/2019] [Accepted: 12/27/2019] [Indexed: 11/27/2022]
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Gollub EL, Green J, Richardson L, Kaplan I, Shervington D. Indirect violence exposure and mental health symptoms among an urban public-school population: Prevalence and correlates. PLoS One 2019; 14:e0224499. [PMID: 31774835 PMCID: PMC6881142 DOI: 10.1371/journal.pone.0224499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022] Open
Abstract
Available literature identifies the need for a deeper understanding of the role of gender, age and socioeconomic status in children's exposure to violence and associations with mental health (MH) outcomes. The 1548 participants for this study were enrolled from 28 public charter schools and 9 community-based settings; youth were administered a screener that assessed exposure to traumatic events and symptoms of post-traumatic stress disorder (PTSD) and depression. Respondents reported extremely high levels of exposure to indirect violence: 41.7% witnessed shooting/stabbing/beating; 18.3% witnessed murder; and 53.8% experienced the murder of someone close. Frequency of adverse MH outcomes was high: 21.2% screened positive for depression; 45.7% for lifetime PTSD; and 26.9% for current PTSD. More males than females reported witnessing shooting/stabbing/beating (p = .04); females more often reported experiencing the murder of someone close (p = .001). Indirect violence exposure generally increased with age. Youth attending schools with ≥90% free/reduced lunch participation (FRLP) showed significantly higher levels of violence exposure compared to youth in schools with <90% FRLP. Females endorsed significantly higher levels of depression (21.4% vs. 9.7%), and lifetime (53.9% vs. 34.9%) and current (32.5% vs. 19.6%) PTSD, compared with males (p < .0001, all comparisons). Female sex (aOR = 2.6), FRLP (aOR = 1.4 for ≥90% vs. <90%) and the number of different indirect violence exposures (aORs from 1.3 to 10.4), were significantly associated with a positive screen for any adverse MH outcome. Our data add important insights into gender heterogeneity of viewed violence, mental health symptoms, and their association-all of which are critical to guiding effective intervention efforts.
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Affiliation(s)
- Erica L. Gollub
- Health Science Program, College of Health Professions, Pace University, Pleasantville, NY, United States of America
| | - Jakevia Green
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
| | - Lisa Richardson
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
| | - Ilyssa Kaplan
- Department of Psychology, Pace University, New York, NY, United States of America
| | - Denese Shervington
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
- Charles R. Drew School of Medicine and Science, Psychiatry and Behavioral Sciences, Los Angeles, CA, United States of America
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14
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Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav 2019; 9:e01360. [PMID: 31339236 PMCID: PMC7649956 DOI: 10.1002/brb3.1360] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Medical students are in a very demanding environment and are affected by high degree of stress. High levels of anxiety can affect a student's academic performance and also increase the risk of other health-related problems. This study aims to evaluate, thanks to the intensity of stress manifestations (4DSQ) together with the sense of coherence (SOC), the prevalence of TMD and oral parafunctions in students enrolled in the University of Medical Sciences. Moreover, it aims to evaluate the relationship between the psychosocial manifestations of stress and sense of coherence in relation to gender. MATERIALS AND METHODS A total of 324 students of Poznań University of Medical Sciences participated in this study. Students were assessed using a three-part questionnaire: one was to assess symptoms of TMD, the second part was 4DSQ, and the third was a SOC Questionnaire. RESULTS About one-third of the students in this study presented symptoms of TMD and perceived more intensively symptoms of distress, anxiety, somatization, and depression. They presented a higher level of somatic symptoms and a lower level of Sense of Coherence than students without TMD symptoms. CONCLUSION There is a strong negative relationship between the sense of coherence and the level of perceived distress, anxiety, somatization, and depression. Female students attending Medical School showed a higher level of somatization of stress but with a higher capacity to overcome challenges as compared to men.
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Affiliation(s)
- Anna Sójka
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
| | - Bogusław Stelcer
- Department of Clinical PsychologyPoznań University of Medical SciencesPoznanPoland
| | - Marco Roy
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
| | - Ewa Mojs
- Department of Clinical PsychologyPoznań University of Medical SciencesPoznanPoland
| | - Mariusz Pryliński
- Department of ProsthodonticsPoznań University of Medical SciencesPoznanPoland
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15
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Chung JE, Song G, Kim K, Yee J, Kim JH, Lee KE, Gwak HS. Association between anxiety and aggression in adolescents: a cross-sectional study. BMC Pediatr 2019; 19:115. [PMID: 30999891 PMCID: PMC6471775 DOI: 10.1186/s12887-019-1479-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background The purpose of this study was to investigate the relationship between anxiety proneness and aggressive behavior in adolescents. Methods A quantitative, large scale cross-sectional study was conducted in Korea. The survey questionnaire included general health behavior and scales for assessing anxiety (Revised Children’s Manifest Anxiety Scale; RCMAS) and aggressive behavior (The Aggression Questionnaire; AQ) in adolescents. Results A total of 2432 students participated in the survey, and 1933 individuals completed the questionnaire, indicating a response rate of 79.5%. Based on RCMAS, 163 (8.4%) subjects were classified as the anxiety group. Aggressive behavior was significantly associated with higher anxiety scores. In particular, among four subdomains of aggression, anger and hostility had a stronger relationship with anxiety than did physical and verbal aggression. Multivariate analysis demonstrated that anxiety was independently associated with gender, age, headache, constipation, asthma, and aggression score. Adolescents with total aggression scores of 69 or higher showed a 9-fold (AOR = 9.00, CI = 6.33–13.51) higher risk of anxiety compared to those with under 69. Conclusion Aggression and anxiety are important aspects of mental health in adolescents. Our results demonstrated that higher risk of anxiety was associated with total aggression scores. In particular, indirect aggression (i.e. anger and hostility) was more closely associated with anxiety than direct aggression.
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Affiliation(s)
- Jee Eun Chung
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, 15588, South Korea
| | - Gonjin Song
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-Gu, Seoul, 03760, South Korea
| | - Kitai Kim
- Department of Communication, Honam University, 417 Eodeung-daero, Gwangsan-gu, Gwangju, 62399, South Korea
| | - Jeong Yee
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-Gu, Seoul, 03760, South Korea
| | - Joo Hee Kim
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-Gu, Seoul, 03760, South Korea.,College of Pharmacy, Ajou University, 206 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju, 28160, South Korea.
| | - Hye Sun Gwak
- College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-Gu, Seoul, 03760, South Korea.
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16
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Vera EM, Vacek K, Coyle LD, Stinson J, Mull M, Doud K, Buchheit C, Gorman C, Hewitt A, Keene C, Blackmon S, Langrehr KJ. An Examination of Culturally Relevant Stressors, Coping, Ethnic Identity, and Subjective Well-Being in Urban, Ethnic Minority Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2156759x1101500203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study explored relations between culturally relevant stressors (i.e., urban hassles, perceived discrimination) and subjective well-being (SWB; i.e., positive/negative affect, life satisfaction) to examine whether ethnic identity and/or coping strategies would serve as moderators of the relations between stress and SWB for 157 urban, ethnic minority adolescents. Ethnic identity moderated the relation between perceived discrimination and life satisfaction. Self-distraction coping moderated the relation between urban hassles and negative affect. This article discusses implications for school counseling prevention and interventions.
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Affiliation(s)
| | | | - Laura D. Coyle
- Department of Psychology at Fayetteville State University, Fayetteville, NC
| | - Jennifer Stinson
- Department of Educational Psychology at the University of Houston
| | - Megan Mull
- School of Education, Loyola University Chicago
| | | | | | | | | | | | - Sha'kema Blackmon
- Department of Counseling, Educational Psychology, and Research, University of Memphis
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17
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18
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Björling EA, Singh N. Exploring Temporal Patterns of Stress in Adolescent Girls with Headache. Stress Health 2017; 33:69-79. [PMID: 27018460 DOI: 10.1002/smi.2675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/30/2016] [Accepted: 02/14/2016] [Indexed: 01/03/2023]
Abstract
As part of a larger study on perceived stress and headaches in 2009, momentary perceived stress, head pain levels and stress-related symptom data were collected. This paper explores a temporal analysis of the patterns of stress, as well as an analysis of momentary and retrospective stress-related symptoms compared by level of headache activity. Adolescent girls (N = 31) ages 14-18 were randomly cued by electronic diaries 7 times per day over a 21-day period responding to momentary questions about level of head pain, perceived stress and stress-related symptoms. Multivariate general linear modelling was used to determine significant differences among headache groups in relation to temporal patterns of stress. Significant headache group differences were found on retrospective and momentary stress-related symptom measures. A total of 2841 diary responses captured stress levels, head pain and related symptoms. The chronic headache (CH) group reported the highest levels of hourly and daily stress, followed by the moderate headache (MH) and low headache (LH) groups. Patterns of stress for the three headache groups were statistically distinct, illustrating increased stress in girls with more frequent head pain. This evidence suggests that because of increased stress, girls with recurrent head pain are likely a vulnerable population who may benefit from stress-reducing interventions. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elin A Björling
- Nursing and Healthcare Leadership Program, University of Washington-Tacoma, Tacoma, WA, USA
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19
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McKillop HN, Banez GA. A Broad Consideration of Risk Factors in Pediatric Chronic Pain: Where to Go from Here? CHILDREN (BASEL, SWITZERLAND) 2016; 3:E38. [PMID: 27916884 PMCID: PMC5184813 DOI: 10.3390/children3040038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 01/23/2023]
Abstract
Pediatric chronic pain is a significant problem associated with substantial functional impairment. A variety of risk factors have been found to be associated with chronic pain in youth. The greatest amount of evidence appears to support that temperament, anxiety, depression, subjective experience of stress, passive coping strategies, sleep problems, other somatic-related problems, and parent and/or family factors are important variables. However, a great deal of this research focuses on a single risk factor or on multiple risk factors in isolation. Much of the literature utilizes older diagnostic criteria and would benefit from replication, larger sample sizes, and comparison across pain disorders. Problems also exist with disagreement across definitions, resulting in inconsistency or unclear use of terms. Furthermore, recent consideration has suggested that outcome measures should include functional disability in addition to pain. A second generation of research is needed to shed light on the complex interactions that likely play a role in the transition from acute to chronic pain. Building on recent calls for changes in research in this area, we propose the next steps for this research, which involve consideration of both biopsychosocial and developmental contexts.
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Affiliation(s)
- Hannah N McKillop
- Case Western Reserve University, 11220 Bellflower Rd, Cleveland, OH 44106, USA.
| | - Gerard A Banez
- Cleveland Clinic Children's Hospital for Rehabilitation, Pediatric Pain Rehabilitation Program, CR 11/ 2801 MLK Jr. Drive, Cleveland, OH 44104, USA.
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20
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Bung S, Saile H, Laessle R. [Stress related correlates of anxiety and depression in girls with chronic headache]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 46:41-46. [PMID: 27873540 DOI: 10.1024/1422-4917/a000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic headache in adolescents is frequent and often associated with anxiety and depression. The present study investigated, whether psychological and physical stress symptoms have an infl uence on the occurrence of anxiety and depression and what is the role of stress coping. The sample consisted of 77 15 years old girls with chronic headache and 72 girls, who served as controls. Stress symptoms and stress coping were measured with the Stressverarbeitungsfragebogen für Kinder und Jugendliche (Coping with Stress Questionnaire for Children and Adolescents), depression was assessed by the Depression Inventory for Children and Adolescents, anxiety by the State-Trait Anxiety Inventory for Children. Linear regression was used to analyze the relationship between stress factors and anxiety resp. depression. Physical stress symptoms were related to anxiety, but not to depression. Coping strategies of the depressed as well as the anxious children were characterized by stress reinforcing behaviors. The results point to focusing on physical symptoms in the anxious headache patients and to avoidance coping in the depressed children.
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Affiliation(s)
- Simone Bung
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
| | - Helmut Saile
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
| | - Reinhold Laessle
- 1 Abteilung für Biologische und Klinische Psychologie, Universität Trier
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21
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Fife B, Forste R. Physical and social factors associated with early adolescent headache and stomachache pain. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0062/ijamh-2016-0062.xml. [PMID: 27665418 DOI: 10.1515/ijamh-2016-0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/14/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Approximately one third of adolescents in the United States report experiencing frequent headaches and stomachaches. We examined the association of psychosocial and physical factors with the report of weekly headaches or stomachaches using a representative sample of US teens. METHODS Data for this project are from the survey of Health Behavior in School-Aged Children (HBSC), 2005-2006, a nationally representative sample of students in grades 6-10 in the United States. The total sample includes 12,070 students aged 11-17. Using logistic regression we modeled chronic headache and stomachache separately with the same set of physical predictors (dieting and substance use habits) and psychosocial predictors (attitudes towards self-image, peers, and family) along with demographic controls. RESULTS Almost 20% of respondents experienced headaches weekly, and 12% experienced abdominal pain. Both physical and psychosocial factors were predictive of chronic symptoms. Increased substance usage and unhealthy eating practices were associated with the likelihood of experiencing both headaches and stomachaches. Negative self-image, family relationships, and school life were also predictive of symptom frequency. CONCLUSION Headaches and stomachaches are associated with poor eating and substance use habits, as well as problems with self-image or social relationships among adolescents. For health care professionals, a holistic approach is needed to effectively address symptoms and prevent long-term health problems.
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Affiliation(s)
- Benjamin Fife
- Department of Sociology, Brigham Young University, Provo, UT,United States of America
| | - Renata Forste
- Department of Sociology, Brigham Young University, Provo, UT,United States of America
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22
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Gaylord-Harden NK, So S, Bai GJ, Henry DB, Tolan PH. Examining the Pathologic Adaptation Model of Community Violence Exposure in Male Adolescents of Color. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:125-135. [PMID: 27653968 DOI: 10.1080/15374416.2016.1204925] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The current study examined a model of desensitization to community violence exposure-the pathologic adaptation model-in male adolescents of color. The current study included 285 African American (61%) and Latino (39%) male adolescents (W1 M age = 12.41) from the Chicago Youth Development Study to examine the longitudinal associations between community violence exposure, depressive symptoms, and violent behavior. Consistent with the pathologic adaptation model, results indicated a linear, positive association between community violence exposure in middle adolescence and violent behavior in late adolescence, as well as a curvilinear association between community violence exposure in middle adolescence and depressive symptoms in late adolescence, suggesting emotional desensitization. Further, these effects were specific to cognitive-affective symptoms of depression and not somatic symptoms. Emotional desensitization outcomes, as assessed by depressive symptoms, can occur in male adolescents of color exposed to community violence and these effects extend from middle adolescence to late adolescence.
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Affiliation(s)
| | - Suzanna So
- a Department of Psychology , Loyola University Chicago
| | - Grace J Bai
- a Department of Psychology , Loyola University Chicago
| | - David B Henry
- b Institute for Research and Policy , University of Illinois at Chicago
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23
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Kingery JN, Ginsburg GS, Alfano CA. Somatic Symptoms and Anxiety Among African American Adolescents. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798407307041] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Somatic symptoms are an associated feature of anxiety disorders that have received little research attention among non-White samples. In addition, the majority of previous studies have examined the influence of somatic symptoms in a cross-sectional rather than a prospective manner. This study examines the prevalence of 12 somatic symptoms, the association of somatic and anxiety symptoms (both concurrently and prospectively) with psychosocial functioning, and gender differences in somatic symptoms among a community sample of 114 African American adolescents (57 girls). In all, 83% of the sample reported at least one somatic symptom (some or most of the time within the past 2 weeks), and on average, adolescents reported 2.5 somatic symptoms. Somatic symptoms correlated positively with severity of anxiety symptoms and negatively with aspects of perceived competence. After the initial level of anxiety symptoms was controlled for, somatic symptoms were a unique predictor of perceived competence (at initial assessment) and anxiety symptoms (at 6-month follow-up). Overall, girls endorsed significantly more somatic symptoms than did boys. Findings replicate those of studies with White samples and suggest that somatic symptoms may be a risk factor for anxiety disorders among African American youth.
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24
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Gaylord-Harden NK, Dickson D, Pierre C. Profiles of Community Violence Exposure Among African American Youth: An Examination of Desensitization to Violence Using Latent Class Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:2077-101. [PMID: 25716195 DOI: 10.1177/0886260515572474] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The current study employed latent class analysis (LCA) to identify distinct profiles of community violence exposure and their associations to desensitization outcomes in 241 African American early adolescents (M age = 12.86, SD = 1.28) in the sixth through eighth grade from under-resourced urban communities. Participants self-reported on their exposure to community violence, as well as on depressive and anxiety symptoms. The LCA revealed three distinct classes: a class exposed to low levels of violence (low exposure class), a class exposed to moderately high levels of victimization (victimization class), and a class exposed to high levels of all types of violence (high exposure class). Consistent with predictions, the high exposure class showed the lowest levels of depressive symptoms, suggesting a desensitization outcome. Gender and age were also examined in relation to the classes, and age was significantly associated with an increased risk of being a member of the high exposure class relative to the low exposure class. Using person-based analyses to examine desensitization outcomes provides useful information for prevention and intervention efforts, as it helps to identify a specific subgroup of youth that may be more likely to show desensitization outcomes in the context of community violence.
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25
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Liang J, Matheson BE, Douglas JM. Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:1926-1940. [PMID: 27346929 PMCID: PMC4916917 DOI: 10.1007/s10826-015-0351-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Misdiagnoses of racial/ethnic minority youth's mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: 1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth's mental health problems are misdiagnosed? 2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included "race", "ethnicity", "minority", "culture", "children", "youth", "adolescents", "mental health", "psychopathology", "diagnosis", "misdiagnosis", "miscategorization", "underdiagnosis", and "overdiagnosis". Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth's emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.
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Affiliation(s)
- June Liang
- University of California, San Diego, Department of Pediatrics
| | - Brittany E. Matheson
- University of California, San Diego, Department of Pediatrics
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology
| | - Jennifer M. Douglas
- University of California, San Diego, Department of Pediatrics
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology
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26
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Kim J, Ahn H, Lyon DE, Stechmiller J. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients. Healthcare (Basel) 2016; 4:healthcare4010007. [PMID: 27417595 PMCID: PMC4934541 DOI: 10.3390/healthcare4010007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 12/10/2015] [Accepted: 12/28/2015] [Indexed: 01/15/2023] Open
Abstract
Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.
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Affiliation(s)
- Junglyun Kim
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Hyochol Ahn
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Debra E Lyon
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
| | - Joyce Stechmiller
- Department of Family, Community and Health System Science, University of Florida College of Nursing, P.O. BOX 100197, Gainesville, FL 32610-0197, USA.
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27
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Bian SZ, Jin J, Zhang JH, Li QN, Yu J, Yu SY, Chen JF, Yu XJ, Qin J, Huang L. Principal Component Analysis and Risk Factors for Acute Mountain Sickness upon Acute Exposure at 3700 m. PLoS One 2015; 10:e0142375. [PMID: 26554385 PMCID: PMC4640520 DOI: 10.1371/journal.pone.0142375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/21/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE We aimed to describe the heterogeneity in the clinical presentation of acute mountain sickness (AMS) and to identify its primary risk factors. METHODS The participants (n = 163) received case report form questionnaires, and their heart rate (HR), oxygen saturation (SpO2), echocardiographic and transcranial Doppler variables, ability to perform mental and physical work, mood and psychological factors were assessed within 18 to 22 hours after arriving at 3700 m from sea level (500 m) by plane. First, we examined the differences in all variables between the AMS-positive and the AMS-negative groups. Second, an adjusted regression analysis was performed after correlation and principal component analyses. RESULTS The AMS patients had a higher diastolic vertebral artery velocity (Vd; p = 0.018), a higher HR (p = 0.006) and a lower SpO2. The AMS subjects also experienced poorer sleep quality, as quantified using the Athens Insomnia Scale (AIS). Moreover, the AMS population exhibited more negative mood states, including anxiety, depression, hostility, fatigue and confusion. Five principal components focused on diverse aspects were also found to be significant. Additionally, more advanced age (p = 0.007), a higher HR (p = 0.034), a higher Vd (p = 0.014), a higher AIS score (p = 0.030), a decreased pursuit aiming capacity (p = 0.035) and decreased vigor (p = 0.015) were risk factors for AMS. CONCLUSIONS Mood states play critical roles in the development of AMS. Furthermore, an elevated HR and Vd, advanced age, elevated AIS sores, insufficient vigor and decreased mental work capacity are independent risk factors for AMS.
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Affiliation(s)
- Shi-Zhu Bian
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Ji-Hang Zhang
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qian-Ning Li
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Yu
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shi-Yong Yu
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jian-Fei Chen
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xue-Jun Yu
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jun Qin
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA; Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Kleiveland B, Natvig GK, Jepsen R. Stress, sense of coherence and quality of life among Norwegian nurse students after a period of clinical practice. PeerJ 2015; 3:e1286. [PMID: 26468439 PMCID: PMC4592150 DOI: 10.7717/peerj.1286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/11/2015] [Indexed: 11/20/2022] Open
Abstract
Background. Previous research has found that sense of coherence is significantly related to aspects of health, but studies on nurse students with a salutogenic approach are limited. Objectives. To investigate (1) if nurse students' experience of stress differs among clinical practice in nursing homes and medical/surgical wards. (2) Whether sense of coherence and stress are associated with quality of life. (3) If sense of coherence acts as a moderator in the relationship between stress and quality of life. Participants. Data were collected from 227 nurse students between January and April 2014. Methods. Questionnaires measuring stress, sense of coherence and quality of life were completed after a period of clinical practice. Linear regression analyses were used to measure associations between stress, and sense of coherence respectively, and quality of life. Results. The results showed that 33.92% of the students experienced moderate or high levels of stress, and there was significantly more stress in hospital wards compared to nursing homes (p = 0.027). Sense of coherence was positively associated with quality of life in the simple and multiple regression analyses (p < 0.01). Stress was negatively associated with quality of life in the simple regression analysis (p < 0.01), but not in the multiple analyses when sense of coherence was included. However, when we included an interaction term, stress was no longer associated with quality of life and sense of coherence appeared to be a significant moderator in the relationship between stress and quality of life (p = 0.015). Thus, a negative association was seen among students with the lowest levels of sense of coherence. Conclusion. These findings suggest that sense of coherence could be seen as a resource that nurse educators can build upon when supporting students in coping with stress.
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Affiliation(s)
- Benedicte Kleiveland
- Department of Global Public Health and Primary Care, University of Bergen , Bergen, Hordaland , Norway
| | - Gerd Karin Natvig
- Department of Global Public Health and Primary Care, University of Bergen , Bergen, Hordaland , Norway
| | - Randi Jepsen
- Faculty of Health Studies, Sogn og Fjordane University College , Førde , Norway ; Nykøbing F. Hospital, Region Zealand , Nykøbing F. , Denmark
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Koenig J, Oelkers-Ax R, Parzer P, Haffner J, Brunner R, Resch F, Kaess M. The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study. Child Adolesc Psychiatry Ment Health 2015; 9:32. [PMID: 26417388 PMCID: PMC4584487 DOI: 10.1186/s13034-015-0069-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND While several population-based studies report that pain is independently associated with higher rates of self-destructive behaviour (suicidal ideation, suicide attempts, and self-injurious behaviour) in adults, studies in adolescents are rare and limited to specific chronic pain conditions. The aim of this study was to investigate the link between self-reported idiopathic pain and the prevalence and frequency of self-injury (SI) and suicide attempts in adolescents. METHODS Data from a cross-sectional, school-based sample was derived to assess SI, suicide attempts, recurrent pain symptoms and various areas of emotional and behavioural problems via a self-report booklet including the Youth Self-Report (YSR). Adolescents were assigned to two groups (presence of pain vs. no pain) for analysis. Data from 5,504 students of 116 schools in a region of South Western Germany was available. A series of unadjusted and adjusted multinomial logistic regression models were performed to address the association of pain, SI, and suicide attempts. RESULTS 929 (16.88%) respondents reported recurrent pain in one of three areas of pain symptoms assessed (general pain, headache, and abdominal pain). Adolescents who reported pain also reported greater psychopathological distress on all sub-scales of the YSR. The presence of pain was significantly associated with an increased risk ratio (RR) for SI (1-3 incidences in the past year: RR: 2.96; >3 incidences: RR: 6.04) and suicide attempts (one attempt: RR: 3.63; multiple attempts: RR: 5.4) in unadjusted analysis. Similarly, increased RR was observed when adjusting for sociodemographic variables. While controlling for psychopathology attenuated this association, it remained significant (RRs: 1.4-1.8). Sub-sequent sensitivity analysis revealed different RR by location and frequency of pain symptoms. CONCLUSIONS Adolescents with recurrent idiopathic pain are more likely to report previous incidents of SI and suicide attempts. This association is likely mediated by the presence of psychopathological distress as consequence of recurrent idiopathic pain. However, the observed variance in dependent variables is only partially explained by emotional and behavioural problems. Clinicians should be aware of these associations and interview adolescents with recurrent symptoms of pain for the presence of self-harm, past suicide attempts and current suicidal thoughts. Future studies addressing the neurobiology underpinnings of an increased likelihood for self-injurious behaviour and suicide attempts in adolescents with recurrent idiopathic pain are necessary.
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Affiliation(s)
- Julian Koenig
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- />Department of Psychology, The Ohio State University, Columbus, OH USA
| | - Rieke Oelkers-Ax
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Johann Haffner
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Franz Resch
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- />Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Law EF, Beals-Erickson SE, Noel M, Claar R, Palermo TM. Pilot Randomized Controlled Trial of Internet-Delivered Cognitive-Behavioral Treatment for Pediatric Headache. Headache 2015; 55:1410-25. [PMID: 26316194 DOI: 10.1111/head.12635] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache. BACKGROUND Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet. METHODS We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-based management of adolescent pain. Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between 11 and 17 years of age, and had recurrent headache for 3 months or more as diagnosed by a pediatric neurologist. Eighty-three youths were enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days. RESULTS Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multilevel modelling (MLM) was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to 3-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, P < .001). However, there was no statistically significant difference between the Internet CBT group and the specialized headache treatment group at post-treatment or follow-up (group × time interaction F(2, 134) = 0.94, P = .395). For our secondary treatment outcomes, findings from MLM showed that adolescents in both groups demonstrated statistically significant improvement headache pain intensity, activity limitations, depressive symptoms, and parent protective behaviors from baseline to post-treatment and these gains were maintained at 3-month follow-up. Adolescent anxiety symptoms and sleep did not change during the study period for either group. There were no statistically significant group differences on any secondary outcomes at post-treatment or follow-up (P > .05 for all outcomes). No adverse events were reported. CONCLUSION Although adjunctive Internet CBT did not lead to additional benefit in this population, future research should evaluate whether it is an effective intervention for adolescents with headache who are unable to access specialized headache treatment.
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Affiliation(s)
- Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Sarah E Beals-Erickson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Melanie Noel
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
| | - Robyn Claar
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA
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Slavin-Spenny O, Lumley MA, Thakur ER, Nevedal DC, Hijazi AM. Effects of anger awareness and expression training versus relaxation training on headaches: a randomized trial. Ann Behav Med 2014; 46:181-92. [PMID: 23620190 DOI: 10.1007/s12160-013-9500-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. METHODS Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. RESULTS On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. CONCLUSIONS Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain.
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Affiliation(s)
- Olga Slavin-Spenny
- Department of Psychology, Wayne State University, 5057 Woodward Ave., 7th Floor, Detroit, MI, 48202, USA
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Zhao FF, Lei XL, He W, Gu YH, Li DW. The study of perceived stress, coping strategy and self-efficacy of Chinese undergraduate nursing students in clinical practice. Int J Nurs Pract 2014; 21:401-9. [PMID: 24750234 DOI: 10.1111/ijn.12273] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Xiao-Ling Lei
- School of Nursing; Nantong University; Nantong China
| | - Wei He
- School of Nursing; Nantong University; Nantong China
| | - Yan-Hong Gu
- Nursing Department; Affiliated Hospital of Nantong University; Nantong China
| | - Dong-Wen Li
- Nursing Department; Chengdu Military General Hospital; Chengdu China
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Validation and clinical application of a biopsychosocial model of pain intensity and functional disability in patients with a pediatric chronic pain condition referred to a subspecialty clinic. PAIN RESEARCH AND TREATMENT 2013; 2013:143292. [PMID: 24251035 PMCID: PMC3819919 DOI: 10.1155/2013/143292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/01/2013] [Indexed: 01/25/2023]
Abstract
Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (P = 0.002). Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (P = 0.025), patient anxiety (P = 0.021), patient pain coping (P = 0.009), and parent functional disability (P = 0.027). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous.
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Hart SL, Hodgkinson SC, Belcher HME, Hyman C, Cooley-Strickland M. Somatic symptoms, peer and school stress, and family and community violence exposure among urban elementary school children. J Behav Med 2013; 36:454-65. [PMID: 22772584 PMCID: PMC3726557 DOI: 10.1007/s10865-012-9440-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
Somatic symptoms are a common physical response to stress and illness in childhood. This study assessed 409, primarily African American (85.6 %), urban elementary school children to examine the association between: (1) somatic symptoms and potential external stressors (school and peer stress, family conflict, and community violence) and (2) parent and child agreement on children's self-report of somatic symptoms. The odds of self-report of somatic complaints were significantly associated with family conflict, school and peer stress, and community violence exposure (OR = 1.26, 95 % CI: 1.05-1.50; OR = 1.18, 95 % CI 1.08-1.28; and OR = 1.02, 95 % CI: 1.00-1.05, respectively). Identifying the associations between social, family, and community based stress and somatic symptoms may improve the quality of life for children living in urban environments through early identification and treatment.
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Affiliation(s)
- Shayla L. Hart
- Department of Psychology, Howard University, Washington, DC, USA
| | | | - Harolyn M. E. Belcher
- Family Center at Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA. Johns Hopkins University School of Medicine, Baltimore, MD, USA. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Corine Hyman
- Family Center at Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Michele Cooley-Strickland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. University of California, Los Angeles, Los Angeles, CA, USA
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Risk factors for high-altitude headache upon acute high-altitude exposure at 3700 m in young Chinese men: a cohort study. J Headache Pain 2013; 14:35. [PMID: 23578252 PMCID: PMC3630053 DOI: 10.1186/1129-2377-14-35] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/09/2013] [Indexed: 11/15/2022] Open
Abstract
Background This prospective and observational study aimed to identify demographic, physiological and psychological risk factors associated with high-altitude headache (HAH) upon acute high-altitude exposure. Methods Eight hundred fifty subjects ascended by plane to 3700 m above Chengdu (500 m) over a period of two hours. Structured Case Report Form (CRF) questionnaires were used to record demographic information, physiological examinations, psychological scale, and symptoms including headache and insomnia a week before ascending and within 24 hours after arrival at 3700 m. Binary logistic regression models were used to analyze the risk factors for HAH. Results The incidence of HAH was 73.3%. Age (p =0.011), physical labor intensity (PLI) (p =0.044), primary headache history (p <0.001), insomnia (p <0.001), arterial oxygen saturation (SaO2) (p =0.001), heart rate (HR) (p =0.002), the Self-Rating Anxiety Scale (SAS) (p <0.001), and the Epworth Sleepiness Scale (ESS) (p <0.001) were significantly different between HAH and non-HAH groups. Logistic regression models identified primary headache history, insomnia, low SaO2, high HR and SAS as independent risk factors for HAH. Conclusions Insomnia, primary headache history, low SaO2, high HR, and high SAS score are the risk factors for HAH. Our findings will provide novel avenues for the study, prevention and treatment of HAH.
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Parents' initial perceptions of multidisciplinary care for pediatric chronic pain. PAIN RESEARCH AND TREATMENT 2012; 2012:791061. [PMID: 22966428 PMCID: PMC3432383 DOI: 10.1155/2012/791061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022]
Abstract
Chronic and recurrent pain is experienced by many children and adolescents. Treatment of chronic pain using a multidisciplinary approach has been found to be effective for treatment of chronic pain. Parent satisfaction with treatment and treatment providers highly correlates to children's treatment adherence. Parents of children treated at a multidisciplinary chronic pain clinic were interviewed following their initial appointment. Parents reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members' genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is important since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had appreciation of multidisciplinary team structure and the high level of expertise of the team members. This increase in satisfaction when compared to treatment from previous providers is important since increases in satisfaction may correlate with an increase in children's treatment adherence and a reduction in experiences of chronic pain.
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Gaßmann J, Barke A, van Gessel H, Kröner-Herwig B. Sex-specific predictor analyses for the incidence of recurrent headaches in German schoolchildren. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc03. [PMID: 22879857 PMCID: PMC3413875 DOI: 10.3205/psm000081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The aim of the present study was to identify psychosocial risk factors for the incidence of recurrent headache (HA) in children/adolescents (8–15 years). Method: In 2003 (Wave 1) a representative, population-based sample of 8800 parents was mailed a questionnaire. Those who took part were asked to participate again one year later (Wave 2). Of the parents originally contacted, 47.3% participated in both surveys. Potential risk factors concerning the areas ‘school’ and ‘emotional and behavioural problems’ were collected in Wave 1. Binary logistic regression analyses were performed to assess their predictive value for HA in Wave 2. Results: Univariable regression analyses showed that for boys and girls most of the predictor variables influenced the incidence of recurrent HA, but only to a very low extent. When all variables were assessed jointly in a multivariable model, these factors lost their predictive power for boys. For girls, ‘academic problems’ and ‘dysfunctional stress coping’ were shown to increase the chance for the incidence of recurrent HA. Discussion: In contrast to previous findings, school-related factors and emotional and behavioural problems failed to predict HA in boys, and only two factors appeared relevant with regard to girls. This might be due to the strict unidirectional design, which focussed exclusively on the incidence of HA.
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Affiliation(s)
- Jennifer Gaßmann
- Georg-Elias-Müller-Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Georg-August-University Göttingen, Germany
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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Abstract
PURPOSE Child and family education regarding management of pediatric migraine is essential to reduce acute pain, prevent chronic daily migraine, and minimize the total number of headache attacks. This paper summarizes current evidence and provides a foundation for family teaching. CONCLUSIONS Effective management of pediatric migraine can be achieved with a combination of individually tailored biobehavioral strategies, lifestyle modifications, and optimal scheduling of rescue and preventative pharmacologic treatment. PRACTICE IMPLICATIONS Included are goal setting recommendations, common triggers, key comorbidities, lifestyle modifications, principles of pharmacologic management, commonly used naturopathic compounds, and a link to an online downloadable teaching handout.
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Drake KL, Ginsburg GS. Family-Based Cognitive-Behavioral Treatment of Chronic Pediatric Headache and Anxiety Disorders: A Case Study. CHILD & YOUTH CARE FORUM 2012. [DOI: 10.1007/s10566-012-9174-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McDonnell CJ, White KS, Grady RM. Noncardiac chest pain in children and adolescents: a biopsychosocial conceptualization. Child Psychiatry Hum Dev 2012; 43:1-26. [PMID: 21701910 DOI: 10.1007/s10578-011-0240-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Pediatric NCCP may be characterized by recurrent pain accompanied by emotional distress and functional impairment. This paper reviews and critiques literature on pediatric noncardiac chest pain (NCCP) and introduces a theoretical conceptualization to guide future study of NCCP in children and adolescents. A developmentally informed biopsychosocial conceptualization of NCCP etiology is proposed based on a synthesis of empirical evidence and clinical observations of pediatric NCCP within the context of relevant findings from the broader pediatric pain and anxiety literature. Multiple factors from biological, psychological, social, familial, and developmental domains are potentially relevant to the etiology of this ailment. This article concludes with directions for future research and clinical implications.
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Affiliation(s)
- Cassandra J McDonnell
- Department of Psychology, University of Missouri-Saint Louis, Saint Louis, MO 63121, USA.
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White LS. Reducing stress in school-age girls through mindful yoga. J Pediatr Health Care 2012; 26:45-56. [PMID: 22153143 DOI: 10.1016/j.pedhc.2011.01.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 12/19/2022]
Abstract
INTRODUCTION School-age children report much stress in their daily lives, which may lead to psychological and physical problems. Mindfulness-based Stress Reduction is a program of awareness-based practices effective with adults. The purpose of this study was to investigate the efficacy of mindfulness training through yoga with school-age girls to reduce perceived stress, enhance coping abilities, self-esteem, and self-regulation, and explore the relationship between the dose of the intervention and outcomes. METHOD Fourth- and fifth-grade girls were recruited from two public schools and randomly assigned to intervention and wait-list control groups. The intervention group met 1 hour a week for 8 weeks and completed 10 minutes of daily homework. RESULTS Self-esteem and self-regulation increased in both groups. The intervention group was more likely to report greater appraisal of stress (p < .01) and greater frequency of coping (p < .05). Homework accounted for 7% of the variance in reported stress. DISCUSSION Consistent with reports of mindfulness training, greater awareness of the feelings associated with stress may enhance coping abilities. However, it is possible that the increasing awareness of stressors in itself increased stress, possibly as part of the process of developing mindfulness or related to cognitive, emotional, or social development. Mindfulness in children may differ from mindfulness in adults and warrants further investigation.
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Vacek KR, Coyle LD, Vera EM. Stress, Self-Esteem, Hope, Optimism, and Well-Being in Urban, Ethnic Minority Adolescents. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.2161-1912.2010.tb00118.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Vera E, Vacek K, Coyle L, Stinson J, Mull M, Doud K, Buchheit C, Gorman C, Hewitt A, Keene C, Blackmon S, Langrehr K. An Examination of Culturally Relevant Stressors, Coping, Ethnic Identity, and Subjective Well-Being in Urban, Ethnic Minority Adolescents. ACTA ACUST UNITED AC 2011. [DOI: 10.5330/psc.n.2011-15.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gaylord-Harden NK, Elmore CA, Campbell CL, Wethington A. An examination of the tripartite model of depressive and anxiety symptoms in African American youth: stressors and coping strategies as common and specific correlates. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:360-74. [PMID: 21534048 DOI: 10.1080/15374416.2011.563467] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of the current study was to examine the tripartite model of depression and anxiety in a community-based sample of 278 African American adolescents (M age = 12.89) from low-income communities and to identify stressors and coping strategies that were associated with the specific features of each disorder. Participants reported on depression, anxiety, stressors, and coping strategies. As predicted, the three-factor structure of the tripartite model was a valid representation of anxiety and depression in African American youth. Further, stressors and coping strategies showed specific associations to features of depression and anxiety. The findings provide evidence of factors that may help to distinguish between internalizing symptoms in African American youth.
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Affiliation(s)
- Noni K Gaylord-Harden
- Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL 60660, USA.
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van Gessel H, Gassmann J, Kröner-Herwig B. Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period. J Pediatr 2011; 158:977-983.e1-2. [PMID: 21232770 DOI: 10.1016/j.jpeds.2010.11.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/27/2010] [Accepted: 11/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the development of recurrent pain in 3 body locations in children and adolescents (baseline age, 9 to 14 years) in a 4-year period. STUDY DESIGN In a large population-based longitudinal epidemiological study data was collected through annual postal questionnaires (longitudinal, n = 2025). Descriptive statistics and generalized estimating equations were used. RESULTS Girls were more likely to report recurrent pain, demonstrated a steeper development during the 4-year period, and reported multiple pain more often than boys. Younger children reported less recurrent pain, but displayed a steeper trend of increasing prevalence rates as they grew older. Older children illustrated a more stable development of recurrent pain and reported multiple pain more often. Disability experienced because of recurrent pain was related strongest to pain intensity. Stable patterns of pain were related to higher intensity and disability reports. The children experienced headache as the most disabling of the 3 pains. CONCLUSION The results show that boys and girls report recurrent pain in different patterns in the years. To identify risk factors, analysis should be performed separately for boys and girls. Furthermore, it is recommended to include children before the age of 9 years in a prevention study.
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Affiliation(s)
- Hester van Gessel
- Georg-Elias-Müller-Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Georg-August-University of Göttingen, Göttingen, Germany.
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Effects of Exposure to Community Violence on Internalizing Symptoms: Does Desensitization to Violence Occur in African American Youth? JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:711-9. [DOI: 10.1007/s10802-011-9510-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gerber M, Holsboer-Trachsler E, Pühse U, Brand S. Elite Sport is Not an Additional Source of Distress for Adolescents with High Stress Levels. Percept Mot Skills 2011; 112:581-99. [DOI: 10.2466/02.05.10.pms.112.2.581-599] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined whether participation in elite sport inter acts with stress in decreasing or increasing symptoms of depression and anxiety among adolescents, and further, whether the interplay between participation in high-performance sport and stress is related to the perceived quality of sleep. 434 adolescents (278 girls, 156 boys; age: M = 17.2 yr.) from 15 “Swiss Olympic Sport Classes” and 9 conventional classes answered a questionnaire and completed a 7-day sleep log. Analyses of covariance showed that heightened stress was related to more depressive symptoms and higher scores for trait-anxiety Moreover, those classified as having poor sleep by a median split cutoff reported higher levels of depressive symptoms. No significant (multivariate) main effects were found for high-performance sport athletes. Similarly, no significant two- or three-way inter action effects were found. These results caution against exaggerated expectations concerning sport participation as a stress buffer. Nevertheless, participation in high-performance sport was not found to be an additional source of distress for adolescents who reported high stress levels despite prior research that has pointed toward such a relationship.
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De Felice M, Ossipov MH, Wang R, Dussor G, Lai J, Meng ID, Chichorro J, Andrews JS, Rakhit S, Maddaford S, Dodick D, Porreca F. Triptan-induced enhancement of neuronal nitric oxide synthase in trigeminal ganglion dural afferents underlies increased responsiveness to potential migraine triggers. Brain 2010; 133:2475-88. [PMID: 20627971 DOI: 10.1093/brain/awq159] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Migraine is a common neurological disorder often treated with triptans. Triptan overuse can lead to increased frequency of headache in some patients, a phenomenon termed medication overuse headache. Previous preclinical studies have demonstrated that repeated or sustained triptan administration for several days can elicit persistent neural adaptations in trigeminal ganglion cells innervating the dura, prominently characterized by increased labelling of neuronal profiles for calcitonin gene related peptide. Additionally, triptan administration elicited a behavioural syndrome of enhanced sensitivity to surrogate triggers of migraine that was maintained for weeks following discontinuation of drug, a phenomenon termed 'triptan-induced latent sensitization'. Here, we demonstrate that triptan administration elicits a long-lasting increase in identified rat trigeminal dural afferents labelled for neuronal nitric oxide synthase in the trigeminal ganglion. Cutaneous allodynia observed during the period of triptan administration was reversed by NXN-323, a selective inhibitor of neuronal nitric oxide synthase. Additionally, neuronal nitric oxide synthase inhibition prevented environmental stress-induced hypersensitivity in the post-triptan administration period. Co-administration of NXN-323 with sumatriptan over several days prevented the expression of allodynia and enhanced sensitivity to stress observed following latent sensitization, but not the triptan-induced increased labelling of neuronal nitric oxide synthase in dural afferents. Triptan administration thus promotes increased expression of neuronal nitric oxide synthase in dural afferents, which is critical for enhanced sensitivity to environmental stress. These data provide a biological basis for increased frequency of headache following triptans and highlight the potential clinical utility of neuronal nitric oxide synthase inhibition in preventing or treating medication overuse headache.
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Affiliation(s)
- Milena De Felice
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
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Smith TR, Nicholson RA, Banks JW. Migraine education improves quality of life in a primary care setting. Headache 2010; 50:600-12. [PMID: 20148982 DOI: 10.1111/j.1526-4610.2010.01618.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care. BACKGROUND Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches). METHODS In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months). RESULTS Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in "worry about headaches,""self-efficacy for managing headaches," and "satisfaction with headache care." CONCLUSION The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.
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Affiliation(s)
- Timothy R Smith
- Ryan Headache Center/Mercy Health Research - St. John's Mercy Medical Group, St. Louis, MO 63104, USA
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