Chronic Abdominal Pain and Depressive Symptoms: Analysis of the National Longitudinal Study of Adolescent Health NADER N. YOUSSEF,* KATHERINE ATIENZA,* ANNETTE L. LANGSEDER,* and RICHARD S. STRAUSS ‡ *Center for Pediatric Irritable Bowel & Motility Disorders, Goryeb Childrens Hospital at Atlantic Health, Morristown, New Jersey; and ‡ Johnson and Johnson, Product Development Unit, Titusville, New Jersey Background & Aims: Abdominal pain is common in adolescence. The aim of this study was to determine the prevalence of depressive symptoms in a large cohort of patients with frequent abdominal pain. Methods: A pro- spective, cross-sectional, nationally representative sample of children aged 13 to 18 years (mean age, 16.2 1.7 y; 49% male) completed in-home interviews and separate in-school questionnaires for the National Longitudinal Study in Ad- olescent Health (the Add Health Study). Depressed mood was assessed with the Center for Epidemiologic Studies Depression Scale. Subjective measures of abdominal pain were reported by 20,745 adolescents from wave 1 of the Add Health Study. Frequency of abdominal pain over the previ- ous 1 year was rated as rare (0 –1 episode/wk), moderate (2–3 episodes/wk), or daily (>4 episodes/wk). Results: Daily pain is reported in 3.2% of adolescents, with an ad- ditional 14% reporting pain as moderate in frequency. Six- teen percent of all adolescents are at risk for developing depression. The risk for depression goes from 16% to 45% (P < .001) when the pain is daily. Compared with rare pain, children with daily pain were more likely to miss school 10 or more times per year (46% vs 19%, P < .001), cry (12.1% vs 1%, P < .001), feel sad (25.2% vs 5.3%, P < .001), and lonely (25.2% vs 6.4%, P < .001). Children with daily pain were likely to consider life a failure versus those with no pain (10.2% vs 3.3%, P < .001). Conclusions: Adolescents with frequent abdominal pain are at increased risk for depres- sive symptoms, social isolation, and missing school. F requent abdominal pain is a common complaint among adolescents in the United States, with 17% of high school students in small community, school-based samples experienc- ing abdominal pain once a week. 1 The exact prevalence of abdominal pain is unknown but does increase with age through adolescence and affects more females. Frequent abdominal pain in children and adolescents has been associated with social withdrawal, school absenteeism, and a poor quality of life for patients and their parents. 2 Other associated restrictions in- clude decreased appetite, not playing with friends, and less time with hobbies. 3 Suffering from frequent abdominal pain earlier in life often leads to increased health care use as adults and also is more likely to result in an anxiety disorder later in life. 4 Psychiatric morbidities such as anxiety and depression are common in adults who suffer from frequent abdominal pain. Recent literature has examined the relationship of suicidal ideation and depression in adults who suffer from both organic and nonorganic abdominal pain. Adult patients with chronic pain have higher rates of suicidal ideation. 5 A recent study by Smith et al 5 suggested that abdominal pain in adults may be an independent risk factor for suicidal ideation. Moreover, suicidal ideation increases with symptom severity and perceived inter- ference with life in adults with irritable bowel syndrome. 6 The lifetime prevalence of depression through adolescence is 20%. 7 One study noted the rate of weekly depressive symptoms in 15-year-olds to be 49% in females and 34% in males. 7 The aim of this study was to examine on a national level the association between frequent abdominal pain in adolescents and depressive symptoms. Methods A prospective, cross-sectional, nationally representative sample of adolescents in the United States aged 13 to 18 years (mean age, 16.2 1.7 y; 49% male) completed both in-house interviews and at-school questionnaires for the National Lon- gitudinal Study in Adolescent Health (the Add Health Study). Initiated in 1994 under a grant from the National Institute of Child Health and Human Development with co-funding from 17 other federal agencies, the Add Health Study is the largest, most comprehensive survey of adolescents ever undertaken. 8 Data at the individual, family, school, and community levels were collected in 2 waves between 1994 and 1996. In addition to baseline demographic data, measures of health status, health- related behaviors, and social function including school activi- ties, friends, and home activities were collected. A parental respondent gave information on household income and paren- tal education. The sample population of adolescents was stratified according to region, school type, ethnicity, and urban areas. The current study used data from the in-home interview sample of 20,745 adolescents (wave 1 in April–December 1995). Additional informa- tion on the Add Health Study design, sampling strategy, and methodology are available at www.cpc.unc.edu/addhealth. Depressed mood was assessed with the Center for Epidemi- ologic Studies Depression Scale (CES-D). The CES-D initially was designed to screen adults for symptoms of depression during the previous week. It is not a psychiatric diagnostic tool for clinical depression but identifies individuals at risk for a clinical diagnosis of depression. The Add Health Study contains questions about depressive symptoms that correspond to those Abbreviations used in this paper: Add Health, National Longitudinal Study in Adolescent Health; CES-D, Center for Epidemiologic Studies Depression Scale. © 2008 by the AGA Institute 1542-3565/08/$34.00 doi:10.1016/j.cgh.2007.12.019 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:329 –332
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
