Stomachaches in Kids Linked to Anxiety, Depression Later On

Megan Brooks

August 12, 2013

Children with medically unexplained functional abdominal pain (FAP) are vulnerable to developing anxiety disorder or depression in adolescence and young adulthood, even if the pain resolves, new research shows.

"Chronic or recurrent pain should be addressed by a multidisciplinary health team that can evaluate the physical, emotional/mental, and interpersonal aspects of pain in order to develop a treatment plan that addresses all the factors that contribute to pain," study investigator Lynn S. Walker, PhD, from the Division of Adolescent and Young Adult Health, Monroe Carell Jr Children's Hospital at Vanderbilt University in Nashville, Tennessee, told Medscape Medical News.

The study was published online August 12 in Pediatrics.

High Anxiety

"Prior research showed that pediatric patients with FAP had higher rates of anxiety than peers without FAP; this is the first study to follow FAP patients and schoolchildren without FAP into adolescence and young adulthood (average age, 20 years at follow-up) and show that the FAP patients continued to have significantly higher rates of anxiety than their peers," Dr. Walker said.

The study involved 332 children with FAP and 147 control children without FAP. Among the 332 children with FAP, abdominal pain persisted from childhood into adolescence and young adulthood in 133 (40.1%).

By the time of follow-up in adolescence and young adulthood, half (51%) of those with a childhood history of FAP had met criteria for an anxiety disorder during their lifetime, and approximately one third (30%) met criteria for a current anxiety disorder.

In contrast, only one fifth (20%) of those without childhood FAP met criteria for an anxiety disorder during their lifetime, and only 12% met criteria for current anxiety disorder at follow-up, the researchers say.

Controlling for sex and age, the odds ratio was 4.9 (95% confidence interval [CI], 2.83 - 7.43) for lifetime anxiety disorder and 3.57 (95% CI, 2.00 - 6.36) for current anxiety disorder at follow-up for children with FAP vs control children (both P < .001).

"When they were interviewed as adolescents and young adults, the FAP group continued to have high rates of anxiety disorders, even if they no longer had FAP," said Dr. Walker.

Dr. Lynn Walker

"The risk for anxiety disorder in adolescence/young adulthood was 5 times greater than in controls for FAP patients who continued to have abdominal pain; the risk was 2.7 times greater than in controls for FAP patients who no longer had abdominal pain. Thus, even the FAP patients whose pain resolved continued to have a significantly higher risk for anxiety disorders than their peers as they became adults," she added.

The most common anxiety disorder in the FAP group was social anxiety, with roughly one quarter (26%) meeting criteria for social anxiety disorder during their lifetime.

The lifetime risk for depressive disorder was also significantly higher in the FAP group than the control group (40% vs 16%), with an odds ratio 2.62 times greater for the FAP group. The risk for current depressive disorder at age 20 years was low and did not differ significantly between the groups.

A Vicious Cycle

Anxiety that is related to the pain, or even anxiety related to other things in the child's life, can exacerbate the pain and lead to increased suffering and disability, Dr. Walker noted.

"Anxiety has features that lead to a vicious cycle of pain and disability. Children who are anxious tend to be hypervigilant to threat — they may notice even a mild sensation, focus attention on it, worry about it.

"They tend to be cautious — they may want to stay home rather than risk having a stomachache at school, at the mall, at a ball game. As they discontinue activities and isolate themselves socially, they have more time to focus on the pain and worry about it. As they fall behind their peers, they have additional things to worry about, in a vicious cycle," she said.

"We need research to determine if early treatment of anxiety in children with FAP will alleviate their abdominal pain and reduce the risk for anxiety and abdominal pain later in life," Dr. Walker said.

This is an "interesting study from a group with access to good longitudinal data for these patients," Rona L. Levy, PhD, director of the Behavioral Medicine Research Group at University of Washington in Seattle, who was not involved in the study, told Medscape Medical News.

However, she cautioned readers to "be careful not to misinterpret this correlational study as causal. In other words, it is not showing FAP causes long-term anxiety but rather that tendencies toward anxiety, or whatever causes anxiety, likely contributes to FAP."

The study was funded by the National Institutes of Health. The authors and Dr. Levy report no relevant financial relationships.

Pediatrics. Published online August 12, 2013. Abstract


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