Location: Children's Nutrition Research CenterTitle: Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome
|HOLLIER, JOHN - Baylor College Of Medicine|
|VAN TILBURG, MIRANDA - University Of North Carolina|
|LIU, YAN - Baylor College Of Medicine|
|CZYZEWSKI, DANITA - Baylor College Of Medicine|
|SELF, MARIELLA - Baylor College Of Medicine|
|WEIDLER, ERICA - Children'S Nutrition Research Center (CNRC)|
|HEITKEMPER, MARGARET - University Of Washington|
|SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)|
Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/16/2018
Publication Date: 12/13/2018
Citation: Hollier, J.M., Van Tilburg, M.A., Liu, Y., Czyzewski, D.I., Self, M.M., Weidler, E.M., Heitkemper, M., Shulman, R.J. 2018. Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome. Neurogastroenterology & Motility. 31:e13509. https://doi.org/10.1111/nmo.13509.
Interpretive Summary: It is recognized that children with irritable bowel syndrome, a common type of functional gastrointestinal disorder that causes abdominal pain and changes in stooling, and is, in some individuals, diet related, is associated with a poor quality of life. Additionally, many children with the disorder have symptoms like anxiety and/or depression. However, it is unclear how the many different psychological symptoms that a person can experience in life might affect abdominal pain symptoms. In this study we found that having multiple symptoms (somatization) and unintentionally exaggerating the pain experience (pain catastrophizing) were key in predicting how much pain the children would have. The results also highlight the importance of targeting these two psychological concerns in addressing children with this issue.
Technical Abstract: Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [B] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized B 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized B 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized B 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized B 0.19, CI 0.04-0.19).Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.