Elsevier

The Journal of Pediatrics

Volume 164, Issue 4, April 2014, Pages 900-905.e2
The Journal of Pediatrics

Original Article
Predictors for Persistence of Functional Somatic Symptoms in Adolescents

https://doi.org/10.1016/j.jpeds.2013.12.003Get rights and content

Objective

To identify risk factors for persistence of functional somatic symptoms (FSS; ie, somatic symptoms that cannot be sufficiently explained by underlying organic pathology).

Study design

The first (N = 2230, mean age = 11.1 years [SD 0.6], 50.8% girls), second (N = 2149, mean age = 13.7 years [SD 0.5], 51.0% girls), and third (N = 1816, mean age = 16.3 years [SD 0.7], 52.3% girls) assessment waves of the general population study TRacking Adolescents' Individual Lives Survey were used. FSS were assessed with the Youth Self-Report and the Child Behavior Checklist. Growth mixture models were used to identify different subgroups of adolescents on the basis of the developmental trajectory of their symptoms. Adolescents with persistent symptoms were compared with adolescents with decreasing symptoms with a multivariable logistic regression analysis.

Results

In our general population cohort, 4.1% of adolescents suffered from persistent FSS. Risk factors for persistent FSS were being a girl (OR 4.69, 95% CI 2.17-10.12), suffering from depressive symptoms (OR 5.35, 95% CI 1.46-16.62), poor self-rated health (OR 1.56, 95% CI 1.02-2.39), and high parent-reported FSS (OR 4.03, 95% CI 1.20-13.54). Anxiety, parental overprotection, school absenteeism, and diversity of symptoms did not predict persistence of FSS.

Conclusions

This study identified risk factors for persistence of FSS in adolescents. Future studies might study effects of coping strategies and iatrogenic factors on symptom persistence.

Section snippets

Method

The TRacking Adolescents' Individual Lives Survey (TRAILS) is a prospective cohort study of Dutch adolescents, approved by the Dutch Central Committee on Research Involving Human Subjects. Participating centers of TRAILS include various departments of the University Medical Center and University of Groningen, the Erasmus University Medical Center Rotterdam, the University of Utrecht, the Radboud Medical Center Nijmegen, and the Parnassia Bavo group, all in The Netherlands. The current study

Results

The mean item score of FSS decreased during subsequent waves and was 0.47 (SD 0.35) at T1 (n = 2115), 0.39 (SD 0.35) at T2 (n = 2015), and 0.34 (SD 0.34) at T3 (n = 1636). A total of 2210 adolescents had valid data on FSS on at least one assessment wave (Figure 2; available at www.jpeds.com). Developmental pathways were examined for these adolescents. Figure 2 shows a flowchart with number of adolescents included in subsequent analyses.

Discussion

Our results suggest that 4.1% of adolescents suffer from persistent FSS from age 10 up to age 17. Of all adolescents that suffered from many FSSs at baseline (14.6%), 32.4% had persistent FSS (ie, having persistent instead of decreasing symptoms). Risk factors for persistence of FSS were being a girl, poor self-rated health, depressive symptoms, and high parent-reported FSS. Symptom diversity, anxiety, school absenteeism, and parental overprotection were not predictive of symptom persistence.

In

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    This research is part of TRAILS, which has been financially supported by various grants from the Netherlands Organization for Scientific Research, Zorgonderzoek Nederland Medische Wetenschappen, Gebied Maatschappij-en Gedragswetenschappen, the Dutch Ministry of Justice, the European Science Foundation, Biobanking and Biomolecular Research Infrastructure, the participating universities, and Accare Center for Child and Adolescent Psychiatry. The authors declare no conflicts of interest.

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