Skip to main content

Advertisement

SpringerLink
Log in

The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child’s experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Reasonable requests to access the datasets analyzed will be adjudicated by the Generation R management committee.

References

  1. Goddard JM (2011) Chronic pain in children and young people. Curr Opin Support Palliat Care 5(2):158–163. https://doi.org/10.1097/SPC.0b013e328345832d

    Article  Google Scholar 

  2. Hunfeld JAM, Perquin CW, Hazebroek-Kampschreur AAJM, Passchier J, van Suijlekom-Smit LWA, van der Wouden JC (2002) Physically unexplained chronic pain and its impact on children and their families: the mother’s perception. PsycholPsychother 75(Pt 3):251–260

    Google Scholar 

  3. Knook LME, Lijmer JG, Konijnenberg AY, Taminiau B, van Engeland H (2012) The course of chronic pain with and without psychiatric disorders: a 6-year follow-up study from childhood to adolescence and young adulthood. J Clin Psychiatry 73(1):e134-139. https://doi.org/10.4088/JCP.10m06751

    Article  Google Scholar 

  4. Groenewald CB, Essner BS, Wright D, Fesinmeyer MD, Palermo TM (2014) The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain 15(9):925–933. https://doi.org/10.1016/j.jpain.2014.06.002

    Article  Google Scholar 

  5. Campo JV (2012) Annual research review: functional somatic symptoms and associated anxiety and depression—developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 53(5):575–592

    Article  Google Scholar 

  6. Kroenke K (2003) The interface between physical and psychological symptoms. Prim Care Companion J Clin Psychiatry 5:11–18

    Google Scholar 

  7. Kinnunen P, Laukkanen E, Kylmä J (2010) Associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood. Int J NursPract 16(1):43–50. https://doi.org/10.1111/j.1440-172X.2009.01782.x

    Article  Google Scholar 

  8. Mahrer NE, Montaño Z, Gold JI (2012) Relations between anxiety sensitivity, somatization, and health-related quality of life in children with chronic pain. J Pediatr Psychol 37(7):808–816. https://doi.org/10.1093/jpepsy/jss054

    Article  Google Scholar 

  9. Compas BE, Jaser SS, Dunn MJ, Rodriguez EM (2012) Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol 8:455–480. https://doi.org/10.1146/annurev-clinpsy-032511-143108

    Article  Google Scholar 

  10. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C (2009) A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr 154(3):322–326. https://doi.org/10.1016/j.jpeds.2008.09.047

    Article  Google Scholar 

  11. Viner RM, Clark C, Taylor SJC et al (2008) Longitudinal risk factors for persistent fatigue in adolescents. Arch Pediatr Adolesc Med 162(5):469–475. https://doi.org/10.1001/archpedi.162.5.469

    Article  Google Scholar 

  12. Egger HL, Costello EJ, Erkanli A, Angold A (1999) Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry 38(7):852–860. https://doi.org/10.1097/00004583-199907000-00015

    Article  CAS  Google Scholar 

  13. Dhossche D, Ferdinand R, van der Ende J, Verhulst F (2001) Outcome of self-reported functional-somatic symptoms in a community sample of adolescents. Ann Clin Psychiatry 13(4):191–199

    Article  CAS  Google Scholar 

  14. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC (2007) The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 133(4):581–624

    Article  Google Scholar 

  15. Martin A, McGrath P, Brown S, Katz J (2007) Children with chronic pain: Impact of sex and age on long-term outcomes. Pain 128(1–2):13–19. https://doi.org/10.1016/j.pain.2006.08.027

    Article  Google Scholar 

  16. El-Metwally A, Halder S, Thompson D, Macfarlane GJ, Jones GT (2007) Predictors of abdominal pain in schoolchildren: a 4-year population-based prospective study. Arch Dis Child 92(12):1094–1098. https://doi.org/10.1136/adc.2006.115089

    Article  CAS  Google Scholar 

  17. Stanford EA, Chambers CT, Biesanz JC, Chen E (2008) The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach. Pain 138(1):11–21. https://doi.org/10.1016/j.pain.2007.10.032

    Article  Google Scholar 

  18. Walker LS, Garber J, Van Slyke DA, Greene JW (1995) Long-term health outcomes in patients with recurrent abdominal pain. J Pediatr Psychol 20(2):233–245. https://doi.org/10.1093/jpepsy/20.2.233

    Article  CAS  Google Scholar 

  19. Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S (1998) Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. BMJ 316(7139):1196–1200. https://doi.org/10.1136/bmj.316.7139.1196

    Article  CAS  Google Scholar 

  20. McGrath PA, Hillier LM (2003) Modifying the psychological factors that intensify children’s pain and prolong disability, 2nd edition. In: Schechter NL, Berdes CB, Yaster M (eds) Pain in infants, children, and adolescents. Lippincott Williams & Wilkins, Philadelphia, pp 85–104

    Google Scholar 

  21. Wolff NJ, Darlington A-SE, Hunfeld JAM et al (2012) Concurrent and longitudinal bidirectional relationships between toddlers’ chronic pain and mental health: the generation R study. J Pediatr Psychol 37(5):546–556

    Article  Google Scholar 

  22. Jaddoe VWV, Mackenbach JP, Moll HA, Steegers EAP, Tiemeier H, Verhulst FC et al (2006) The generation R study: design and cohort profile. Eur J Epidemiol 21(6):475–484

    Article  Google Scholar 

  23. Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA et al (2000) Pain in children and adolescents: A common experience. Pain 87(1):51–58

    Article  Google Scholar 

  24. Achenbach T, Rescorla L (2000) Manual for the ASEBA preschool forms & profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington

    Google Scholar 

  25. Statistics Netherlands (2004) Allochtonen in Nederland (Immigrants in the Netherlands). Statistics Netherlands, Voorburg

    Google Scholar 

  26. Derogatis LR, Spencer PM (1992) The Brief Symptom Inventory (BSI) Administration, scoring and procedures manual-II. Clinical Psychometric Research, Inc., Baltimore, pp 1–67

    Google Scholar 

  27. De Beurs E (2004) Brief symptom inventory, handleiding. Leiden, The Netherlands

    Google Scholar 

  28. de Brock A, Vermulst AA, Gerris JRM, Abidin RR (1992) NOSI, manual experimental version nijmeegse ouderlijke stress index (NOSI), handleiding experimentele versie. Pearson, Amsterdam

    Google Scholar 

  29. Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D (1998) Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents. Child Abuse Negl 22(4):249–270

    Article  CAS  Google Scholar 

  30. Bonfim CB, Santos DN, Menezes IG, Reichenheim ME, Barreto ML (2011) A study on the construct validity of the Parent-Child Conflict Tactics Scale (CTSPC) in an urban population in Northeast Brazil. Cadernos De SaudePublica 27(11):2215–2226. https://doi.org/10.1590/s0102-311x2011001100015

    Article  Google Scholar 

  31. Reichenheim ME, Moraes CL (2006) Psychometric properties of the Portuguese version of the Conflict Tactics Scales: parent-child version (CTSPC) used to identify child abuse. Cadernos de SaúdePública 22(3):503–515. https://doi.org/10.1590/S0102-311X2006000300005

    Article  Google Scholar 

  32. Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster family assessment device. J Marital Fam Ther 9(2):171–180. https://doi.org/10.1111/j.1752-0606.1983.tb01497.x

    Article  Google Scholar 

  33. Doering LV, Dracup K, Moser D (1999) Comparison of psychosocial adjustment of mothers and fathers of high-risk infants in the neonatal intensive care unit. J Perinatol 19(2):132–137. https://doi.org/10.1038/sj.jp.7200083

    Article  CAS  Google Scholar 

  34. Thastum M, Watson M, Kienbacher C, Piha J, Steck B, Zachariae R, Baldus C, Romer G (2009) Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer. Cancer 115(17):4030–4039. https://doi.org/10.1002/cncr.24449

    Article  Google Scholar 

  35. van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16(3):219–242. https://doi.org/10.1177/0962280206074463

    Article  Google Scholar 

  36. King S, Chambers C, Huguet A et al (2011) The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 152(12):2729–2738. https://doi.org/10.1016/j.pain.2011.07.016

    Article  Google Scholar 

  37. Perquin CW, Hunfeld JAM, Hazebroek-Kampschreur AAJM et al (2003) The natural course of chronic benign pain in childhood and adolescence: a two-year population-based follow-up study. Eur J Pain 7(6):551–559. https://doi.org/10.1016/S1090-3801(03)00060-0

    Article  Google Scholar 

  38. Dersh J, Polatin P, Gatchel R (2002) Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med 64(5):773–786

    Google Scholar 

  39. McBeth J, Macfarlane GJ, Benjamin S, Silman AJ (2001) Features of somatization predict the onset of chronic widespread pain: results of a large population-based study. Arthritis Rheum 44(4):940–946

    Article  CAS  Google Scholar 

  40. Fishbain DA, Lewis JE, Gao J, Cole B, Rosomoff RS (2009) Is chronic pain associated with somatization/hypochondriasis? An evidence-based structured review. Pain Pract 9(6):449–467. https://doi.org/10.1111/j.1533-2500.2009.00309.x

    Article  Google Scholar 

  41. Scharf M, Mayseless O, Rousseau S (2016) When somatization is not the only thing you suffer from: examining comorbid syndromes using latent profile analysis, parenting practices and adolescent functioning. Psychiatry Res 244:10–18. https://doi.org/10.1016/j.psychres.2016.07.015

    Article  Google Scholar 

  42. Lavigne JV, Saps M, Bryant FB (2014) Models of anxiety, depression, somatization, and coping as predictors of abdominal pain in a community sample of school-age children. J Pediatr Psychol 39(1):9–22. https://doi.org/10.1093/jpepsy/jst060

    Article  Google Scholar 

  43. Gilliam W, Burns JW, Quartana P, Matsuura J, Nappi C, Wolff B (2010) Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal × emotion regulation model. J Behav Med 33(3):191–199. https://doi.org/10.1007/s10865-009-9245-0

    Article  Google Scholar 

  44. Zeman J, Cassano M, Perry-Parrish C, Stegall S (2006) Emotion regulation in children and adolescents. J Dev BehavPediatr 27(2):155–168

    Google Scholar 

  45. Gullone E, King NJ, Ollendick TH (2001) Self-reported anxiety in children and adolescents: a three-year follow-up study. J Genet Psychol 162(1):5–19. https://doi.org/10.1080/00221320109597878

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The Generation R Study is conducted by the Erasmus Medical Center Rotterdam in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam. The work of H.T. was supported by a NWO–VICI grant (NOW ZonMW 016.VICI.170.200).

Author information

Authors and Affiliations

  1. Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece

    Gerasimos Kolaitis & Foivos Zaravinos-Tsakos

  2. The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands

    Jan van der Ende, Tonya White & Ivonne Derks

  3. Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

    Tonya White, Ivonne Derks & Henning Tiemeier

  4. Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, The Netherlands

    Ivonne Derks

  5. Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark

    Frank Verhulst

  6. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Frank Verhulst

  7. Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA

    Henning Tiemeier

Authors
  1. Gerasimos Kolaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan van der Ende
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Foivos Zaravinos-Tsakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tonya White
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivonne Derks
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Verhulst
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Henning Tiemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GK conceived the study, appraised the background literature, coordinated subsequent revisions; JvdE conducted statistical analyses on the survey database, contributed to quality assurance of the database, contributed to reviewing the manuscript and evaluating the survey database; FZT contributed to the background literature appraisal, contributed to drafting and reviewing the manuscript; TW contributed to revise the manuscript and contributed to quality assurance of the database; ID contributed to revise the manuscript and contributed to quality assurance of the database; FV conceived the study and contributed to revise the manuscript; HT conceived the study, coordinated subsequent revisions and revised the manuscript.

Corresponding author

Correspondence to Gerasimos Kolaitis.

Ethics declarations

Conflict of interest

Dr. Verhulst was the contributing editor of the Achenbach System of Empirically Based Assessment, from which he received remuneration. No other disclosures were reported.

Ethics approval

The study was conducted following the principles of the Declaration of Helsinki and its later amendments.

Consent to participate

Written informed consent for all children was obtained from the caregivers.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 132 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kolaitis, G., van der Ende, J., Zaravinos-Tsakos, F. et al. The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?. Eur Child Adolesc Psychiatry 31, 1933–1941 (2022). https://doi.org/10.1007/s00787-021-01821-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-021-01821-7

Keywords

Search

Navigation