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Abstract

The aim of the present study was to investigate the associations between parental chronic pain and anxiety, depression, and conduct problems in adolescents. The current study was based on cross-sectional surveys performed during 2006 to 2008 from the Nord Trøndelag Health Study (HUNT 3 and Young-HUNT 3). The sample consisted of 3227 adolescents aged 13 to 18 years for whom information was available on parental chronic pain and health statuses. Separate analyses were conducted for girls and boys. The results indicated that if both parents experienced chronic pain, there was an increased risk of symptoms of anxiety and depression in girls (OR=2.17, CI=1.36-3.45, P=.001) and boys (OR=2.33, CI=1.17-4.63, P=.016) compared with children for whom neither parent had chronic pain. Girls had an increased risk of conduct problems in school if their mothers had chronic pain (OR=1.33, CI=1.02-1.74, P=.034). These results remained after adjusting for the possible effects of confounding factors and parental mental health. The results suggest that the presence of both maternal and paternal chronic pain is a high risk factor for internalizing symptoms in both girls and boys. The present study offers insights that should prove useful in clinical work and further large-scale research.

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... [4][5][6][7] Similarly, children's depression, coping difficulties, behavior problems, anxiety, sleep issues, compulsive behaviors, stress, internalizing and externalizing behaviors, conduct problems, and substance use have been linked with parental physical illness/injury including cancer and chronic pain. [8][9][10][11][12] While any causal pathways remain unclear, the authors of these studies hypothesize that parental injury impairs family functioning and parental capacity to care for children. [8][9][10][11][12] Children of brain-injured parents are at increased odds of experiencing post-traumatic stress symptoms, emotional and behavioral problems, psychiatric disorders, developmental disorders, depression, substance abuse, and problems with social coping. ...
... [8][9][10][11][12] While any causal pathways remain unclear, the authors of these studies hypothesize that parental injury impairs family functioning and parental capacity to care for children. [8][9][10][11][12] Children of brain-injured parents are at increased odds of experiencing post-traumatic stress symptoms, emotional and behavioral problems, psychiatric disorders, developmental disorders, depression, substance abuse, and problems with social coping. [13][14][15][16][17] Studies also indicate that children's care for mental health conditions overall and prescription psychiatric medication use increase following parental illness or injury. ...
... Global findings of increased children's mental health care following parental illness/injury are consistent with research indicating a clinically elevated stress response in children of parents with cancer, 10 children's increased behavioral and mental health issues with parental mental health conditions, 4-7 and parental physical illness/injury. [8][9][10][11][12] Results are also consistent with a meta-analysis of children of parents with Acquired Immune Deficiency Syndrome who had increased internalizing and externalizing behaviors, 25 and studies of children of brain-injured parents being at increased risk of psychiatric and developmental disorders. [13][14][15][16][17] However, these studies did not look at child age or how distinctive age groups might be impacted differently. ...
Article
Background Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported. Objective We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age. Methods A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2–16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent’s illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent’s illness/injury overall. Secondary analyses were stratified by age groups of 2–5 years (n = 158,620), 6–12 years (n = 239,614), and 13–16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness. Results There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2–5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6–12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13–16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4–5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001). Conclusion Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children’s mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.
... We found that CCI female offspring also displayed readily visible anxiety-like behavior (Supplementary Fig. 2A, B). These results suggest that maternal chronic pain has significant transgenerational effects on female offspring, which is similar to what occurs in humans (Hoftun et al., 2013;Kaasboll et al., 2012). Thus, the female offspring from maternal mice were further investigated in the present study. ...
... This is consistent with human studies in that the prevalence of chronic pain was higher in women than in men (Bouhassira et al., 2008). Previous studies have found that the associations between parental chronic pain and psychological symptoms in children may depend on the sex and age of the child as well as parental sex (Kaasboll et al., 2012). For example, mothers with chronic pain report more physical and psychological problems than children of fathers with chronic pain (Higgins et al., 2015;Kaasboll et al., 2012), and girls seem to be more vulnerable to the influence of maternal pain (Stone and Wilson, 2016). ...
... Previous studies have found that the associations between parental chronic pain and psychological symptoms in children may depend on the sex and age of the child as well as parental sex (Kaasboll et al., 2012). For example, mothers with chronic pain report more physical and psychological problems than children of fathers with chronic pain (Higgins et al., 2015;Kaasboll et al., 2012), and girls seem to be more vulnerable to the influence of maternal pain (Stone and Wilson, 2016). This proposes that paternal germline effects, which could be produced under persistent pain conditions presented in the current study, are usually overridden by maternal effects (Curley et al.,Fig. ...
Article
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Pain symptoms can be transmitted across generations, but the mechanisms underlying these outcomes remain poorly understood. Here, we identified an essential role for primary somatosensory cortical (S1) glutamate neuronal DNA methyl-CpG binding protein 2 (MeCP2) in the transgenerational transmission of pain. In a female mouse chronic pain model, the offspring displayed significant pain sensitization. In these mice, MeCP2 expression was increased in S1 glutamate (GluS1) neurons, correlating with increased neuronal activity. Downregulation of GluS1 neuronal MeCP2 in maternal mice with pain abolished offspring pain sensitization, whereas overexpression of MeCP2 in naïve maternal mice induced pain sensitization in offspring. Notably, single-cell sequencing and chromatin immunoprecipitation analysis showed that the expression of a wide range of genes was changed in offspring and maternal GluS1 neurons, some of which were regulated by MeCP2. These results collectively demonstrate the putative importance of MeCP2 as a key regulator in pain transgenerational transmission through actions on GluS1 neuronal maladaptation.
... [2][3][4] Parental physical illness affects the children's psychological adjustment, especially with internalizing problems. [5][6][7] Recent literature reviews emphasized the need to uncover variables that mediate or moderate the association between parental chronic pain and children's outcomes. 8,9 Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures to promote the well-being of the child and family. ...
... Further characteristics of the target sample, such as the parental age, education, organ-specific illnesses, cohabitation status, and the child's symptoms of anxiety and depression (SCL-5), were described in a previous publication. 7 In summary, parental chronic pain was associated with higher levels of parental symptoms of anxiety and depression, lower levels of education, organ-specific illness, paternal older age, and dissolved family structure. ...
... As reported in Kaasbøll et al, 7 the results indicate an association between concurrent maternal and paternal chronic ...
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Background A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents’ social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender. Methods The current study was based on cross-sectional data from the Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006–2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis. Results Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring’s symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=−0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender. Conclusion The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers.
... Parents with chronic pain constitute a significant proportion of the adult population in Europe, as approximately 20 % of adults live with moderate to severe chronic pain [1]. Research suggests that chronic pain has a substantial impact on a family's general well-being [2][3][4], and according to recent studies, parental chronic pain and physical illness are associated with children's physical health [5,6] and psychological adjustment [7][8][9]. We have previously demonstrated associations between concurrent maternal and paternal chronic pain and symptoms of anxiety and depression in girls and boys, as well as smoking and alcohol intoxication in boys [9,10]. ...
... Research suggests that chronic pain has a substantial impact on a family's general well-being [2][3][4], and according to recent studies, parental chronic pain and physical illness are associated with children's physical health [5,6] and psychological adjustment [7][8][9]. We have previously demonstrated associations between concurrent maternal and paternal chronic pain and symptoms of anxiety and depression in girls and boys, as well as smoking and alcohol intoxication in boys [9,10]. In line with these findings, Pedersen and Revenson [11] argue that research on parental illness and child outcomes should include more positive and growth-related outcomes in addition to traditional indices of psychopathology. ...
... Most studies on parental chronic pain are limited by including only one parent, mainly the mother as the primary caregiver, whereas the effects of chronic pain among fathers have been studied less frequently [28,45]. In addition, the effects of having two parents with chronic pain have been reported to be greater than the effects of having one or no parent with chronic pain [6,9,10]. Hence, research on this topic should include independent information on the offspring's parents. ...
Article
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Background Parental chronic pain has been associated with adverse outcomes in offspring. However, knowledge on individual and family resilience factors in adolescent offspring of chronic pain sufferers is scarce. This study thus aimed to investigate the associations between parental chronic pain and self-esteem, social competence, and family cohesion levels reported by adolescent girls and boys. Methods Based on cross-sectional surveys from the Nord Trøndelag Health Study (the HUNT 3 study), the study used independent self-reports from adolescents aged 13 to 18 years (n = 3227) and their parents and conducted separate linear regression analyses for girls and boys. Results Concurrent maternal and paternal chronic pain was associated with reduced self-esteem, social competence, and family cohesion in girls. Moreover, maternal chronic pain was associated with higher social competence in boys and reduced self-esteem in girls. The majority of the observed associations were significantly different between girls and boys. Paternal chronic pain was not found to be associated with child outcomes. Conclusions The findings indicate that the presence of both maternal and paternal chronic pain could be a potential risk factor for lower levels of individual and family resilience factors reported by girls. Further research on the relationship between parental pain and sex-specific offspring characteristics, including positive resilience factors, is warranted. The study demonstrates the importance of targeting the entire family in chronic pain care.
... Previous studies that have examined offspring of parents with chronic pain have studied the effects of parental chronic pain on the offspring's own pain complaints, 37 other aspects of their physical health, 51,53 their psychological health, 44 and variables related to family relationships. 75 While several studies have found that offspring of parents with chronic pain have poorer pain, 37 health, 51 and psychological 44 outcomes than other offspring, other studies have found no between-group differences on pain complaints 43 and psychological and family outcomes. ...
... Previous studies that have examined offspring of parents with chronic pain have studied the effects of parental chronic pain on the offspring's own pain complaints, 37 other aspects of their physical health, 51,53 their psychological health, 44 and variables related to family relationships. 75 While several studies have found that offspring of parents with chronic pain have poorer pain, 37 health, 51 and psychological 44 outcomes than other offspring, other studies have found no between-group differences on pain complaints 43 and psychological and family outcomes. 75 Additionally, few studies have explored possible differences in the effects of maternal vs paternal chronic pain on offspring, although at least one study has found such differences, 37 and other research has explored differences in mothers' and fathers' interactions with children during child pain. ...
... One study 44 found that adolescents with both parents having chronic pain had increased risk of experiencing anxiety and depressive symptoms than adolescents of control parents, whereas this was not seen in children with only 1 parent with chronic pain. They also found an increased risk of conduct problems in girls whose mothers had chronic pain. ...
Article
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Offspring of parents with chronic pain may be at risk for poorer outcomes than offspring of healthy parents. The objective of this research was to provide a comprehensive mixed-methods, systematic synthesis of all available research on outcomes in offspring of parents with chronic pain. A systematic search was conducted for published articles in English examining pain, health, psychological, or family outcomes in offspring of parents with chronic pain. Fifty-nine eligible articles were identified (31 population-based, 25 clinical, 3 qualitative), including offspring from birth to adulthood and parents with varying chronic pain diagnoses (e.g., mixed pain samples, arthritis). Meta-analysis was used to synthesize the results from population-based and clinical studies, while meta-ethnography was used to synthesize the results of qualitative studies. Increased pain complaints were found in offspring of mothers and of fathers with chronic pain, and when both parents had chronic pain. Newborns of mothers with chronic pain were more likely to have adverse birth outcomes, including low birthweight, preterm delivery, caesarean section, intensive care admission, and mortality. Offspring of parents with chronic pain had greater externalizing and internalizing problems and poorer social competence and family outcomes. No significant differences were found on teacher-reported externalizing problems. The meta-ethnography identified six key concepts (developing independence, developing compassion, learning about health and coping, missing out, emotional health, and struggles communicating with parents). Across study designs, offspring of parents with chronic pain had poorer outcomes than other offspring, although the meta-ethnography noted some constructive impact of having a parent with chronic pain.
... According to recent studies, parental chronic pain is associated with children's physical health [4][5][6][7] and psychological adjustment. 8,9 Knowledge about the health-related factors in the family context of chronic pain sufferers is important, as the family environment is central in the treatment of chronic pain. 10 The way the family copes with these difficulties argues for examining chronic pain in the context of the chronic pain sufferers' primary social network: the family, including the children. ...
... 25,26 Furthermore, recent studies indicate an additive effect of parental chronic pain on children's psychological and physical health. 5,8 That is, the effects of having both parents with chronic pain are greater than having one or neither parents with chronic pain. Hence, research on this topic should include independent information from the offspring's mother and father. ...
... Parental chronic pain has been associated with increased levels of internalizing symptoms in offspring 8,9 which in turn are linked to adolescent substance use. 27,28 Symptoms of anxiety and depression were associated with high numbers of alcohol intoxications among adolescent girls in a Norwegian population based study. ...
Article
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Purpose The aim of the present study was to investigate possible associations between parental chronic pain and smoking, alcohol, and drug use in adolescent offspring. Methods Cross-sectional data from Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in the period 2006–2008 was utilized. The present sample consisted of adolescents aged 13–18 years (n=3,227) for whom information was available on maternal and paternal health statuses. Results Results from multivariable ordinal and binary logistic regression analyses, adjusting for potential confounding factors (child age, parental age, education, and organ specific illness) indicated that the estimated odds ratios (OR) for smoking (OR =1.72, 95% confidence interval [CI] [1.00, 3.05], P=0.049) and alcohol intoxication (drunkenness) (OR =1.56, 95% CI [1.05, 2.33], P=0.029) were higher for boys whose mother and father had chronic pain, compared with boys for whom neither parent had chronic pain. These associations were slightly attenuated by additional adjustment for pain-related factors, such as parental smoking and symptoms of anxiety and depression. Parental chronic pain was not significantly associated with girls’ levels of substance use. There were significant interaction effects between parental chronic pain and child sex on offspring’s alcohol intoxication and smoking. Conclusion The present study expands on existing knowledge and provides groundwork for preventive and specific measures targeting substance use in families burdened with parental chronic pain.
... It is also important to note that the impacts of bodily pain can extend beyond the parent-students themselves. Previously researchers have found that pain experienced by parents can have significant impacts on a family's general wellbeing (Romano et al., 1997;Roy, 2006), as well as on children's physical health (Hoftun et al., 2013), mental health (Kaasbøll et al., 2012), self-esteem and social competence did (i.e., only 5% of children in Canada are adopted; Dave Thomas Foundation for Adoption, 2022). Among women who have experienced childbirth there is a high prevalence of pain conditions that often continue long into the postpartum period (Kanakaris et al., 2011). ...
... Despite these strengths, the study was not without limitations. Due to the relatively small sample size of parents in this study compared to non-parents, age was unable to be controlled for (Kaasbøll et al., 2015), and psychological adjustment (Barkmann et al., 2007;Kaasbøll et al., 2012). While the current study did not explore chronic pain specifically, the study conducted by Kaasbøll and colleagues (2012) may be instructive and relevant nonetheless. ...
Article
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Post-secondary students are an at-risk population for poor mental health and high levels of stress—both of which might influence their resilience and health-related quality of life (HRQOL). Additional difficulties experienced by post-secondary students who are also parents may result in further challenges to their resilience and HRQOL. However, current literature is scant regarding the resilience and health-related outcomes among parents pursuing post-secondary education. Therefore, the purpose of this study was to explore the resilience and HRQOL of parents (with children/youth aged 0–18 years) pursuing post-secondary education in Ontario compared to non-parent post-secondary students. Selective, non-probability sampling was used to recruit participants for the online survey wherein data was collected from 86 parent-students (Mage = 34.69 years; SD = 7.07) and 288 non-parent-students (Mage = 22.41 years; SD = 5.00). By Mann-Whitney U tests, there were no statistical differences in the self-reported resilience between groups. However, significant differences between groups were found in their HRQOL; compared to non-parents, parents reported significantly more physical health problems, role limitations due to physical health, and bodily pain, while also reporting less favourable changes in their health over the past year. While parent-students reported more physical health challenges compared to non-parent students, their levels of resilience were alike. Results from this study offer important insights on some unique challenges that parent-students experience and provides the first understanding of Ontario parent-students’ levels of resilience. Additional research on the physical health challenges of parent-students is warranted.
... The Young-HUNT studies aimed to capture rapidly changing health statuses, behaviors, and functions that differed from those of adults; data collection included self-reported questionnaires, and clinical measurements [18]. To ensure maximum comparability, health data in the HUNT studies were collected comparably using interviews, identical self-administrated questionnaires, including screening for ADHD problems (adolescent's school functioning in Young-HUNT3 [19] and Adult ADHD self-report scale in HUNT4 [20]), and clinical examinations, which corresponded to the three waves of the CAP study. During the school day, students completed the questionnaires printed with a unique barcode without names or other identifiers; questionnaires were sealed in a blank envelope by the student after completion. ...
... Neuroinflammation is considered at the origin of ADHD and pain comorbidity [5], but it is unclear how neuroinflammation is related to sex differences in pain prevalence in children. Accordingly, the prevalence of pain in those with ADHD is complex and multifactorial and includes risk factors such as genetics and intergenerational recurrence of ADHD or chronic pain [19,35]. The prospective decrease in pain prevalence in ADHD patients may be attributable to symptoms in chronic pain states that are episodic and fluctuates in narrow time scale [13,36]. ...
Article
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Attention-deficit/hyperactivity disorder (ADHD) and chronic pain are prevalent and associated. We examined the prevalence and distribution of chronic pain in adolescents and young adults with ADHD using 9-years longitudinal data (from T1:2009–2011 to T3:2018–2019) with three time points from a clinical health survey compared to two age-matched reference population-based samples. Mixed-effect logistic regression and binary linear regression were used to estimate the probability for chronic and multisite pain at each time point and to compare the prevalence of chronic pain with the reference populations. The prevalence of chronic and multisite pain was high in those with ADHD, especially in female young adults, with highly prevalent chronic pain at 9 years of follow-up (75.9%) compared to 45.7% in females in the reference population. The probability of having pain was only statistically significant for chronic pain in males at 3 years of follow-up (41.9%, p = 0.021). Those with ADHD were at higher risk of reporting single-site and multisite pain compared to the general population at all measurement points. Longitudinal studies should be tailored to further understand the complex sex differences of comorbid chronic pain and ADHD in adolescents, exploring predictive factors of pain assessing long-term associations with bodyweight, psychiatric comorbidities, and possible mechanisms of stimulant use effects on pain.
... Women are three times more likely to experience migraine than men, and are predominantly affected during their childbearing years (Burch et al., 2018). There is growing concern of the long-term mental health problems in the children born to mothers with migraine (Evans et al., 2005;Kaasbøll et al., 2012;Güngen et al., 2017). Children of mothers with migraine had more psychological and behavioural problems that were assessed through questionnaires in several previous studies (Evans et al., 2005;Kaasbøll et al., 2012;Güngen et al., 2017). ...
... There is growing concern of the long-term mental health problems in the children born to mothers with migraine (Evans et al., 2005;Kaasbøll et al., 2012;Güngen et al., 2017). Children of mothers with migraine had more psychological and behavioural problems that were assessed through questionnaires in several previous studies (Evans et al., 2005;Kaasbøll et al., 2012;Güngen et al., 2017). It was suggested that maternal migraine may affect offspring psychiatric disorders via altered intrauterine environment in the central nervous system (Burch, 2020). ...
Article
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Aims Maternal migraine may contribute to mental heath problems in offspring but empirical evidence has been available only for bipolar disorders. Our objective was to examine the association between maternal migraine and the risk of any and specific psychiatric disorders in offspring. Methods This population-based cohort study used individual-level linked Danish national health registers. Participants were all live-born singletons in Denmark during 1978–2012 ( n = 2 069 785). Follow-up began at birth and continued until the onset of a psychiatric disorder, death, emigration or 31 December 2016, whichever came first. Cox proportional hazards model was employed to calculate the hazard ratios (HRs) of psychiatric disorders. Results Maternal migraine was associated with a 26% increased risk of any psychiatric disorders in offspring [HR, 1.26; 95% confidence interval (CI), 1.22–1.30]. Increased rates of psychiatric disorders were seen in all age groups from childhood to early adulthood. Increased rates were also observed for most of the specific psychiatric disorders, in particular, mood disorders (HR, 1.53; 95% CI, 1.39–1.67), neurotic, stress-related and somatoform disorders (HR, 1.44; 95% CI, 1.37–1.52) and specific personality disorders (HR, 1.47; 95% CI, 1.27–1.70), but not for intellectual disability (HR, 0.84; 95% CI, 0.71–1.00) or eating disorders (HR, 1.10; 95% CI, 0.93–1.29). The highest risk was seen in the offspring of mothers with migraine and comorbid psychiatric disorders (HR, 2.13; 95% CI, 1.99–2.28). Conclusions Maternal migraine was associated with increased risks of a broad spectrum of psychiatric disorders in offspring. Given the high prevalence of migraine, our findings highlight the importance of better management of maternal migraine at childbearing ages for early prevention of psychiatric disorders in offspring.
... Studies have shown that mothers of children with chronic abdominal pain show pain bias when interpreting ambiguous emotional expressions, and such bias might possibly contribute to parenting behaviors that maintain or enhance the child's pain [131]. Children of parents with chronic pain have been shown to display poorer outcomes in health, as well as psychological and familial functioning [132], and show increased risk of developing anxiety and depression as teenagers [133]. ...
... Opioids administered for primary pain disorders have low long-term efficacy, a poor safety profile, and commonly a worse clinical outcome [133][134][135][136][137][138][139]. Thus, opioids should not be administered to pediatric patients with primary pain disorders [43], i.e., chronic pain defined that extends beyond the expected time of healing and hence lacks the acute warning function of physiological nociception. ...
Article
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Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.”We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy. http://www.mdpi.com/2227-9067/3/4/42/html
... Additionally, there is evidence that parental CP may negatively impact the well-being of their offspring, as well as the parent-child relationship. On the one hand, some studies indicate that children whose parents suffer from CP have a higher risk of experiencing pain and poor physical and emotional well-being (Kaasbøll et al., 2012;Higgins et al., 2015). On the other hand, the disabling nature of parental CP increases the risk of role reversal, where children assume responsibilities that they should not have to, resulting in negative consequences for them, which seems to be a concern for parents with CP (Duryea, 2007;Kristiansen et al., 2012;Parton et al., 2022;Umberger, 2014). ...
Article
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Introduction Suffering from chronic pain (CP) and coping with parenthood can be challenging for parental mental health. Pain can hinder the ability to deal with demands related to parenthood, which can negatively affect their psychological well-being because of unmet caregiving expectations. Methods Considering the limited amount of research regarding the mental health of parents with CP, the study’s main aim was to test a predictive model based on previous scientific literature, using structural equation analysis, in which parental competence and parental guilt partially mediate the relationship between parental stress and depression. To examine the moderating role of CP, the model was tested on a group of parents with CP and a control group of parents without CP. The study included 380 parents from all over Spain, of which 200 formed the group with CP and 180 participants formed the control group. A cross-sectional design was used to collect data through self-report measures. Results Higher levels of stress, guilt, and depression were observed in parents with CP. Based on the results, both groups of parents showed a good fit with the predictive model; parental stress was a good predictor of symptoms of depression both in parents with and without CP, parental competence mediated the relationship between parental stress and depression, being the relationship between competence and depression partially mediated by parental guilt. Discussion This study is the first to quantitatively examine parental competence and guilt in parents with CP, and to analyze their role as mediators between parental stress and depression in both CP and healthy parents. The results confirm previous qualitative findings and extend them to parents with CP, showing that the tested model aligns with the main theories on stress, self-efficacy, and depression, as well as existing literature on CP. These results suggest the relevance of addressing parental stress levels for reducing and preventing depressive symptoms in parents with CP and the importance of working on guilt reduction and enhancing competence in order to improve the emotional well-being of parents. The need to take into account the mental health of parents with CP to improve their quality of life is discussed.
... Related literature on chronic pain, which may also be observed in CVD cases [13], could provide relevant insight on the plausible relationship between parental CVD and child mental health and behaviors. For example, recent evidence and a systematic review suggest that parental chronic pain and illness increase the risk of child psychological dysfunction, including increased internalizing symptoms for depression and anxiety [14,15]. Parental illness may also potentially affect child mental health through financial strain as well, which can increase parenting stress [16]. ...
Article
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Background: This study assessed the association between cardiovascular disease (CVD), the leading cause of death in the United States, among parents and child mental health. Methods: Our sample included 9076 children aged 6 to 17 years. Data were pooled from the 2016-2018 waves of the National Health Interview Survey. We fitted a logistic regression to obtain the odds ratios in favor of child mental health problems for parental CVD. We also fitted a multinomial logistic regression to obtain the odds in favor of the severity of mental health problems (i.e., minor, definite, and severe). Results: The adjusted odds of facing difficulties for a child of a parent with CVD were 1.64 (95% CI: 1.28-2.11) times that of their peers whose parents did not have CVD. The adjusted relative risk of facing minor and definite difficulties for a child of a parent with CVD were 1.48 (95% CI: 1.13-1.94) and 2.25 (95% CI: 1.47-3.46) times that of their peers of parents without CVD. Conclusions: The results suggest a strong association between child mental health and parental cardiovascular morbidity, demonstrating the need for the development or adaptation of existing public health interventions to facilitate mental health support for children of parents with CVD.
... Steht der Schmerz im Mittelpunkt der Gespräche oder wird als Hauptfaktor für die Planungsfähigkeit bezüglich Alltagsgestaltung, familiärer Unternehmungen oder sozialer Interaktion wahrgenommen, wird er als legitimer "Bestimmer des Alltags" empfunden. Je höher die Anzahl an Personen mit Schmerzen im familiären Umfeld, desto eher besteht die Gefahr, dass auch das Kind unter ihnen leiden wird und sich ihnen hilflos ausgeliefert fühlt [26][27][28]. Vor allem Eltern, die selbst Schmerzen haben, tendieren dazu, mitzuleiden und ihr Kind überfürsorglich zu behandeln [29], was ein Fortbestehen der Schmerzen begünstigt. ...
Article
ZUSAMMENFASSUNG Chronische Schmerzen bei Kindern und Jugendlichen werden oft in Zusammenhang mit Angst, Depression und Verhaltensauffälligkeiten gebracht, zugleich begünstigen diese psychischen Auffälligkeiten eine Chronifizierung. Lebensqualität, Angst-Vermeidungs-Tendenzen, elterliches Verhalten und sozioökonomischer Status modulieren ebenfalls Prozesse der Schmerzchronifizierung. Darüber hinaus müssen Schlafverhalten, operative/invasive Eingriffe, spezielle Schmerzarten und -orte und frühkindliche Schmerzerfahrungen als mögliche Prädiktoren für chronische Schmerzen rechtzeitig in Erwägung gezogen werden. Im klinischen Alltag sollten all diese Faktoren in Anamnese, Edukation und Therapieverlauf einbezogen werden. Ein rechtzeitiges Erkennen und Therapieren psychischer und sozialer Belastungen kann die Gefahr der Chronifizierung von Schmerzen reduzieren.
... Adolescents whose parents are chronically ill are significantly more likely to show internalizing problems (i.e., anxious, depressed, and withdrawn behaviors and somatic complaints) than other children (5,8,(14)(15)(16)(17)(18). While in the general population, adolescent females show more internalizing symptoms than males (19)(20)(21), a meta-analysis found that sex differences regarding internalizing problems in children with parental chronic illnesses are negligible (5). ...
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Background: Parental chronic illness is associated with an elevated risk for developing social-emotional and behavioral problems in children, in particular internalizing symptoms. This study aimed to investigate the associations between parental chronic illness when participants were adolescents and subsequent internalizing symptoms in young adulthood and whether adolescent attachment to parents or peers mediates these associations. Methods: The study used longitudinal survey data from the Youth and Mental Health Study, a cohort study including a representative sample of youth in central Norway assessed in the period from 1999 to 2000 (mean age 14.9 years) and in 2012 (mean age 27.2 years) (N = 1,266). The data consist of youth self-reports at both time points. Parental chronic illness was reported by the adolescents, quality of attachment was measured using the Inventory of Parent and Peer Attachment (IPPA), and internalizing problems were assessed in young adulthood by using the Adult Self-Report (ASR). Data were analyzed using parallel mediation analyses, controlling for adolescent sex, parental socioeconomic status, and divorce. In addition, separate analyses were conducted for adolescent girls and boys. Results: The total longitudinal effect was significant for both maternal and paternal chronic illness on internalizing problems in young adulthood. The direct effect on internalizing problems was only significant for maternal chronic illness. Attachment to fathers partially mediated the relationship between maternal chronic illness in adolescence and internalizing symptoms in young adulthood, whereas attachment to both mothers and fathers fully mediated the relationship between paternal chronic illness in adolescence and internalizing symptoms in young adulthood. A separate analysis for girls and boys indicated that the results were only significant for girls. Parental chronic illness did not play a significant indirect effect via attachment to peers on internalizing problems. Conclusions: Identifying protective factors in the pathways between parental chronic illness and mental distress in children could guide measures that promote the well-being of the child and family. The study demonstrates the importance of targeting the entire family in chronic illness care.
... For example, parental chronic pain increases risk of chronic pain in their children (Higgins et al., 2015;Hoftun et al., 2013;Saunders et al., 2007). It has been widely observed that chronic pain in parents is additionally associated with greater risk of offspring internalizing disorders (Higgins et al., 2015;Kaasbøll et al., 2012;Smith & Chambers, 2006), and parental internalizing symptoms appear to worsen pain outcomes in their children (Brown et al., 2021;Wallrath et al., 2020). Recent literature has emphasized that rather than focusing on individual characteristics, the combination of parental factors, such as physical functioning, psychological functioning, and parenting style, together best predict chronic pain experiences within their children (Birnie et al., 2020;Brown et al., 2021;Poppert Cordts et al., 2019;Stone & Wilson, 2016;Wallrath et al., 2020). ...
Article
Objective The combination of parental chronic pain and internalizing characteristics are relevant to chronic pain experiences in their children. A promising unified multifactorial intergenerational model of chronic pain was published in 2019; however, this model was only generalizable to children with severe chronic pain and some factors had limitations. This study aimed to determine validity of an adapted multifactorial model, including parent and child chronic pain status, pain characteristics, pain-related functioning, and internalizing symptoms, in a community setting. Subgroup analyses based on presence of chronic pain in parents and children were explored to determine whether effects were stronger in certain subsamples. Methods Adolescents (N = 1,450, Mage=12.7 years, 50% female), and their parents (82% mothers), were recruited from five schools to complete online surveys. Structural equation modeling was used to investigate interrelated pain-related experiences between parents and their offspring. Results The adapted unified multifactorial model had good model fit in the community sample. Significant weak associations were found between all parent and child factors. The strongest associations were found in the subsample of parents and children with chronic pain. In all subgroups, internalizing factors were the most strongly linked intergenerational constructs. Conclusions Our results support the validity of the unified multifactorial model of parental factors in pediatric chronic pain, although associations were weaker in the community sample than those previously reported in a clinical sample. In children who develop chronic pain, it is important to consider their parent’s chronic pain and internalizing symptoms to best manage intergenerational effects.
... Without any doubts, diminished attention and emotional presence of the caregivers have direct impact on the character of the children, their perceptions of themselves, their environment, and most importantly on their sense of self-worth and self-esteem. Additionally, there appeared to be a possible connection between maternal and paternal chronic pain and occurrence of anxiety and depression-related symptoms among girls and boys, smoking and alcohol misuse among adolescent boys (Kaasbøll et al., 2012). All facts and aspects taken into account the current research is certain that, these issues are strong demonstrations that are redolent of an urgent necessity for enrolment in training workshops and informative programs. ...
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Objective: The aim of this study was to review the impact of a possible association between self- efficacy, symptom severity, pain intensity, depression, anxiety and catastrophizing on health- related quality of life among chronic pain patients. Background: A large number of people experience and live with various types of physiological-oriented chronic pain (CP) diseases. Lives of individuals who suffer from CP may alter in various ways. Particularly, in terms of health-related quality of life after diagnosis. Even though, there has been significant increase in chronic pain research, this area of research continues to offer patients significant health repercussions. Findings: This research has discovered that, there still, is an urgent need for improvements in regard to treatment and quality of chronic pain management care. A range of literatures assessed several aspects in which CP alters the patients’ lives, as well as its potential repercussions in the workplace, on the dynamic of patients’ families, and their social environments. Methods: An exploratory review of literature alongside the implementation of a small exemplary pilot study that was solely undertaken to help further validate the results that were acquired via review of literature. The data presented in the pilot study were drawn from purposive sampling and structured survey questionnaires. Participants of the pilot study: Thirty adults (>18 years) diagnosed and currently living with various kinds of chronic physical non-cancer pain.
... The pathways by which meditation reduces pain are beginning to receive empirical attention, though important questions remain unanswered. Given the prevalence and costs of chronic pain (6)(7)(8), concomitant opioid medication abuse/addiction (9)(10)(11)(12), and meditation's potential for drug-free analgesia, developing a more complete picture of the pathway or pathways by which meditation can cause analgesia is an important public health priority. ...
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Objective: Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice.Methods: Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist Naloxone (0.15mg/kg bolus dose, then 0.2mg/kg/hr infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation.Results: Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = 0.019, Cohen’s d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = 0.001, Cohen’s d = 0.68), confirming the presence of meditation analgesia. Comparing saline and Naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = 0.004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = 0.002, d = 0.62), during meditation under Naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia, it made meditation analgesia stronger.Conclusions: Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone’s blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under Naloxone than under saline. Possible biological mechanisms by which Naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.
... The pathways by which meditation reduces pain are beginning to receive empirical attention, though important questions remain unanswered. Given the prevalence and costs of chronic pain (6)(7)(8), concomitant opioid medication abuse/addiction (9)(10)(11)(12), and meditation's potential for drug-free analgesia, developing a more complete picture of the pathway or pathways by which meditation can cause analgesia is an important public health priority. ...
Article
Full-text available
Objective: Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice. Methods: Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist Naloxone (0.15mg/kg bolus dose, then 0.2mg/kg/hr infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation. Results: Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = 0.019, Cohen's d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = 0.001, Cohen's d = 0.68), confirming the presence of meditation analgesia. Comparing saline and Naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = 0.004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = 0.002, d = 0.62), during meditation under Naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia, it made meditation analgesia stronger. Conclusions: Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone's blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under Naloxone than under saline. Possible biological mechanisms by which Naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.
... [2][3][4][5][6][7][8][9] Many studies identified the association of headache with various psychosocial characteristics. [10][11][12][13][14] In addition, our recent research on the population sample showed more or less close linkages with psychosocial factors such as quality of family interaction, school stress and certain psychological characteristics of children with headache of every type. These studies consisted of cross-sectional analyses or longitudinal designs with short intervals. ...
Article
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The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.
... Studies from the UK and Norway have found that parents with serious mental health problems often do not receive help in order to support their children [1,8,9]. Children of seriously ill parents are at risk of developing their own psychosocial and health problems [10][11][12]. Hence, children and families at risk should be identified so their needs can be recognized and support can be ensured [13,14]. ...
Article
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Background: Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. Method: A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. Results: It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. Conclusion: Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.
... Das gehäufte familiäre Vorkommen von chronischen Schmerzen bei Eltern und Kindern [z. B.[20,21]] scheint weniger durch genetische Modelle erklärbar als durch psychologische Erklärungsmodelle (z. B. empathisches "Mitleiden, Lernen am Modell[22,23]). ...
Article
Chronic pain syndromes in children and adolescents are defined as constant pain over a period of 3 months or more. They are currently estimated to affect every fourth child in Germany, with every twentieth suffering extremely from the recurring pain. Besides headache and abdominal pain, musculoskeletal pain is increasingly reported, fluctuating in localisation, intensity, quality and frequency. Due to pain, antalgic postures and psychological factors such as fear and sadness, patients' quality of life declines as school attendance, social activities and hobbies are reduced over time. This review summarises the background of this chronic illness and introduces a multimodal therapeutic approach, which is implemented at the Centre of Pain Therapy in Garmisch-Partenkirchen.
... In addition to pain, offspring of parents with chronic pain are more likely to experience externalizing and internalizing problems. 70 Genetic contributions to these intermediate psychological phenotypes could help elucidate the transmission of risk for multiple outcomes in the context of parental chronic pain. ...
Article
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Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
... Several third variables may cause the associations found in the studies in this thesis. For example, age, sex, SES, living situation, neighborhood characteristics, negative life events, low social support, externalizing symptoms, violence, physical disease, chronic pain, and inflammation may be confounding variables (Baumeister, Russell, Pariante, & Mondelli, 2014;Dalgard, Bjørk, & Tambs, 1995;Kaasbøll, Lydersen, & Indredavik, 2012;Landolt, Ystrøm, Stene-Larsen, Holmstrøm, & Vollrath, 2014;Leventhal & Brooks-Gunn, 2000). Adjustment for confounders depends on firm knowledge that a variable in fact is a confounder as adjustment for colliders or mediating variables in the causal chain would lead to bias (Christenfeld et al., 2004;Hernán, Hernández-Díaz, Werler, & Mitchell, 2002). ...
Thesis
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In this thesis, several psychosocial factors associated with internalizing symptoms in adolescence were addressed, with a focus on familial aggregation. Having a parent with mental health problems is one of the most important risk factors for developing psychiatric symptoms, but existing research is limited by the fact that paternal mental health seldom has been examined. In addition, the development and maintenance of internalizing symptoms may rely on individual characteristics of the child, peer factors, socioeconomic status, and other psychosocial factors. Psychosocial correlates can have important implications for both prevention and treatment of internalizing symptoms because such variables can often be modified, in contrast to biological correlates, and may also serve to increase identification of symptoms. Previous research indicates that especially social anxiety is understudied and not easily recognized by adults, even mental health professionals working with youth. The main objectives in this thesis were to examine several psychosocial correlates of internalizing symptoms. In study 1, associations between several mental health symptoms in both parents and internalizing symptoms in adolescent offspring were investigated. In addition, we examined whether parental and offspring sex moderated these associations. In study 2, the associations between recurrent internalizing symptoms in parents over a ten-year time span and internalizing symptoms in adolescent offspring were examined. In addition, we investigated whether associations between parental and offspring internalizing symptoms were mediated by offspring self-esteem and moderated by physical activity. In study 3, we focused solely on internalizing symptoms related to social anxiety and their correlates. All three studies were based on data from the adolescent portion of The Nord-Trøndelag Health Study (Young-HUNT3). The sample in studies 1 and 2 consisted of 5732 adolescents in Young-HUNT3 (ages 13-18) who had one (N=2503) or both parents (N=3229) participating in the adult HUNT3. In study 2, the sample moreover included data from those parents who also participated in the adult HUNT2 when offspring were of a preschool age. This constituted 3198 of the mothers (78%) and 2488 of the fathers (77%). In study 3, the study sample consisted of 7669 adolescents from Young-HUNT3, in addition to comparable data from a clinical sample consisting of 694 participants (ages 13-18) in The Health Survey in the Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital in Sør-Trøndelag, Norway (the CAP Survey). All participants responded to questionnaires reporting on their own mental health. The findings showed that parental symptoms of anxiety and depression, but not alcohol abuse and eating problems, were associated with low subjective well-being, low self-esteem, and more symptoms of depression, general anxiety, and social anxiety in adolescent offspring. None of the associations were dependent on parental or offspring sex, suggesting that internalizing symptoms in fathers and mothers were equally important for offspring symptoms. Parental symptoms of anxiety and depression when offspring were of a preschool age were associated with such symptoms in offspring ten years later, but these associations were fully mediated by current parental symptoms. These findings suggest that the children of parents with internalizing symptoms are at a sustained risk for such symptoms themselves due to the apparent 10-year stability of both maternal and paternal symptoms. The associations between parental and adolescent internalizing symptoms were partly mediated by low adolescent selfesteem, which may be an important precursor of symptoms and amenable to interventions. Adolescent physical activity moderated the association between maternal and offspring internalizing symptoms, and may reduce familial aggregation of such symptoms. This suggests encouraging physical activity in the offspring of parents with such symptoms could be useful. Social anxiety symptoms were frequently reported by adolescents, and the most prominent correlates were academic school problems, bullying, eating problems, and acne problems. These correlates may be easier to detect than social anxiety symptoms, and prevention programs targeting these factors may also be useful for reducing such symptoms. Based on the combined findings, routine screening of a broad range of problems among children, adolescents, and parents may be vital to reduce the burden of internalizing problems in adolescence.
... Studies based on the Young-HUNT study 2008 found that both chronic pain and psychological symptoms "runs in the family", i.e., are most prevalent among adolescents with parents suffering from similar symptoms. [58,59] Several authors have confirmed higher prevalence of musculoskeletal pain among girls [14,16,20,60], suggesting gender to be an explanatory factor of pain. There was some higher prevalence of musculoskeletal pain among the girls also in this study sample (Table 1). ...
Article
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Background: Long-term musculoskeletal pain and negative stress are health risks with adverse long-term health effects, and these health risks seem to increase among young people. The mechanisms behind this are unclear. There is a need for a better understanding of perceived stress and musculoskeletal pain among adolescents, in order to improve health promotion and treatment approaches in this group. Methods: Objectives were to evaluate the current prevalence of perceived stress and musculoskeletal pain in 15 and 16 year olds, to explore stress-pain associations and the probability that perceived stress (PSQ) was related to the reporting of pain and variations in pain, and to investigate possible differences in stress between different types of musculoskeletal pain in the adolescents. A cross-sectional study was conducted. Elementary schools participated. The outcomes were stress (Perceived stress questionnaire; PSQ) and musculoskeletal pain (pain/no pain, pain sites, pain duration and pain intensity (Visual analogue scale; VAS). Results: Fifty-one point two percent (N = 422) reported pain, of which 70.8 % reported long-term pain. Some more girls (57.9 %) reported pain. 22.0 % of the study population reported moderate to severe stress (PSQ ≥ 0.45), of which 79.6 % were bothered by pain (Pearson Chi-square 38.47, p ≤ .001). All stress and pain variables were significantly associated (p < .01). The strongest association appeared between pain intensity (VAS) and stress (PSQ) (r = 0.40). Perceived stress (PSQ) was associated with the reporting of pain among the adolescents (Odds Ratio [OR] 1.68) and could explain some of the variation in pain intensity (VAS; β = 0.15, p < .001) and number of pain sites (β = 0.14, p < .01), according to the regression analyses. There were no mean differences in stress (PSQ) between different types of musculoskeletal pain. Conclusions: There was high prevalence of musculoskeletal pain, long-term pain and moderate to severe stress (PSQ ≥ 0.45) in this study sample. Perceived stress (PSQ) was related to the reporting of musculoskeletal pain among the adolescents and could explain some of the variation in pain intensity (VAS) and number of pain sites. There were no differences in stress levels (PSQ) between different types of musculoskeletal pain in the adolescents.
... Finally, the parents' health status was considered as possibly affecting child mental health and contributing to financial stress through decreased ability to work. 26 Parents' sick leave was used to assess parents' health status and defined as long term if parents reported having taken 60 or more sick leave days the last 12 months. ...
Article
Background: The Nordic welfare system has been acknowledged as favourable for children, successfully contributing to low child mortality and poverty rates. Nevertheless, mental health problems among children and adolescents are common and the economic situation of the family has been highlighted as an important determinant. In spite of similar social, political and cultural structures, the Nordic countries differ; Iceland was most affected by the global financial crisis in 2008. The aim of this study was to examine potential differences in parental financial stress and the associations to child mental health between the Nordic countries as well as age and gender differences. METHODS: The study sample consisted of 6330 children aged 4-16 years old included in the 2011 version of the Nordic Study of Children's Health, Wellbeing and Quality of life. The Strengths and Difficulties Questionnaire was used to measure mental health problems. RESULTS: In Iceland, 47.7% of the parents reported financial stress while ≤20% did so in the other countries except for Finland (33.5%). However, in case of parental financial stress the OR of mental health problems comparing children to parents with and without financial stress was significantly lower among the Icelandic children (OR 1.60, 95% CI 1.15-2.24) than among the others: Denmark OR 3.07 (95% CI 2.15-4.39), Finland OR 2.28 (95% CI 1.60-3.25), Norway OR 2.77 (95% CI 1.86-4.12), Sweden OR 3.31(95% CI 2.26-4.86). No significant age or gender differences in the ORs were observed. CONCLUSIONS: Besides socioeconomic situation, relative deprivation should be considered an important determinant of child mental health.
... Parental physical illness or disability has to our knowledge not been directly examined as a risk factor for depression diagnosis in adolescence and young adulthood. However studies have shown that children of parents with multiple sclerosis [38], cancer [39], brain injury [40], and chronic pain [41] report more emotional problems including depressive symptoms. Chronic illness in parents have been found to be a source of stress and linked to adjustment problems as well as depressive symptoms in children [42][43][44][45]. ...
Article
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The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.
... Little is known, however, about the additive impact of parental chronic pain-that is, the effects of having neither, one, or both parents with chronic pain. A recent study (Kaasboll, Lydersen, & Indredavik, 2012) found significant additive effects for parental chronic pain on children's internalizing emotional symptoms, but it did not investigate effects on children's pain. ...
Article
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Objective: To evaluate effects of mothers' and fathers' chronic pain on health outcomes in adult sons and daughters with a childhood history of functional abdominal pain (FAP). Method: Adults (n = 319; Mean age = 22.09 years) with a childhood history of FAP reported parental history of chronic pain and their own current health (chronic pain, somatic symptoms, disability, use of medication and health care, illness-related job loss). Results: Positive histories of maternal and paternal chronic pain were each associated with poorer health in sons and daughters, regardless of child or parent gender. Having 2 parents with chronic pain was associated with significantly poorer health than having 1 or neither parent with chronic pain. Conclusions: Chronic pain in both mothers and fathers is associated with poor health and elevated health service use in young adults with a childhood history of FAP. Having both parents with chronic pain increases risk for adverse outcomes.
Article
Chronic pain in Canadian Veterans is twice that of the general population and the prevalence of their related mental health concerns is alarmingly high. This likely puts their children at an increased risk of developing pain and mental health problems that can pervasively impact daily life and persist into adulthood. Pain care and military culture of (acute and chronic) pain has been identified as a top priority of Canadian Veterans. This study aimed to gain an in-depth understanding of the pain experiences of Canadian Armed Forces (CAF) families. Thirty-five semi-structured qualitative interviews were conducted. Demographic information was collected; age, gender, and ethnicity were reported. Twelve CAF members/Veterans, 17 youth, and six spouses were interviewed. Ninety-two percent of Veteran participants reported chronic pain. Reflexive thematic analyses generated four themes: i) Military mindset: herd culture and solider identity, ii) The culture of pain within military families, iii) Inseparability of mental health and pain, iv) Breaking the cycle and shifting the military mindset. Military culture and identity create a unique context within which pain expression and experience is integrally shaped within these families. This study sheds light on how pain is experienced and perceived within military families and can inform research on and efforts to foster resilience in these families. PERSPECTIVE: This is the first qualitative study to explore the lived experiences of pain in Canadian military families. Findings underscore the key role that military culture and identity plays in how pain is experienced and perceived in all family members.
Article
Background: Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking. Aims/objectives: To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice. Materials and methods: Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain. Results: Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain. Conclusions: Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain. Significance: The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.
Article
Parental injuries and illnesses affect child and family life. We hypothesized that military parental injury would adversely affect children's preventive care, injuries, maltreatment, mental health care, and psychiatric medication prescriptions. Visit and prescription data of 485,002 military-connected children ages 2-16 were tracked for two years before and two years after the injury of a parent in the period 2004-14. Adjusted negative binomial regression compared pre- and post-injury visit and prescription rates. Children with injured parents had decreased rates of preventive care visits and increased rates of visits for injuries, maltreatment, and mental health care, as well as increased psychiatric medication use, following their parent's injury. Across all categories of care, children of parents with posttraumatic stress disorder (PTSD), both alone and with traumatic brain injury, appeared to have more pronounced changes in care patterns. Parental injury and illness are associated with changes in children's health care use, and PTSD in a parent increases the effect.
Article
Background Currently, there is mixed evidence regarding the effects on children when a parent is chronically ill. Research has also primarily been conducted with adolescent samples. This study investigated developmental vulnerabilities in young children of parents with chronic illness. Methods This study used linked administrative data. The study population included children born in Western Australia during 2003–2004 (n=19 071; mean age 5.5 years). The outcome measure was a score in the bottom 25% on any of the five developmental domains (physical, social, emotional, communicative and cognitive) of the Australian Early Development Census (2009 collection). Parental chronic illnesses were identified from hospital and cancer registry records, during the period from 1 year prior to the child’s birth and until the end of 2009. Results Higher odds of developmental vulnerabilities in physical, social, emotional and communication domains were observed for daughters of chronically ill mothers. Sons of chronically ill mothers had increased odds of language and cognitive difficulties. Risk level increased with each additional year of exposure to maternal chronic illness. Results also indicated increased odds of developmental vulnerabilities for children of mothers experiencing multiple compared with single chronic conditions; however, results were not statistically significant (all p>0.05). No association between fathers’ chronic illness and children’s developmental outcomes was found. Conclusions Maternal chronic illness is associated with an increased risk of poor developmental outcomes for children, particularly daughters. Healthcare services have an important role to play in linking families into appropriate family-centred services to best support the needs of chronically ill mothers.
Article
The aim of this study was to assess the prevalence of chronic multisite pain with high disability in relation to emotional or behavioral problems and resilience factors in adolescence. A second aim was to investigate if resilience factors could attenuate the associations between psychiatric symptoms and chronic multisite pain. The study was based on a large cross-sectional study carried out in Norway between 2006 and 2008 and included 7,070 adolescents aged 13-19 years. Chronic multisite pain was defined as pain at least once a week during the last 3 months, scoring high on a disability index, and occurring in three or more locations. Chronic multisite pain was prevalent among adolescents with high scores (>85 %) for anxiety/depression, social anxiety, conduct or attention problems (22.8-31.0 % for girls, 8.8-19.0 % for boys). Several coexistent psychiatric symptoms increased the prevalence of chronic multisite pain for both girls and boys. Resilience factors, including high self-esteem, seldom feeling lonely, and high scores for family cohesion or social competence, were associated with a lower prevalence and markedly attenuated the association between psychiatric symptoms and chronic multisite pain. Psychiatrists should be careful to assess and treat comorbid chronic pain in adolescents with emotional or behavioral problems.
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Background: Parental characteristics can increase the risk of the development of adolescent depression. In this study, we focus on the parental factors of parents in a non-intact relationship, dissatisfaction with personal economy, physical illness or disability, and internalizing and externalizing problems. The aim is to examine which of these parental risk factors, separately for mothers and fathers, are associated with clinical depression in adolescents in a community sample. Methods: In the Youth and Mental Health study, 345 adolescents (mean age ± standard deviation 15.0 ± 0.6 years, range 13.8-16.6 years; 72.5% girls) and their parents (79% at least one parent) completed questionnaires and the diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL). Adolescents were classified into current major depressive disorder or dysthymia (n = 46), depression not otherwise specified (n = 48), or no depression (n = 251). The parental risk factors were based on interview and the Adult Self-Report. Risk factors associated with mothers (n = 267) and fathers (n = 167) were separately analyzed using ordinal logistic regression with current depression category as the dependent variable. All analyses were adjusted for youth sex and age. Results: Mothers' economical dissatisfaction, physical illness/disability, internalizing problems and externalizing problems were associated with adolescent current depression (P ≤ 0.02). Adjusting for all other factors, only mothers' internalizing problems (P < 0.001) remained significantly associated with adolescent depression. Fathers' risk factors were not associated with adolescent depression. Conclusion: Characteristics of mothers are associated with adolescent current depression. Mothers' internalizing problems is independently strongly associated with increased risk of current adolescent depression. Clinicians should assess mothers' mental health when treating depressed adolescents.
Article
Chronic non-cancer pain (CNCP) is a prevalent occurrence and is experienced by adults in their child-rearing years. Communication within the family about parental illness can be formidable, and family members are often uninformed about illness details. To date, there is no research exploring how children and adolescents understand parental chronic pain, a very complex phenomenon, and its related disability. The aim of this study was to develop a substantive theory that describes how adolescents manage the experience of living with a parent suffering with CNCP and environmental factors that help or hinder this process. Grounded theory was used, the focus of which was adolescents' processes of dealing with parental illness in the interpersonal and environmental contexts of their daily lives. A sample of 30 young adults was recruited in northeastern Ohio using theoretical sampling. During open-ended interviews, participants were asked to look back on their adolescence and talk about how they managed living with parental chronic pain. Interview transcripts and field notes were analyzed using constant comparative methods. Six ways of understanding parental chronic pain emerged from the data: noticing something is different, wrestling with not knowing, searching for answers, questioning the validity of pain, developing insight into the complexity of pain, and learning important life lessons. Findings shed light on how adolescents understand and attach meaning and significance to parental chronic pain and disability and serve as the basis for the development of personalized family interventions.
Article
Chronic noncancer pain (CNCP) is a prevalent occurrence and is experienced by adults in their child-rearing years. Somatic or psychiatric illness in a parent constitutes a potential threat to the physical, mental health, and normative development in children. A comprehensive review of the literature was performed to answer the question: What are the effects of parental CNCP on children in the family system? The search was performed using the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, and Academic Search Premier. Search terms used were "parent pain or parent chronic pain or parent illness or parent chronic illness" and "child or adolescent or teenager." Inclusion and exclusion criteria were developed a priori. Eighteen articles (n = 18) met criteria and were included in the sample. Three clusters were identified: (a) child/adolescent somatic complaints or behavior; (b) child/adolescent internalizing or externalizing symptoms; and (c) important mediating and moderating variables. The results of this review show that children and adolescents whose parents suffer from CNCP are at risk for more and similar-to-parent pain complaints and greater degree of internalizing and externalizing symptoms than those with healthy parents. Implications for clinical nursing practice and research are given.
Article
Functional somatic symptoms (FSS) are common in children and adolescents, but explanatory models that synthesize research findings are lacking. This article reviews the studies published from January 2012 to March 2013 that investigate the neurophysiological mechanisms that may underlie FSS. Studies from diverse medical disciplines suggest that FSS are associated with functional differences in hypothalamic-pituitary-adrenal function, imbalances in vagal-sympathetic tone, upregulation of immune-inflammatory function, and primed cognitive-emotional responses that serve to amplify reactivity to threatening stimuli, thereby contributing to the subjective experience of somatic symptoms. FSS appear to reflect dysregulations of the stress system. When seemingly disparate research findings are interpreted together within an overarching 'stress-system' framework, a coherent explanatory model begins to emerge.
Article
Purpose: The purpose of this article is to describe a substantive theory that details how adolescents manage living with a parent experiencing chronic noncancer pain (CNCP). Design: Grounded theory methods were used to recruit 30 young adults, ages 18 through 21 years, from community settings. Methods: During open-ended interviews, participants were asked to look back on their adolescence and talk about how they managed living with parental chronic pain. Interview transcripts and field notes were analyzed using constant comparative methods. Findings: Participants who lived with heavily shrouded parents (a) endured hardships; (b) distanced themselves; (c) lamented losses; and (d) held back on revealing their authentic selves. Those who lived with minimally shrouded parents (a) received nurturance and parenting; (b) empathized with their parents' pain situations; (c) lamented losses; and (d) revealed to their parents how parental pain affected them. Participants who connected with significant others "filled the gaps" created by parental pain disability, while those who did not connect with significant others "cooped up" their thoughts, feelings, and needs. Conclusions: Findings shed light on psychosocial processes and behavior within families experiencing CNCP and serve as the basis for the development of personalized family interventions. Clinical relevance: Nursing interventions should focus on helping adolescents and parents build interpersonal relationship and communication skills. Aggressive diagnosis and treatment of mood disturbance in the parent with CNCP should be part of a holistic treatment plan.
Article
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The second Nord-Trøndelag Health Study in 1995-97 (HUNT 2) was partly a follow-up study of HUNT 1, conducted in 1984-86. HUNT 2 comprised, however, a larger scientific program. The large amount of information collected from each participant, and the large number of participants in a wide age range covering an entire county population, make HUNT one of the largest health studies ever performed. This paper describes the survey covering persons aged 20 years and older. In total, 66.7% of men (n=30,860) and 75.5% of women (n=35,280) participated, the highest participation was in age group 60-69 and the lowest among the young and the elderly. Data collected from several questionnaires and with blood and urine samples and various clinical measurements, some of them in sub-samples of the study population, comprise a huge database for research. All data for each person are linked, and data are also linked to various health registries; all data handling being supervised by The Data Inspectorate and The Regional Ethical Committee. Procedures for data access are established, and more than 100 researchers are currently working on HUNT data. A large number of scientific papers in various disciplines are published, among them 15 doctoral theses (June 2003). The research potential of the HUNT biobank is still not fully exploi- ted, but initiatives are taken. In line with other population based studies both in Norway and abroad, there was a decline in participation rate from HUNT 1 to HUNT 2 (16.9%). This has raised concern about the validity of future population based health studies. However, the good local and national network and the support from the population, make up a good platform also for future health studies in Nord-Trøndelag.
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A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The aims of this study were to describe alcohol use among Norwegian teenagers and investigate the associations between mental health problems and alcohol intoxications with focus on age and gender. Population based, cross-sectional survey addressing all adolescents aged 13-19 years, attending secondary or high school in North - Trøndelag County, Norway. 8983 youths (91%) answered the Young-HUNT questionnaire in the 1995-1997 survey. Logistic regression models were used to study associations. 80% of the respondents reported that they had tried drinking alcohol, and 57% had been intoxicated at least once. The proportion of the students, which had tried alcohol, was equal in both genders and increased with age. Attention problems and conduct problems were strongly associated with frequent alcohol intoxications in both genders. Anxiety and depressive symptoms among girls were also related to high numbers of intoxications Gender differences in number of alcohol intoxications were small. There was a close association between both conduct and attention problems and high alcohol consumption in both genders. Girls with symptoms of anxiety and depression reported more frequent alcohol intoxications.
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Full-text available
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity to environmental insults.
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Pain syndrome is thought to play a role in depression. This study assesses the prevalence of chronic (>or= 6 months' duration) painful physical conditions (CPPCs) (joint/articular, limb, or back pain, headaches, or gastrointestinal diseases) and their relationship with major depressive disorder. We conducted a cross-sectional telephone survey of a random sample of 18 980 subjects from 15 to 100 years old representative of the general populations of the United Kingdom, Germany, Italy, Portugal, and Spain. Answers provided during telephone interviews using the Sleep-EVAL system were the main outcome measure. Interviews included questions about mental disorders and medical conditions. Data on painful physical conditions were obtained through questions about medical treatment, consultations, and/or hospitalizations for medical conditions and a list of 42 diseases. Of all subjects interviewed, 17.1% reported having at least 1 CPPC (95% confidence interval [CI], 16.5%-17.6%). At least 1 depressive symptom (sadness, depression, hopelessness, loss of interest, or lack of pleasure) was present in 16.5% of subjects (95% CI, 16.0%-17.1%); 27.6% of these subjects had at least 1 CPPC. Major depressive disorder was diagnosed in 4.0% of subjects; 43.4% of these subjects had at least 1 CPPC, which was 4 times more often than in subjects without major depressive disorder (odds ratio [OR], 4.0; 95% CI, 3.5-4.7). In a logistic regression model, CPPC was strongly associated with major depressive disorder (OR: CPPC alone, 3.6; CPPC + nonpainful medical condition, 5.2); 24-hour presence of pain made an independent contribution to major depressive disorder diagnosis (OR, 1.6). The presence of CPPCs increases the duration of depressive mood. Patients seeking consultation for a CPPC should be systematically evaluated for depression.
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In a prospective-longitudinal study of a representative birth cohort, we tested why stressful experiences lead to depression in some people but not in others. A functional polymorphism in the promoter region of the serotonin transporter (5-HT T) gene was found to moderate the influence of stressful life events on depression. Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events than individuals homozygous for the long allele. This epidemiological study thus provides evidence of a gene-by-environment interaction, in which an individual's response to environmental insults is moderated by his or her genetic makeup.
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Unlabelled: This large scale computer-assisted telephone survey was undertaken to explore the prevalence, severity, treatment and impact of chronic pain in 15 European countries and Israel. Screening interviews identified respondents aged 18 years with chronic pain for in-depth interviews. 19% of 46,394 respondents willing to participate (refusal rate 46%) had suffered pain for 6 months, had experienced pain in the last month and several times during the last week. Their pain intensity was 5 on a 10-point Numeric Rating Scale (NRS) (1 = no pain, 10 = worst pain imaginable) during last episode of pain. In-depth interviews with 4839 respondents with chronic pain (about 300 per country) showed: 66% had moderate pain (NRS = 5-7), 34% had severe pain (NRS = 8-10), 46% had constant pain, 54% had intermittent pain. 59% had suffered with pain for two to 15 years, 21% had been diagnosed with depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job and 13% had changed jobs because of their pain. 60% visited their doctor about their pain 2-9 times in the last six months. Only 2% were currently treated by a pain management specialist. One-third of the chronic pain sufferers were currently not being treated. Two-thirds used non-medication treatments, e.g,. massage (30%), physical therapy (21%), acupuncture (13%). Almost half were taking non-prescription analgesics; 'over the counter' (OTC) NSAIDs (55%), paracetamol (43%), weak opioids (13%). Two-thirds were taking prescription medicines: NSAIDs (44%), weak opioids (23%), paracetamol (18%), COX-2 inhibitors (1-36%), and strong opioids (5%). Forty percent had inadequate management of their pain. Interesting differences between countries were observed, possibly reflecting differences in cultural background and local traditions in managing chronic pain. Conclusions: Chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Very few were managed by pain specialists and nearly half received inadequate pain management. Although differences were observed between the 16 countries, we have documented that chronic pain is a major health care problem in Europe that needs to be taken more seriously.
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The monograph series reports work carried out in the Institute and in the associated Hospital. This book gives an account of work that formed the subject of an M.D. thesis submitted to the University of Birmingham. Not only may a study of interactions between illnesses in the parent and the child improve understanding of the role of the environment in the aetiology of child psychiatric disorders, and of ways in which the family and social setting may determine the form of a disorder but there are also public health considerations. Treatment of adult illness involves decisions as to whether the patient should remain at home, be admitted to hospital or receive care elsewhere, and these must take into account not only what is best for the individual, but also the effects on the family. The effect upon children of a mentally ill parent in the home is particularly pertinent in view of recent trends towards community care of psychiatric patients.
Book
Although recognized clinically for some time as an important condition that increases risk of ill-health in affected individuals, it is only recently that obesity had been recognized as a population-wide problem that requires preventive action. Obesity is a major contributor to diseases and disability, the associated health costs are enormous and obesity has already reached epidemic proportions in many countries, and incidence is continuing to increase in children and adults. Disturbingly the epidemic is not confined to developed countries, with many developing countries and those in transition affected. While recognized as a major population health problem, our understanding of the causes of the epidemic is poor, there has been relatively little population-based research that has focused on the prevention of unhealthy weight gain, and as a consequence knowledge regarding how and where best to intervene is limited. This book provides a scholarly text that assists those concerned with understanding prevalence and trends in obesity; its health, social, and economic consequences, the underlying causes of the obesity epidemic, the existing evidence regarding strategies to prevent obesity, and the potential of public health initiatives to impact on the population prevalence of obesity.
Article
Background Self-rated health is a commonly used measure of health status, usually having three to five categories. The measure is often collapsed into a dichotomous variable of good versus less than good health. This categorization has not yet been justified. Methods Using data from the 1958 British birth cohort, we examined the relationship between socioeconomic conditions, indicated by occupational class at four ages, and self-rated health. Results obtained for a dichotomous variable using logistic regression were compared with alternative methods for ordered categorical variables including polytomous regression, cumulative odds, continuation ratio and adjacent categories models. Results and Conclusions Findings concerning the relationship between socioeconomic position and self-rated health yielded by a logistic regression model were confirmed by alternative statistical methods which incorporate the ordered nature of self-rated health. Similarity of results was found regarding size and significance of main effects, type of association and interactive effects.
Article
Foreword Arlene Vetere 1. Structural Family Therapy 2. A Family in Formation 3. A Family Model 4. A Kibbutz Family 5. Therapeutic Implications of a Structural Approach 6. The Family in Therapy 7. Forming the Therapeutic System 8. Restructuring the Family 9. A "Yes, But" Technique 10. A "Yes, And" Technique 11. The Initial Interview 12. A Longitudinal View Epilog
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Epidemiological research has revealed that psychi- atric disorders in children and adolescents are common, persistent and handicapping. Only 1 in 10 of those with a disorder is seen in specialist mental health services. However, the majority of chil- dren and adolescents see their general practitioner (GP) every year. Although the majority present with physical complaints, there are indications that rates of psychiatric disorder in those attending are increased and that psychiatric disorder is associated with increased consulting. These findings raise ques- tions about the role of primary care in the promotion and management of mental health in young people. Research evidence of the prevalence, patterns and detection of psychiatric disorder in primary care has been accumulating. Factors affecting consultation and referral to specialist services have received atten- tion. Here, we will summarise this evidence before discussing studies of interventions within primary care. Implications for service delivery and future direc- tions for research will be discussed. This review will focus mainly on studies of children and adolescents in primary care within the UK; however, where suitable data are not available, relevant studies of other countries, settings or age groups will be cited.
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Following a brain injury, parents often experience dispositional changes that can have a devastating effect on family relationships. Such problems are often amplified by the presence of chronic pain,which is a common sequela of brain injury and can reduce or impede the parent's ability to maintain a warm and responsive relationship with the child. In this case study involving two fathers with brain injury and severe chronic pain, we evaluated the effects of errorless compliance training, a recently developed, nonintrusive and success-based intervention, on the cooperation of their sons. After their parents' head injury, the children became severely avoidant and oppositional with the injured parents. Following treatment, children demonstrated high levels of compliance to parental requests as well as generalization and maintenance of treatment gains. Errorless compliance training may be useful for assisting parents with cognitive, emotional, and physical impairments to maintain a more cooperative relationship with their children.
Chapter
This chapter reviews ways in which chronic pain has been measured in epidemiological studies. It summarizes a simple approach which emphasizes the need for core standard definitions to describe pain presence and persistence, i.e., a discussion of the principles underlying work on a core definition of back pain and how they might be rolled out to epidemiological definitions of chronic pain generally.
Article
The present handbook was designed to provide the most current material on many different types of treatment strategies. The emphasis in many chapters is on chronic pain, but acute pain, pain associated with cancer, and pain specifically connected with work-related injuries are considered as well. In addition, attention is given to the developmental issues associated with treatment of children and the elderly; a focus on families is also included. Finally, the increasingly important roles of the mental health specialist in pain consulting, prevention, and outcome evaluation are addressed. It is [the editors'] intention that this volume will bridge the gap between laboratory research and direct application to the clinical environment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The association between parental mental health problems and negative outcomes for children has been long known. This paper addresses three issues in relation to this. First, the scale of the problem is outlined, in terms of both the prevalence of mental health problems in parents and the likelihood of children exhibiting negative outcomes in these circumstances. Secondly, the specificity, or lack of it, of particular outcomes in the child in relation to different parental mental health problems is explored. Thirdly, the paper focuses on the importance of disruptions to parenting as a mechanism in the transmission of mental health problems to negative impacts on the child. Examples are given of how parenting is disrupted in non-clinical community populations, and the subsequent impacts on the child. The case is made for the preventative importance of parenting and family support in mediating between parental mental health problems and negative impacts on the child.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
Sixty-nine families (father, mother, and one child) in which the father had hemophilia, approximately half of whom were HIV positive, were assessed in an examination of the relationship between parental chronic illness, family functioning, child coping strategies, and child adjustment. Latent variable path analyses with partial least-squares estimation procedures (PLS) were used to test a model of the relationship between parental chronic illness, family process variables, child coping strategies, and child internalizing behavior problems. The severity of the father''s illness predicted family process variables, which predicted the coping style of the child. The use of more avoidant coping strategies was associated with more internalizing problems.
Article
The evidence for an association between leisure-time physical activity and prevalence of pain is insufficient. This study investigated associations between frequency, duration, and intensity of recreational exercise and chronic pain in a cross-sectional survey of the adult population of a Norwegian county (the Nord-Trøndelag Health Study; HUNT 3). Of the 94,194 invited to participate, complete data were obtained from 46,533 participants. Separate analyses were performed for the working-age population (20-64 years) and the older population (65 years or more). When defined as pain lasting longer than 6 months, and of at least moderate intensity during the past month, the overall prevalence of chronic pain was 29%. We found that increased frequency, duration, and intensity of exercise were associated with less chronic pain in analyses adjusted for age, education, and smoking. For those aged 20-64 years, the prevalence of chronic pain was 10-12% lower for those exercising 1-3 times a week for at least 30 minutes duration or of moderate intensity, relative to those not exercising. Dependent on the load of exercise, the prevalence of chronic pain was 21-38% lower among older women who exercised, relative to those not exercising. Similar, but somewhat weaker, associations were seen for older men. This study shows consistent and linear associations between frequency, duration, and intensity of recreational exercise and chronic pain for the older population, and associations without an apparent linear shape for the working-age population.
Article
Multiple imputation by chained equations is a flexible and practical approach to handling missing data. We describe the principles of the method and show how to impute categorical and quantitative variables, including skewed variables. We give guidance on how to specify the imputation model and how many imputations are needed. We describe the practical analysis of multiply imputed data, including model building and model checking. We stress the limitations of the method and discuss the possible pitfalls. We illustrate the ideas using a data set in mental health, giving Stata code fragments.
Article
Recent epidemiological studies have indicated that as many as 78% of individuals with chronic pain come from families in which at least one other family member has chronic pain. This suggests that children of individuals with chronic pain may be at particular risk for developing chronic pain conditions in the future. This study examined the relationship between parental chronic pain and children's general adjustment. A group of parents reporting chronic tension or migraine headache and their children were compared to a group of illness-free parents and their children. Results revealed that children of chronic headache sufferers were more somatically focused than their control counterparts. It is suggested that this heightened concern with their health status may be either a reaction to, or a means of coping with ongoing stress. A number of significant correlations between parents' and their children's level of emotional adjustment are also reported. The implications of these findings for general family health status, and characteristic ways of dealing with illness are discussed.
Article
This article provides a conceptual framework for thinking about the system created at the interface of chronic illness with the family life cycle. First, a psychosocial typology and time phases of illness schema is described as a necessary, preliminary step to create a common language that bridges the worlds of illness, individual, and family development. This schema organizes similarities and differences between diseases in a manner useful to psychosocial-developmental rather than biomedical inquiry. Then, drawing on several major life-cycle theories in the literature, key concepts (periods of transition, life-structure building and maintaining, centripetality, and centrifugality) are used in a complementary fashion to link these three lines of development. Equipped with these psychosocial languages, consideration is given to transgenerational aspects of illness, loss, and crisis, and the interwoven threads of illness, family, and individual development. Clinical vignettes are provided to highlight this conceptual framework.
Article
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
Examined the impact of a range of health related constructs reflecting maternal physical symptomatology, health services utilization, subjective health status, depressed mood, medical-psychological complaints, and marital adjustment on children's internalizing and externalizing behavior problems in a community sample (N = 145). Physical symptomatology predicted a general second-order latent factor of children's behavior problems. Depressed mood predicted a primary latent factor of internalizing child behavior problems. Seizure symptoms, and more health problems in the last 4 years specifically predicted child psychosomatic complaints/anxiety. Thus, general physical symptoms predicted a broad spectrum of problem behaviors, whereas specific mental or physical health problems predicted similar distinct problem behavior syndromes. Implications of these results for identifying children at risk for psychopathology, and the relevance of social learning theory and a broader based family systems approach are discussed.
Article
There is a need for a short form questionnaire with known psychometric characteristics that may be used as an indicator of level of global mental distress. A weighted sum of 5 questions from the Symptom Check List (SCL) anxiety and depression subscales (SCL-25) correlates at r = 0.92 with the global SCL-25 score. The alpha reliability for the (5-item) short form questionnaire was 0.85%. Age differences seemed to be trivial, and sex differences were moderate. Descriptive statistics for short form scores in a large, representative sample are given.
Article
The extensive literature on pain and the family contains little on migraine and the family. A national sample of migraine sufferers, interviewed by telephone, was questioned on how they perceived migraine affected their family life. Sixty percent believed that their families were significantly affected. Most stated that their families were understanding, but a considerable number reported that family members took a negative attitude. This was particularly so with younger children deprived of parental care during migraine attacks. Spousal relationships also suffered. Frequency and quality of sexual relationships were affected; and in a small number of cases, divorce was the outcome. The significance of these findings in migraine management is discussed.
Article
To review the literature investigating the effects of parental affective illness on children over the past decade. A computerized search of articles published over the past 10 years was completed. Articles were reviewed and relevant studies are presented. Over the course of the past 10 years a number of longitudinal studies have confirmed that children of affectively ill parents are at a greater risk for psychiatric disorders than children from homes with non-ill parents. Life table estimates indicate that by the age of 20 a child with an affectively ill parent has a 40% chance of experiencing an episode of major depression. Children from homes with affectively ill parents are more likely to exhibit general difficulties in functioning, increased guilt, and interpersonal difficulties as well as problems with attachment. Marital difficulties, parenting problems, and chronicity and severity of parental affective illness have been associated with the increased rates of disorder observed in these children. The presence of depression in parents should alert clinicians to the fact that their children also may be depressed and therefore in need of services. J. Am. Acad. Child Adolesc.
Article
Self-rated health is a commonly used measure of health status, usually having three to five categories. The measure is often collapsed into a dichotomous variable of good versus less than good health. This categorization has not yet been justified. Using data from the 1958 British birth cohort, we examined the relationship between socioeconomic conditions, indicated by occupational class at four ages, and self-rated health. Results obtained for a dichotomous variable using logistic regression were compared with alternative methods for ordered categorical variables including polytomous regression, cumulative odds, continuation ratio and adjacent categories models. Findings concerning the relationship between socioeconomic position and self-rated health yielded by a logistic regression model were confirmed by alternative statistical methods which incorporate the ordered nature of self-rated health. Similarity of results was found regarding size and significance of main effects, type of association and interactive effects.
Article
Objectives In this article, the assessment of global pain severity in clinical and health services research is considered. Specifically , the focus is on assessing pain during a defined period by retrospective self-report. Evidence is reviewed that indicates that it can be useful to regard pain severity as a global construct measured by pain intensity and interference with activities. In contrast, pain experience per se is more usefully regarded as multidimensional. Research on methods of assessing key dimensions of pain experience is reviewed, including pain intensity, affect, and chronicity. The authors suggest that global pain severity (made up of pain intensity and interference with activities) and pain persistence (chronicity) should be focal points for brief pain assessment. Two brief measures of pain severity are reviewed that provide practical, reliable , and valid approaches to pain assessment in clinical and health services research.
Article
The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale. To examine the psychometric properties of the HAD scale in a large population. All inhabitants aged 20-89 years (n=92 100) were invited to take part in The Nord-Trøndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations. Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both subscales were found to be internally consistent, with values of Cronbach's coefficient (alpha) being 0.80 and 0.76, respectively. Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.
Article
To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
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Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art.
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A great number of questionnaires and instruments have been developed in order to measure psychological distress/mental health problems in populations. The Survey of Level of Living in 1998 conducted by Statistics Norway used both Hopkins Symptom Checklist (SCL-25) and the Short Form 36 (SF-36), including the five-item mental health index (MHI-5). Five-item and 10-item versions of the SCL-25 have also been used in Norwegian surveys. The purpose of this study was to investigate the correlation between the various instruments, and to assess and to compare psychometric characteristics. A random sample of 9735 subjects over 15 years of age drawn from the Norwegian population received a questionnaire about their health containing SCL-25 and SF-36. Response rate was 71.9%. Reliability of the SCLs and MHI-5 were assessed by Cronbach alpha. The scores from full and abbreviated instruments were compared regarding possible instrument-specific effects of gender, age and level of education. The correlations between the instruments were calculated. The capacity of the various instruments to identify cases was assessed in terms of sensitivity, specificity, predictive values, receiver operating characteristics (ROC) and area under the curve (AUC). The reliabilities were high (Cronbach alpha>0.8). All instruments showed a significant difference in the mean scores for men and women. The correlation between the various versions of SCL ranged from 0.91 to 0.97. The correlation between the MHI-5 and the SCLs ranged from -0.76 to -0.78. The prevalence rate was 11.1% for SCL-25 scores above 1.75 and 9.7% for scores below 56 in MHI-5. AUC values indicated good screening accordance between the measures (AUC>0.92). The results suggest that the shorter versions of SCL perform almost as well as the full version. The corresponding cut-off points to the conventional 1.75 for SCL-25 are 1.85 for SCL-10 and 2.0 for SCL-5. MHI-5 correlates highly with the SCL and the AUC indicate that the instruments might replace each other in population surveys, at least when considering depression. An operational advantage of the MHI-5 over the SCL instruments is that it has been widely used not only in surveys of mental health, but also in surveys of general health.
Article
Population-based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health-related variables between persons with and without chronic pain were evaluated. A total of 4000 Norwegian citizens, were randomly drawn from the National Register, by Statistics Norway and were mailed a questionnaire. The response rate was 48.5%. The majority of the sample was female (51%), married (59%), and working for pay (69%) with a mean age of 45.2 years. The prevalence of chronic pain in the total sample was 24.4%, and 65% of the participants with chronic pain indicated that they had experienced chronic pain for over 5 years. The cause of the pain was not specified by 57% of the participants in chronic pain, and 31% reported no pain treatments. Women, older individuals, persons with less education, and those who were pensioned, reported chronic pain more frequently. The results of a logistic regression analysis indicate that the variables that provide unique contributions to predicting pain group memberships were: gender, education, being frequently ill, or having a chronic illness. These findings suggest that chronic pain is a significant problem in the general Norwegian population, and that gender, education, being frequently ill, or having a chronic illness are important variables in predicting pain group membership.
Article
In medical research, continuous variables are often converted into categorical variables by grouping values into two or more categories. We consider in detail issues pertaining to creating just two groups, a common approach in clinical research. We argue that the simplicity achieved is gained at a cost; dichotomization may create rather than avoid problems, notably a considerable loss of power and residual confounding. In addition, the use of a data-derived 'optimal' cutpoint leads to serious bias. We illustrate the impact of dichotomization of continuous predictor variables using as a detailed case study a randomized trial in primary biliary cirrhosis. Dichotomization of continuous data is unnecessary for statistical analysis and in particular should not be applied to explanatory variables in regression models.
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**This is a prospective Norwegian study of a group of adolescents with an experience of parental divorce or separation (n=413) and a comparison group without this experience (n=1758). Mean age at T1 was 14.4 years and mean age at T2 was 18.4 years. Parental divorce was prospectively associated with a relative change in anxiety and depression, subjective well-being, self-esteem, and school problems. Considering boys separately, parental divorce was prospectively associated only with school problems. Among the girls, divorce was prospectively associated with all variables. The effect of divorce on relative change was partially mediated by paternal absence.