Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome

Abstract

Background Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. Methods We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. Key Results We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [β] 0.11, CI 0.05‐0.18) and in multiple analysis (mediated standardized β 0.18, CI 0.09‐0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized β 0.08, CI0.02‐0.14) and pain catastrophizing (mediated standardized β 0.06, CI 0.01‐0.11) in individual analyses and in multiple analysis (mediated standardized β 0.19, CI 0.04‐0.19). Conclusions and Inferences Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.

The Influence of Caregiver Distress and Child Anxiety in Predicting Child Somatization in Youth with Functional Abdominal Pain Disorders

“…We note that our research examined whether child anxiety accounts for caregiver distress in relation to pain-related outcomes, which we conceptualized to include somatization (consistent with other literature). However, we note that yet other research has explored somatization as a mediator between child anxiety and pain severity [45,46], and between coping with pain and pain severity [45]. We did not explicitly examine coping with pain in our investigation.…”

Paediatric functional abdominal pain disorders

“…Indeed, several studies found that specific pain-related cognitions and coping behaviours are directly related to pain and disability. For example, one study 110 found that the effect of anxiety and depression on abdominal pain was mediated by somatization and pain catastrophizing. Studies on the active ingredients of CBT also found that treatment effects on disability and pain can be predicted by changes in pain-related cognitions such as catastrophizing, disease threat and avoidance behaviours 111,112 .…”

Somatization in patients with predominant diarrhoea irritable bowel syndrome: the role of the intestinal barrier function and integrity

“…The SSD and the functional GI diseases mostly coexist [ 12 ], ranging from 15 to 48% in IBS patients [ 13 , 14 ]. This evidence is of particular interest considering the close relationship between pain and somatization in patients with functional diseases [ 15 ], including those with IBS [ 16 ].…”