Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers

Abstract

BackgroundThere is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.MethodsThe total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.ResultsSomatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.ConclusionsSomatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

Psychosomatic problems in relation to alcohol use and physical exercise: a study between 1988 and 2011 among adolescents in Sweden

“…Adolescent psychosomatic symptoms such as pain, sleep problems, and bad moods have been associated with adverse prospective outcomes such as the development of psychiatric diagnoses and future psychosomatic problems (Bohman et al 2012;Ruchkin and Schwab-Stone 2014;Kinnunen et al 2010). Alcohol use and exercise have also been associated with mental health prospectively (Huurre et al 2010;Tan et al 2014;Fedewa et al 2014;Biddle and Asare 2011;Kushner et al 1999) but to the best of our knowledge no prior study has investigated the association between adolescent psychosomatic problems in relation to lifestyles in terms of both alcohol use and exercise.…”

“…Further, psychosomatic symptoms in adolescence are risk factors for psychiatric disorders such as depression, somatisation disorders and anxiety disorders in early adulthood (e.g. Bohman et al 2012;Kinnunen et al 2010). Humans do, however, have some agency in influencing their current and future health.…”

Influence of the number and severity of somatic symptoms on the severity of depression and suicidality in community-dwelling elders

“…The recent finding of pathologically high levels of cytokines in the brains (IL-6) of people who have attempted suicide links somatic symptoms with suicidal behavior and severity of depression (Lindqvist et al , 2009). The number of somatic symptoms in depression may reflect increased levels of pro-inflammatory cytokines such as IL-6 in the brain, which correlates with suicidal behavior due to low levels of intracerebral serotonin (Bohman et al , 2012; Träskman et al , 1981). …”

Bipolar Disorder and ADHD: Comorbidity and Diagnostic Distinctions

“…In contrast, children with BD are more likely to have more variable, uneven performances, at times doing very well, and then experiencing significant changes in grades coinciding with periods of emotional instability and especially depressive phases or periods of increased anxiety and school refusal. Somatic complaints are frequent in children with depression and have been found to predict suicide attempts, BD, psychosis, as well as recurrent and chronic depression [56]. As both diagnoses can be associated with learning disorders, a thorough neuropsychological assessment can help provide adequate accommodations and support.…”