Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence

Abstract

Background Health anxiety (HA) is an increasing public health problem related to increased health service costs, and associated with functional somatic symptoms (FSS) and considerable personal suffering. Abnormal bodily experiences which may resemble HA and FSS are common in psychotic disorders, but a potential link between HA and psychosis vulnerability in childhood is largely unexplored. The current study estimates the association between subclinical psychotic experiences (PE) and HA and FSS in a general population cohort of preadolescents. Methods The study population consisted of 1,572 11–12‐year‐old children from the Copenhagen Child Cohort 2000. PE were comprehensibly assessed as either present or not present using the Kiddie Schedule of Affective Disorders and Schizophrenia psychosis section. HA and FSS were assessed by self‐report on validated questionnaires. Additional variables on general psychopathology, puberty, and chronic somatic illness were also obtained. Results Psychotic experiences were associated with the top 10% high scores of HA (Odds Ratio (OR) 3.2; 95% CI: 2.1–4.8) and FSS (OR 4.6; 95% CI: 3.1–6.9) in univariate analyses. After mutual adjustment, the association was reduced to (HA: OR 2.3; 95% CI: 1.5–3.5; FSS: OR 3.7; 95% CI: 2.4–4.7), suggesting interdependence. Further adjustment for potential confounders and general psychopathology only reduced the associations slightly: HA OR 2.2 (95% CI: 1.4–3.4); FSS OR 3.3 (95% CI: 2.1–5.2). Secondary analyses of subdimensions of HA showed that PE were associated with fears (OR 3.0; 95% CI: 2.0–4.6) and daily impact of HA symptoms (OR 5.0; 95% CI: 3.4–7.5), but not help seeking (OR 1.2; 95% CI: 0.7–2.1). Conclusions This is the first study to investigate the associations between PE and HA and FSS, respectively. PE were significantly associated with HA and FSS over and above general psychopathology in preadolescence. Individuals with PE expressed high levels of health‐related fears and daily impact, but no corresponding help‐seeking behavior.

Editorial: The psychopathology p factor: will it revolutionise the science and practice of child and adolescent psychiatry?

“…The Strengths and Difficulties Questionnaire (SDQ) total scale is a commonly used general psychopathology measure (see, e.g. Rimvall et al., ). While it includes a subscale of peer problems, which is one aspect of social difficulties, the SDQ total does not include autistic traits per se.…”

“…Also in this issue, Rimvall et al. explore novel questions about how positive psychotic experiences such as hallucinations and delusions are associated with health anxiety and functional somatic symptoms (Rimvall et al., ). In their cohort of 11‐ to 12‐year‐olds, they find significant cross‐sectional associations.…”

Continuity of health anxiety from childhood to adolescence and associated healthcare costs: a prospective population‐based cohort study

“…Together with the current findings and retrospective reports suggesting that adult HA is often preceded by similar symptoms in childhood and adolescence (Noyes et al, 2002), the overall evidence suggests continuity of HA across the life span. As outlined in the introduction, important findings from cross-sectional studies on children and adolescents have shown that HA is associated with a broad array of other types of psychopathology (Oliver et al, 2018;Rask et al, 2016;Rimvall et al, 2019;Sirri et al, 2015;Wright et al, 2016). Crucially, even in the adjusted analyses, there was still evidence of an independent effect of high HA at age 11 on the risk of high HA at age 16, since the findings were only partially explained by chronic somatic illness.…”

“…For the analyses on HA continuity from age 11 to age 16 years, HA symptoms at both ages were dichotomized into high (top 10%) and low (bottom 90%) scores based on the entire population participating at the respective follow-ups, thus including individuals for whom longitudinal data were not available. This approach was in line with previous studies of the CCC2000 11-year follow-up (Rask et al, 2016;Rimvall et al, 2019). We categorized HA symptoms from age 11 to 16 into four groups based on continuity of symptoms: a) persistent (high score at both follow-ups), remitting (high at age 11, low at age 16), incident (low at age 11, high at age 16) and consistently low HA (low at both follow-ups).…”

“…During the past decades, specific measures for measuring HA in childhood have been developed, such as the Childhood Illness Attitude Scales (CIAS) (Wright & Asmundson, 2003), demonstrating that symptoms of HA indeed occur in childhood and adolescence. Cross‐sectional studies of young people have also found associations between HA and other psychopathology, such as other anxiety symptoms including obsessive–compulsive symptoms (Wright, Lebell, & Carleton, 2016), subclinical psychotic experiences (Rimvall et al, 2019), functional somatic symptoms (FSS) (Rask, Elberling, Skovgaard, Thomsen, & Fink, 2012) and depression (Sirri, Garotti, Grandi, & Tossani, 2015), as well as somatic conditions such as congenital heart disease (Oliver et al, 2018). A longitudinal study of the Copenhagen Child Cohort 2000 (CCC2000) found increased healthcare costs among individuals with high HA scores at age 11 and showed some continuity of parent reported child HA at age 6 years and child self‐reported HA at age 11 (Rask et al, 2016).…”