Relationship between non-cardiac chest pain and internalizing problems in pre-school aged children

Abstract

Objective: Non-cardiac chest pain is a common and persistent problem for children; yet, typically, there is no clear medical cause. To date, no behavioural and/or psychological factors have been studied to explain chest pain in a pre-school paediatric sample. We hypothesized that pre-school children with medically unexplained chest pain would have higher rates of behavioural problems compared to healthy controls. Methods: We assessed 41 pre-school children with non-cardiac chest pain and 68 age matched children with benign heart murmurs as the control group using the Child Behaviour Check List-1 1/2–5 to evaluate emotional and behavioural problems. Results: Internalizing problem scores comprising emotionally reactive, anxiety/depression, and somatic complaints were higher in children with non-cardiac chest pain than in the control group. Among the possible factors, the factor that is related to behaviour problem scores, in univariate analysis, was a significant and inverse correlation between maternal education and behaviour problem scores. Also, maternal employment status was associated with behavioural problems. Children with a housewife mother were more susceptible to having such behavioural problems. Based on multiple regression analyses, being in the non-cardiac chest pain group was found to be significantly related to internalizing problems in our total sample. Conclusions: These results suggest that pre-school children with non-cardiac chest pain may experience increased levels of certain behavioural comorbidities. Systematic behavioural screening could increase the detection of behavioural problems and improve care for this population. Future studies of non-cardiac chest pain in pre-school children should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

The Etiology of Chest Pain in Children Admitted to Cardiology Clinics and the Use Echocardiography to Screen for Cardiac Chest Pain in Children

“…In our study, in the preschool group and the school-age group, the incidence of non-cardiac chest pain was significantly higher than it in the adolescent group, respectively. This might be related to increasing levels of some behavioral comorbidities as described above ( 21 ). For clarifying the effects of demographic characteristics on the distribution of chest pain etiology, we will conduct prospective, multi-center and social psychology comprehensive research on children with chest pain in the future.…”

“…Other studies showed that children with age over 12 years and in puberty are prone to chest pain ( 5 , 6 , 16 ). In 2020, Yoldaş T. et al ( 21 ) studied the relationship between non-cardiac chest pain and internalizing problems in pre-school aged children, they found that these children might be related to increasing levels of some behavioral comorbidities. In 2020, Aygun E et al ( 22 ) analyzed the etiology of 782 patients aged between 3 and 18 years with chest pain, they found that male patients were more prone to musculoskeletal and gastrointestinal systems diseases, while female patients were more prone to psychogenic disorders.…”

Association between maternal employment and the child´s mental health: a systematic review with meta-analysis

“…Overall internalizing behavior problems. Of six studies comparing children of employed and unemployed mothers [ 60 , 62 , 63 , 66 , 67 , 81 ], only Im and Vanderweele [ 67 ] found results linking employment to more IBP (especially in cases of absent or low paternal involvement). In contrast, when paternal involvement was high, employment was associated with less IBP.…”

“…In contrast, when paternal involvement was high, employment was associated with less IBP. In analyses of Yoldaş and colleagues [ 81 ] children of working mothers exhibited less IBP. Our corresponding meta-analysis including three studies [ 62 , 63 , 81 ] yielded a summary effect under the fixed-effects model ( OR = 0.868, P < 0.001), indicating that children of employed mothers exhibited less IBP (see Fig.…”

“…Anxiety and depressive symptoms. Of six studies comparing children of employed and unemployed mothers [ 45 , 61 , 73 , 74 , 76 , 81 ], only two studies [ 74 , 81 ] included limited evidence linking employment to less anxiety or anxious/depressed behavior. Our corresponding meta-analysis based on three studies [ 73 , 74 , 81 ] yielded a summary effect under the fixed-effects model ( OR = 0.804, P < 0.05), indicating that children of employed mothers exhibited less anxious/depressed behavior (see Fig.…”