Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study

Abstract

BackgroundSomatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.MethodsThe entire school population of 16–17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991–1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17–19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants’ ages of 18 and 35 years.ResultsSomatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose–response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55–4.85; 2–4 symptoms: OR = 2.77, 95% CI 1.04–7.39; ≥ 5 symptoms: OR = 5.75, 95% CI 1.98–16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p < 0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose–response relationship (p < 0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p < 0.05).ConclusionsSomatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.Electronic supplementary materialThe online version of this article (10.1186/s13034-018-0245-0) contains supplementary material, which is available to authorized users.

The effects of a dance intervention on somatic symptoms and emotional distress in adolescent girls: A randomized controlled trial

“…43 It has been suggested that early treatment of adolescent somatic symptoms should have a high priority because of the increased risk of subsequent poor mental health outcomes. 11 Interventions that reduce symptoms and reduce the number of visits to school health care services and mental health services are warranted. Dance intervention may be an example of an active, costeffective, nonpharmacological complementary treatment for this target group.…”

Uppsala Longitudinal Adolescent Depression Study (ULADS)

“…This association was only partly explained by contextual factors, indicating that adolescents suffering from an extended episode of depression are predisposed to future mental health problems 22. Similarly, multiple somatic symptoms in adolescence independently predicted continued depressive episodes and other mental health concerns in early adulthood 89 90. Register-based data showed that females with adolescent depression had an increased consumption of both inpatient and outpatient care, but also more prescribed psychotropic as well as non-psychotropic drugs in early adulthood.…”

The School Environment as a Source of Somatic Problems in Adolescents

“…In the past, they were usually defined as medically unexplained symptoms or functional somatic symptoms (Cerutti et al, 2016). The rising occurrence and persistence until the age of adulthood (Bohman et al, 2018), but especially the fact that they significantly decrease one's quality of life, have resulted in a proposal to include a new category of "Somatic Symptom and Other Related Disorders" within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013). Regardless of the formal definition, these health issues have been occurring in children and adolescents rather frequently for decades and their origin is often too difficult for doctors to determine explicitly because it stems from psychological aetiology.…”