Patterns of physical symptoms and relationships with psychosocial factors in adolescents

Physical symptoms are common in otherwise healthy adolescents. This study sought to identify meaningful patterns of multiple physical symptoms and to examine relationships between the patterns and psychosocial factors. One-year stability of symptom patterns and factors contributing to stability were also examined.

This secondary data analysis used longitudinal data from a nationally representative sample of adolescents in grades 7 through 12 (n = 9,141) who participated in the National Longitudinal Study of Adolescent Health during 1994 to 1996. Ten selected physical symptoms (i.e., headache, stomachaches, fatigue) were used to construct clusters. Each cluster was compared in regard to demographic factors, psychological adjustment and interpersonal relationships.

K-means in combination with Ward method clustered the sample into 4 groups according to the overall patterns of the 10 symptoms: nonsymptom (41%), moderate symptom (38%), high symptom (19%) and extreme symptom (2%). Adolescents in higher symptom clusters were more likely to be girls, nonwhites, or from families on welfare and reported high depressive symptoms, low self-esteem, and poor perceptions of parental affection and friendship quality. About 16% in clusters with lower symptom patterns develop somatizing patterns in Wave II; new onset was predicted by gender, younger age, and depressive symptoms.

Symptom patterns characterized by overall high frequencies of multiple symptoms may indicate somatization. This study also suggests that adolescents with a somatizing tendency are more likely to experience psychological and interpersonal difficulties, and girls and younger adolescents are more vulnerable. Targeted prevention programs are needed for these vulnerable individuals by addressing their psychosocial functioning.