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Multiple somatic symptoms linked to positive screen for depression in pediatric patients with chronic abdominal pain
Cheryl A Little1, Sara E Williams, Martina Puzanovova
1Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Children with chronic abdominal pain (CAP) and multiple non-gastrointestinal (GI) symptoms may have higher rates of depression. A screening of 3 or more non-GI symptoms can help identify children needing further evaluation for depression.
Area of Science:
- Pediatric Gastroenterology
- Child Psychiatry
- Somatic Symptom Disorders
Background:
- Chronic abdominal pain (CAP) is a common pediatric complaint, often accompanied by nonspecific somatic symptoms.
- These comorbid symptoms can complicate diagnosis and lead to excessive testing.
Purpose of the Study:
- To test if multiple non-gastrointestinal (GI) symptoms in children with CAP indicate clinically significant depressive symptoms.
- To identify a potential marker for depression in pediatric patients presenting with abdominal pain.
Main Methods:
- 400 pediatric patients (ages 8-17) with CAP (>3 months) were evaluated.
- Patients reported frequency of 7 non-GI symptoms and were screened for depression using the Children's Depression Inventory.
Main Results:
- 15% of patients screened positive for depression.
- Reporting 3 or more non-GI symptoms was 71% sensitive and 75% specific for predicting positive depression screens.
- Each additional non-GI symptom doubled the odds of a positive depression screen.
Conclusions:
- The presence of 3 or more non-GI symptoms in children with CAP warrants evaluation for depression.
- This finding can serve as an indicator for depression likelihood, even without direct questioning about emotional symptoms.
Objectives:
Abdominal pain is a frequent childhood complaint, comprising 2% to 4% of all reasons for pediatric office visits. Patients referred for evaluation of chronic abdominal pain (CAP) frequently present with comorbid nonspecific somatic symptoms that may complicate the medical evaluation and lead to unnecessary diagnostic tests and procedures. We tested the hypothesis that multiple nongastrointestinal (GI) symptoms in children presenting with CAP is a marker for clinically significant levels of depressive symptoms.
Methods:
Participants were 400 consecutive new patients (ages 8-17 years; 63% female) referred to the pediatric gastroenterology clinic for evaluation of abdominal pain of > 3 months' duration. Patients reported how frequently they experienced 7 non-GI symptoms. Patients were screened for depression with the Children's Depression Inventory.
Results:
On the basis of their Children's Depression Inventory scores, 58 (15%) patients had a positive screen for clinically significant depressive symptoms. Patients with a positive versus negative depression screen did not differ by sex, pain duration or laboratory evidence of organic disease. Patient report of > or = 3 non-GI symptoms maximized sensitivity (71%) and specificity (75%) in prediction of depression screening results. With each addition of a non-GI symptom, the odds of a positive screen for depression doubled.
Conclusions:
For patients with and without organic disease findings associated with CAP, the presence of > or = 3 non-GI symptoms should signal the practitioner to evaluate for depression and may be used as an indicator of the likelihood of depression in the absence of specific inquiry into emotional symptoms.
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