Living conditions and psychosomatic complaints in Swedish schoolchildren

BACKGROUND: The proportion of Swedish schoolchildren that reports psychosomatic complaints has increased during recent decades, parallel to major structural changes in Swedish society. AIM: To investigate the association of psychosomatic complaints in relation to household socio-economic conditions. METHODS: Cross-sectional study based on data from child supplements linked to nationally representative household surveys in Sweden during 2000-2003, covering a sample of 5390 children aged 10-18 y. Symptom variables were based on child interviews, while data from parental interviews were used to create socio-economic variables. RESULTS: Girls more often reported headache and recurrent abdominal pain (RAP) than boys, and these differences became more pronounced with age. Economic stress in the household was associated with headache (OR 1.21, p<0.05), RAP (OR 1.46, p<0.001) as well as difficulties falling asleep (OR 1.35, p<0.01), while there were no consistent associations between symptoms and social class or unemployed parents. Children in single-parent families consistently reported somewhat more symptoms than children in two-parent families (OR 1.26 for at least two of the three symptoms, p<0.05). CONCLUSION: Economic stress, but not social class, was a significant but moderate risk factor for all three psychosomatic symptoms. It is possible that a growing proportion of families in economic stress has contributed to the parallel increase in reported psychosomatic complaints among Swedish schoolchildren. Further studies are needed to clarify the relation between lack of money, relational strain/support and psychosomatic complaints.     

The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study

Psychosomatic symptoms among children are believed to be commonplace. In this investigation by questionnaire, 47% of 1333 schoolchildren reported one or several symptoms, such as recurrent abdominal pain, headache, chest pains, loss of appetite and disturbances in bowel function. Coexistence of such symptoms was considerable and if a child had one of these, the probability that it would have one or more other symptoms was significantly increased. This correlation may strengthen both the suspicion that these symptoms are often psychosomatic and the idea that they have common CNS origin. There were appreciable differences in the frequency of the symptoms, between children at the more socially stable schools and schools with social problems. In the latter, the frequencies of symptoms differed between Swedish and immigrant children, which was not the case in the more socially stable schools.     

Multiple psychosomatic symptoms can indicate child physical abuse - results from a study of Swedish schoolchildren

Aim: To examine whether children with self‐reported experiences of either physical abuse alone or combined with intimate partner violence report more psychosomatic symptoms than other children and to explore whether these possible associations are enhanced by school‐related factors, chronic condition and demographic factors. Methods: A national cross‐sectional study of 2771 pupils in grades 4, 6 and 9 from 44 schools in Sweden was carried out in 2006 (91% response rate). Data were analysed with univariate tests (chi‐square), multiple logistic regression analyses and stratified logistic regression analyses, expressed as crude odds ratio (OR) and adjusted odds ratio (AOR) with 95% confidence intervals. Results: There was a strong association between reported physical abuse and multiple (three or more) psychosomatic symptoms among schoolchildren (AOR 2.12). Chronic condition was the only determinant that had an obvious enhancing effect on the association between physical abuse and psychosomatic symptoms in childhood. Conclusion: This study shows that multiple psychosomatic symptoms are associated with child physical abuse. Health professionals therefore need to pay special attention to schoolchildren who complain about the co‐occurrence of psychosomatic symptoms and pattern of symptoms, which could not be easily explained by other causes.     

Comparison between Japanese and Swedish schoolchildren in regards to physical symptoms and psychiatric complaints

BACKGROUND: Physical symptoms are an increasing problem among Japanese children and adolescents, and the symptoms seem to be related to their school situation. These symptoms are prevalent in Sweden, and a comparison with Japan is of interest due to the differences in the educational system and school climate. OBJECTIVE AND METHODS: To compare physical symptoms and psychiatric complaints in school pupils from Japan and Sweden, using a questionnaire that also addressed life satisfaction and stressful life events. The study population comprised 742 Japanese children and 1,120 Swedish children attending public compulsory schools, grades 4-9 (10-15 y). Physical symptom and psychiatric complaint scores were calculated for each pupil. RESULTS: The Japanese children had significantly higher physical symptom and psychiatric complaint scores than did the Swedish children. Both the physical symptom and psychiatric complaint scores were significantly higher in adolescents than in preadolescents in Japan; this trend was less apparent in Swedish children. In addition, Japanese children were found to have considerably lower life satisfaction. Loss of appetite was the only physical symptom more prevalent in the Swedish population compared to the Japanese population.CONCLUSION: We conclude that Japanese schoolchildren have more physical symptoms and psychiatric complaints and less life satisfaction than Swedish schoolchildren of corresponding ages.     

Classes of disruptive behaviour in a sample of young elementary school children

BACKGROUND: The objectives were to (1) classify young children to groups differing in disruptive behaviour, (2) determine whether the patterns of disruptive behaviour in these groups are in accordance with the conceptualisation of disruptive disorders as described in DSM-IV, and (3) optimise the classification of children in groups. METHODS: Disruptive behaviour of 636 seven-year-old elementary schoolchildren was assessed with the CBCL/4-18. Using CBCL items rated as very consistent with DSM-IV categories Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/Hyperactivity Disorder, latent class analyses were applied to identify classes of children differing in patterns of disruptive behaviour. RESULTS: Three classes were identified: (1) high levels of oppositional defiant problems (ODD problems) and attention-deficit/hyperactivity problems (ADH problems) and intermediate levels of Conduct problems; (2) intermediate ODD problems and ADH problems and low levels of Conduct problems; (3) low levels on all disruptive behaviours. CONCLUSIONS: No classes were identified in which children had symptoms of only Conduct problems, only ODD problems or only ADH problems. Covariates (socio-economic status, gender, parenting stress) improved the classification of children. The findings are discussed in terms of implications for classification, identification of children at risk, prevention and treatment of disruptive behaviour in young children.     

Differential Item Functioning in Trend Analyses of Adolescent Mental Health – Illustrative Examples Using HBSC-Data from Finland

Although there is an increasing focus on trend analyses of adolescent mental health, yet too little attention is paid to the methodological challenges and pitfalls inherent in this type of analyses. The purpose of the study is to analyse the psychometric properties of a Finnish instrument on psychosomatic problems, with a major focus on Differential Item Functioning (DIF) across time. Questionnaire data collected in 1994, 1998, 2006 and 2014 among Finnish schoolchildren in grade 9 (15-year-olds) as part of the Health Behaviour in School-aged Children (HBSC) study were utilised. The polytomous Rasch model was used to examine the psychometric properties of a composite measure of psychosomatic problems. The results clearly indicate that the composite measure on psychosomatic problems consisting of nine items does not work invariantly over time. In particular, the item depressed shows DIF across years of investigations. This item works quite differently at the first year of investigation compared to the last year showing higher expected values 2014 (=less frequent problems) than 1994. This DIF affects the person measure of change in psychosomatic problems between 1994 and 2014. Resolving the item depressed for year of investigation DIF, or removing it, increases the difference in person mean values between the two years, implying increasing psychosomatic problems over time. Since the DIF affects the trend results, different options to address the problems need to be considered. Removing the item depressed would bring the Finnish measure of psychosomatic problems in better accordance with the content of the questions on psychosomatic problems in the international HBSC protocol in which the item depressed is not included.     

The enigma of the welfare state: excellent child health prerequisites – poor subjective health

The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases – on the society level – like health obsession, stress panic, welfare apathy and hyper‐individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self‐esteem. Conclusion: The gradually deteriorating self‐reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.     

Psychosocial factors affecting psychosomatic symptoms in Japanese schoolchildren

BACKGROUND: In a previous study we reported the prevalence of psychosomatic symptoms in 1619 Osaka elementary schoolchildren using our original general health questionnaire assessed by their parents. We found that psychosomatic symptoms were increasing with age. This study was designed to investigate psychosocial factors responsible for increasing psychosomatic symptoms with age. METHODS: We calculated a correlation coefficient between the physical complaints score (PCS) and these psychosocial variables using quantitation I of multiple regression analysis separately in the older (10-12 years, n = 860) and the younger age group (7-9 years, n = 759). RESULTS: A stronger relationship between PCS and psychosocial problems was found in the older (r = 0.719, P < 0.0001) than in the younger age group (r = 0.570, P < 0.0001). Further analysis demonstrated that difficulties in school performance and increasing psychological conflicts with human relationships were major causes of somatic complaints in the older age group. In the younger age group, however, immaturity of social skills seems to be a primary problem. In addition, poor parental interaction and the playing of computer games were found to increase somatic complaints in children. CONCLUSION: Children in the older age reflect the closer bio-psycho-socio interaction compared with their younger counterparts. This may give rise to a high incidence of psychosomatic disorders and school refusal in Japanese children. We emphasize that psychological support by parents in daily life is necessary to reduce psychosomatic symptoms in children.     

Factors Related to Stress and Satisfaction with Life in Families of Children with Down''s Syndrome

In a study of families of children with Down's syndrome, measures of parent, family and child characteristics were obtained from mothers and fathers. Multivariable analyses investigated their relationships to outcome measures of psychosomatic symptoms of stress and parents' perceived satisfaction with life. Personality factors were related to outcome for both parents. For mothers, the children's levels of behaviour problems, excitability and self-sufficiency were strongly related to outcome. Coping strategies, family relationships and socio-economic factors also showed significant effects. For fathers, child characteristics were not related to outcome. The marital relationship was an important factor and there was evidence that factors external to the family acted as stressors.     

Is a large family a protective factor against behavioural and emotional problems at the age of 8 years?

AIM: To study the prevalence of behavioural and emotional problems among children from different family types, sibship size and birth order. METHODS: A prospective birth cohort (n = 9357) study where parents filled in two questionnaires and teachers assessed children's behaviour using the Rutter scale (RB2). RESULTS: 14.3% scored above the cut-off point (RB2 > or = 9) indicating probable psychiatric disturbance, boys more often than girls (OR 2.6, 95% CI 2.3-3.0). Behavioural problems (9.2%) were more common than emotional ones (4.1%). Boys living in families other than two-parent families were at risk for probable psychiatric disturbance, and a corresponding risk was observed for girls living in single-parent or always one-parent families. Other than two-parent family was also a risk for behavioural problems; for boys adjusted odds ratios ranged significantly from 1.8 to 2.4 and for girls from 2.0 to 3.7. "Only children" had the highest prevalence of behavioural problems, while children in very large families had the lowest. Living in a very large family was a protective factor against behavioural problems among boys but not among girls. Eldest children were at lower risk of behavioural problems than the other children. The single-parent and always one-parent family was associated with higher risk of emotional problems among girls. CONCLUSION: Children's psychiatric problems are manifested at school mostly as behavioural problems. A two-parent family and being the oldest in the sibling series seem to be protective factors. Very large family size, if not connected to social disadvantages, does not seem to be a risk factor for children's behaviour.     

PREVALENCE OF BEHAVIOR PROBLEMS IN THREE-YEAR-OLD CHILDREN LIVING NEAR THREE MILE ISLAND: A COMPARATIVE ANALYSIS

The Behavior Screening Questionnaire (BSQ) was used to determine whether 2 1/2-3 1/2 yr old children living near the TMI nuclear reactor were more disturbed than children living near another nuclear plant or near a fossil-fuel facility in Pennsylvania when assessed 2 1/2 yr later. The prevalence of behavior problems was 11%. Differences among the sites in overall rates and individual symptoms were small. Perceptions of environmental stress among the TMI sample of mothers were unrelated to BSQ scores, whereas in the comparison sites, where unemployment was rising, economic concerns were meaningfully related to the BSQ.     

Time-trend changes and psychological risk factors for soiling: findings from the Finnish 16-year time-trend study

Aims: To study changes and associated risk factors in 8‐year‐old children’s soiling at three time points: 1989, 1999 and 2005. Methods: Three cross‐sectional representative samples were compared. All children born in 1981 (1989 sample, n = 1038), 1991 (1999 sample, n = 1035) and 1997 (2005 sample, n = 1030) living in selected school districts in south‐west Finland served as study samples. Parents were asked about the child’s soiling at age eight. Information about parental education level, family structure and child psychopathology was obtained from parents, teachers and children. Results: The prevalence of soiling among 8‐year‐old boys was very similar (1989/1999/2005: 4.9%/4.9%/4.5%) while among girls the prevalence increased (1.0%/2.9%/3.7%; p < 0.05) during the 16‐year period. Living in a non‐intact family and mother’s lower education level were associated with soiling among boys, while a high level of conduct, emotional and self‐reported depressive symptoms was associated with soiling among girls. Hyperactivity symptoms were associated with soiling among both boys and girls. Conclusions: The study shows an increase in prevalence of soiling among girls. Soiling among girls is associated with psychiatric problems.     

Prevalence of allergic rhinitis and nasal smear eosinophilia in 11- to 15 yr-old children in Shiraz

Allergic rhinitis (AR) is a common condition among schoolchildren. The prevalence rate of AR differs among countries and even among regions within the same country. The objective of this study was to determine the prevalence of nasal symptoms and signs of AR and nasal smear eosinophilia in 11- to 15-yr-old children in Shiraz. A total of 4584 children aged 11-15 yr of both sexes were surveyed from May 1995 to April 1996, and nasal symptoms and signs of AR (sneezing, rhinorrhea, nasal blockage, itching, color change, mucosal swelling, nasal wetness, and nasal crease), based on questionnaire and ear, nose and throat (ENT) examination were recorded. In addition, smears were taken from nasal secretions and stained. The results compared with nasal smears related to 340 healthy children. 1008 (22%) schoolchildren had nasal symptoms of AR (based on the questionnaire), 445 (9.7%) were identified as having nasal symptoms and signs of AR (based on the questionnaire and ENT specialist examination), and 226 (5.8%) had nasal symptoms and signs of AR associated with nasal eosinophilia (based on the questionnaire, ENT specialist examination and positive nasal smear for eosinophilia). Nasal eosinophilia was present in 274 (62%) children with nasal symptoms and signs of AR. This survey showed that prevalence of nasal symptoms and signs of AR was high in schoolchildren in Shiraz. Nasal smear eosinophilia had a diagnostic specificity of 96% and sensitivity of 62% and seems to be a potentially valuable test for AR.     

Child psychotherapy in medical practice and the clinic--15 years of the "Brühl Model"]

Living in an industrial society places considerable stress on children and on adolescents, to which they react with behavioural disturbances and psychosomatic disorders. So far, physicians have been trained only insufficiently at universities with regard to psychotherapy, which means they cannot cope sufficiently with such problems if they are confronted with them in their clinical and practical work. Hence, a continuing education programme called the "Brühl Model" has been worked out which imparts knowledge on child psychology and child psychotherapy by means of three-year courses based on depth psychology. This corresponds to the "small-scale psychotherapy in medical practice" as conceived by J. H. Schultz and M. Balint. This educational programme has been largely adapted to the demands made at the Manheim Physicians' Congress in 1977 with regard to acquiring adequate proficiency in the subject of psychotherapy, and has been accepted by the German professional boards of physicians. 600 colleagues have since been undergoing this training during the past 15 years with success. The present seventh training course is now also open to the colleagues from the new German Laender of the former GDR.     

L’enfant perturbateur

Beware not to confuse talk about children with children's talk: this should be the golden rule for childhood professionals. Agitation and somatization disrupt the functioning of what is called the functional spheres. The child eats poorly, sleeps poorly, and has problems controlling his sphincters. He presents symptoms that the growing importance of education in today's modern world can no longer neglect. The diversity of the circumstances in which the child is recognized as “disruptive” shows just how much the borders between children and adults are permeable. The disruptive child is also a child disturbed by the adult world in which he is evolving. The author supports his hypotheses with several examples from his practice as a psychoanalyst.     

Atopy among schoolchildren in northern and southern Sweden in relation to pet ownership and early life events

Studies have suggested a higher prevalence of asthma and allergies in northern, as compared to southern, Scandinavia. The aim of this study was to evaluate regional differences in atopy in relation to pet ownership and certain early life events among schoolchildren (n = 2108) aged 10–11 years from Linköping in southern Sweden and Östersund in northern Sweden. The parents completed a questionnaire, comprising questions on home environment, heredity, socio‐economic conditions, and the core questions on symptoms from the International Study of Asthma and Allergies in Childhood. The children were skin‐prick tested to eight common inhalant allergens. Information on maternal smoking habits, gestational age, and anthropometric measures were obtained from the Swedish Medical Birth Registry. The prevalence of atopic symptoms and sensitization to pollen were similar in Östersund and in Linköping. A higher prevalence of sensitization to animal dander among children in Östersund could be linked to a higher occurrence of pets in the community. Current cat ownership was related to less sensitivity to cat allergen but only in children with an atopic heredity. Ponderal index > 30 kg/m³ was related to an increased risk of atopic sensitization, both in Linköping (adjusted odds ratio 2.1; 95% confidence interval 1.1–4.0) and in Östersund (adjusted odds ratio 2.0; 95% confidence interval 1.1–3.5). Maternal smoking during pregnancy was related to an increased risk of atopic sensitization among children in Linköping, whereas current smoking was associated with a decreased risk of sensitization in Östersund. In conclusion, we demonstrated that a high occurrence of pets in the community was associated with sensitization, whereas atopic symptoms were essentially unaffected. This study has also suggested an association between body size at birth and atopic sensitization at 10–11 years of age.     

Bullying involvement in primary school and common health problems.

AIMS: To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems. METHODS: A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. night waking) health problems and school absenteeism. RESULTS: Of the children studied, 4.3% were found to be direct bullies, 10.2% bully/victims (i.e. both bully and become victims), and 39.8% victims. Direct bully/victims, victims, and girls were most likely to have physical health symptoms (e.g. repeated sore throats, colds, and coughs). Direct bully/victims, direct victims, and year 2 children were most likely to have high psychosomatic health problems (e.g. poor appetite, worries about going to school). Pure bullies (who never got victimised) had the least physical or psychosomatic health problems. No association between relational bullying and health problems was found. CONCLUSIONS: Direct bullying (e.g. hitting) has only low to moderate associations with common health problems in primary school children. Nevertheless, health professionals seeing children with repeated sore throat, colds, breathing problems, nausea, poor appetite, or school worries should consider bullying as contributory factor.     

Does the Strength of the Association Between Peer Victimization and Psychosomatic Health Problems Depend on Whether Bullying or Peer Aggression is Measured?

This study aimed to analyze to what extent the strength of the previously established association between peer victimization and psychosomatic problems depends on which of two measures is being used, a measure of bullying and a measure of peer aggression. The study included 2568 Swedish adolescents aged 13–15 years. An Ordinary Least Square regression showed that all regressors representing bullying and peer aggression revealed significant effects on psychosomatic health using no peer victimization as the reference category. An ANOVA showed no significant differences in mean values on the Psychosomatic Problems Scale captured by the two measures. Given that both measures of peer victimization show strong associations with psychosomatic health, using only one of the two measures is therefore likely not just to underestimate the overall prevalence of peer victimization but also the number of children experiencing psychosomatic problems in relation with peer victimization.     

The siblings of childhood cancer patients need early support: a follow up study over the first year.

BACKGROUND AND METHODS: In a 1 year follow up study, we assessed the life situation of 33 siblings of childhood cancer patients and 357 healthy controls. The hypothesis was that siblings have more behavioural and health related problems just after the cancer diagnosis. Validated assessment methods were used. RESULTS: Siblings below school age tended to have conduct problems, psychosomatic problems, and a mixed group of other behavioural problems, when assessed 3 months after the cancer diagnosis. These symptoms became less evident during follow up. Among the school aged siblings, however, conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive symptoms, and other behavioural symptoms remained unchanged during follow up. In their self assessments, the school aged siblings showed both state and trait anxiety more often than controls at the first assessment, but later these symptoms settled to the same level as the controls. The overall Children's Depression Inventory (CDI) depression scores did not show differences between the study groups. CONCLUSIONS: The ratings of the parents were in keeping with the self assessment of the school aged siblings only in a few aspects; the emphasis of findings can be changed when proxies are used. The siblings have symptoms and adverse feelings which probably could be relieved by targeted, early information about the illness, and possibly by group discussions or activities, soon after the cancer diagnosis. In order to obtain necessary support for the siblings with educational problems, school personnel need to be informed about the sibling distress.     

A Study of Psychosocial Factors in the Psychosomatic Symptoms of Adolescents in Okinawa

High school students (N = 902) in Okinawa were asked to participate in a questionnaire survey which was designed to investigate the psychosocial factors in the psychosomatic symptoms of adolescents. The questionnaire focused on mental distress, perception of school and home environment and psychosomatic symptoms. The Japanese Edition Cornell Medical Index-Health Questionnaire (JCMI) for evaluating emotional instability and the New TK Diagnostic Test for Parent-Child Relationship were also utilized. Distress in relationships with family or friends, finding little pleasure in school and/or home, showing emotional instability as diagnosed according to regions III and IV of JCMI, or showing strained parent-child relationships according to the TK Test items were found to be closely associated with psychosomatic symptoms. In addition, students with human relations problems, especially family problems, tended to have a strained relationship with parents and tended to show autonomic hyperactivity represented by orthostatic dysregulation. Students with peer problems tended to have emotional instability and to find little pleasure in school; they had mental as well as urinary and bowel symptoms. The findings of this study suggest that distresses in family or peer relationships, emotional instability and a strained parent-child relationship are important factors in the onset of psychosomatic symptoms in adolescents.