Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome
Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome
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DOI：
10.1111/nmo.13509
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发表时间：
2019-02-01
影响因子：
3.5
通讯作者：
Shulman, Robert J.
中科院分区：
文献类型：
--
作者：
Hollier, John M.;van Tilburg, Miranda A. L.;Shulman, Robert J.
背景：焦虑和抑郁被认为是小儿肠易激综合征（IBS）腹痛的诱因，但尚不清楚这种疼痛是否与其他心理因素有关。研究目的是测试焦虑或抑郁对IBS症状严重程度的影响是否由躯体化和/或疼痛灾难化介导。方法我们利用当地儿科IBS临床研究的基线数据。通过中介分析，我们评估是否躯体化或疼痛灾难化介导（独立或组合）焦虑或抑郁与IBS腹痛严重程度的单独关系。我们分析了261名参与者。各心理因素与IBS腹痛严重程度呈正相关。焦虑与IBS腹痛的相关性在个体分析（每个中介标准化系数[β] 0.11，CI 0.05-0.18）和多重分析（中介标准化β 0.18，CI 0.09-0.27）中均由躯体化和疼痛灾难化介导。在个体分析和多重分析中，抑郁与IBS腹痛的关联也由躯体化（介导的标准化β 0.08，CI 0.02 -0.14）和疼痛灾难化（介导的标准化β 0.06，CI 0.01-0.11）介导（介导的标准化β 0.19，CI 0.04-0.19）。结论和推论躯体化和疼痛灾难化介导焦虑/抑郁和IBS腹痛严重程度之间的关系。这些发现表明，躯体化和疼痛灾难化可能是比焦虑和抑郁更好的治疗目标。临床医生应评估儿童IBS患者的这些心理因素，并进行干预以改善预后。
Background Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. Methods We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. Key Results We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [beta] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized beta 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized beta 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized beta 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized beta 0.19, CI 0.04-0.19). Conclusions and Inferences Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.