Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders
Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders
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DOI：
10.1542/peds.2012-2191
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发表时间：
2013-09-01
期刊：
影响因子：
8
通讯作者：
Walker, Lynn S.
中科院分区：
文献类型：
--
作者：
Shelby, Grace D.;Shirkey, Kezia C.;Walker, Lynn S.
背景：横断面研究将功能性腹痛（FAP）与儿童时期的焦虑和抑郁联系起来，但没有前瞻性研究评估成年后的精神状态及其与疼痛持续性的关系。方法：对患有FAP的儿童患者（n = 332）和对照组（n = 147）进行前瞻性跟踪，并在青春期和青年期（平均年龄= 20.01岁）随访时评估其精神障碍和功能性胃肠疾病（fgid）。根据随访时fgid的存在（FGID-POS）或缺失（FGID-NEG）对参与者进行分类。结果：FAP患者的终生和当前焦虑障碍风险高于对照组（终生：51% vs 20%；当前：30% vs 12%）。在性别和年龄的控制下，FAP与对照组随访时终生焦虑障碍的比值比为4.9（置信区间= 2.83-7.43），当前焦虑障碍的比值比为3.57（置信区间= 2.00-6.36）。FAP组抑郁障碍终生风险显著高于对照组（40% vs. 16%）；目前的风险没有差异。在大多数情况下，焦虑障碍的初始发作是在儿科FAP评估之前；抑郁障碍的发生在FAP评估之后。在FAP组中，FGID-POS与FGID-NEG随访时当前焦虑障碍的风险显著高于FGID-POS (40% vs 24%)，两者均高于对照组（12%）；目前的抑郁症在FGID-POS、FGID-NEG和对照组之间没有差异。结论：FAP患者具有长期的焦虑易感性，这种易感性始于儿童期，持续到青春期晚期和成年早期，即使腹痛得到缓解。
BACKGROUND: Cross-sectional studies link functional abdominal pain (FAP) to anxiety and depression in childhood, but no prospective study has evaluated psychiatric status in adulthood or its relation to pain persistence.METHODS: Pediatric patients with FAP (n = 332) and control subjects (n = 147) were tracked prospectively and evaluated for psychiatric disorders and functional gastrointestinal disorders (FGIDs) at follow-up in adolescence and young adulthood (mean age = 20.01 years). Participants were classified according to presence (FGID-POS) or absence (FGID-NEG) of FGIDs at follow-up.RESULTS: Lifetime and current risk of anxiety disorders was higher in FAP than controls (lifetime: 51% vs 20%; current: 30% vs 12%). Controlling for gender and age, the odds ratio was 4.9 (confidence interval = 2.83-7.43) for lifetime anxiety disorder and 3.57 (confidence interval = 2.00-6.36) for current anxiety disorder at follow-up for FAP versus controls. Lifetime risk of depressive disorder was significantly higher in FAP versus controls (40% vs. 16%); current risk did not differ. In most cases, initial onset of anxiety disorders was before pediatric FAP evaluation; onset of depressive disorders was subsequent to FAP evaluation. Within the FAP group, risk of current anxiety disorders at follow-up was significantly higher for FGID-POS versus FGID-NEG (40% vs 24%), and both were higher than controls (12%); current depressive disorders did not differ across FGID-POS, FGID-NEG, and controls.CONCLUSIONS: Patients with FAP carry long-term vulnerability to anxiety that begins in childhood and persists into late adolescence and early adulthood, even if abdominal pain resolves.