ILLNESS BEHAVIOR AND SOMATIZATION IN CHILDREN

这个项目的目标是确定心理社会因素和社会- 与发育和维持有关的认知过程 儿童患病行为(即躯体主诉、功能性 残疾、保健服务利用)。我们特别关注级别 看起来与医疗不成比例的疾病行为 调查结果。这一研究计划是由一个概念模型指导的 压力和应对，在其中我们假设疾病的程度 儿童表现出的行为受以下因素影响：(1)疾病的性质 孩子家庭中的行为，如父母的躯体水平 主诉、功能性残疾和应对疼痛的策略， (2)孩子最近经历的负面生活事件；(3) 儿童当前的能力水平和感知的成就压力 在儿童时期扮演重要的角色，特别是与学校有关的角色。 这些影响被认为是由儿童的 评估和应对相关领域的压力源，即疼痛 还有学校。我们的第一个目标是测试这一概念的实用性 解释疾病行为水平差异的模型 首次就诊时有腹痛症状的儿科患者 在一年的随访中。到目前为止，在我们的工作中，我们发现 父母患病行为与子女患病水平呈正相关 疾病行为，以及高水平的负性生活事件 与低学校能力的互动可以预测疾病的维持 在第一次就诊一年后的行为。研究1 拟议的项目需要招聘200名儿科医生 腹痛患者来测试这些影响是 由儿童的评估和应对疼痛的模式和 学校的压力源。我们的第二个目标是评估以下方面的长期结果 不明原因反复腹痛的儿科患者 (RAP)，并评估负面生活事件和 五年疾病行为维持方面的学校/工作能力 在最初的面试之后。这个目标建立在我们发现说唱的基础上 患者表现出持续更高的患病行为水平 儿童、精神病患者和经医学解释的患者 腹痛，因此代表了一个关于童年的独特群体 疾病行为。拟议项目的第二项研究为期五年 对1988-90年间最初采访的274名受试者的随访 一年后被跟踪，保留率为98%，以测试 假设(1)以前的RAP患者将表现出更高的水平 比那些身体健康或有器质性疾病的人更容易患病 在最初的面试中，以及(2)更高级别的 学习/工作能力水平较低的近期负面生活事件 将解释青春期患病行为的显著差异 以及由于早期疾病水平而导致的成年早期 行为。

The goal of this project is to identify psychosocial factors and social- cognitive processes associated with the development and maintenance of children's illness behavior (i.e., somatic complaints, functional disability, health service utilization). We focus particularly on levels of illness behavior that appear to be out of proportion to medical findings. This program of research is guided by a conceptual model of stress and coping, in which we hypothesize that the extent of illness behavior exhibited by a child is influenced by (1) the nature of illness behavior in that child's family, such as the level of parent somatic complaints, functional disability, and strategies for coping with pain, (2) that child's recent experience of negative life events, and (3) that child's current level of competence and perceived achievement pressure in important childhood roles, particularly those associated with school. These effects are hypothesized to be mediated by the child's pattern of appraisal and coping with stressors in relevant domains, that is, pain and school. Our first aim is to test the utility of this conceptual model in explaining variation in the levels of illness behavior exhibited by pediatric patients with abdominal pain at an initial clinic visit and at a one-year follow-up. In our work thus far we have found that levels of parent illness behavior are positively correlated with levels of child illness behavior, and that high levels of negative life events in interaction with low school competence predict maintenance of illness behavior one year following an initial clinic visit. Study 1 of the proposed project entails recruitment of a cohort of 200 pediatric abdominal pain patients to test the hypothesis that these effects are mediated by the child's patterns of appraisal and coping with pain and school stressors. Our second aim is to assess long-term outcomes for pediatric patients with medically unexplained recurrent abdominal pain (RAP) and to evaluate the influence of negative life events and school/work competence on maintenance of illness behavior five year following the initial interview. This aim builds on our finding that RAP patients exhibit persistently higher levels of illness behavior than well children, psychiatric patients, and patients with medically explained abdominal pain, and thus represent a unique group regarding childhood illness behavior. Study 2 of the proposed project entails a five-year follow-up of 274 subjects who were originally interviewed in 1988-90 and were followed one year later with a 98% retention rate in order to test the hypotheses that (1) former RAP patients will exhibit higher levels of illness behavior than those who were well or who had organic disease at the initial interview, and (2) the interaction of higher levels of recent negative life events with lower levels of school/work competence will explain significant variance in illness behavior during adolescence and early adulthood beyond that accounted for by early levels of illness behavior.