Somatisation in adolescents: associations with family characteristics

Abstract

Normal 0 21 false false false NL-BE X-NONE HE About 15 to 25% of all adolescentsreport recurrent or continuous physical complaints, such as dizziness,headaches, or fatigue. The majority of these complaints can be classified asphysical functional complaints (PFC), or complaints for which nostraightforward medical cause is found. The tendency to experience and reportmultiple PFC is named somatisation. Somatisation has a substantial impact, bothfor the adolescent (e.g., physical discomfort, restricted school attendance)and the adolescent s family (e.g., family stress). Insight in associated factorsis needed to serve assessment and treatment. One of the domains that remainunderstudied is the connection with family factors. More specific, threeoverall gaps can be distinguished. These gaps were addressed in the presentdoctoral research by means of five studies, including data of a populationsample of adolescents (born in 1996) and their parents (N = 1499). Data were gathered by means of questionnaires at threetime points (time 1, 2009 = T1, time 2, 2010 = T2, en time 3, 2011 = T3) andobservation at one time point (between T2 and T3). First, there is a lack of knowledgeconcerning independent connections(i.e., main effects) between somatisation and certain family aspects. Thisfirst gap was addressed by investigating the associations between somatisationand dimensions of general parenting behaviour (at age 12-13, T1; at age 13-14,T2; at age 14-15, T3; study 1), dimensionsof specific parenting behaviour (T1, and T2; study 2), family functioning (T1; study 3), and parenting stress (T1, T2, and T3; study 1). Concerning general parenting,significant associations were observed between higher levels of somatisationand less adaptive general parenting (less warmth, more harsh punishment, and morepsychological control) on T1. For T2 only the connection between higher levelsof somatisation and higher levels of psychological control was significant,while for T3 no significant connections were seen. Further, the specificparenting behaviour dimensions encouraging/monitoring and protection were notrelated to adolescents somatisation. The more frequent use of the specificparenting behaviour dimension minimisation was connected to higher levels of somatisationat age 12-13 but not at age 13-14. In addition, it was shown that adolescentsfrom parents reporting average to high amounts of problems in familyfunctioning reported higher levels of somatisation, compared to adolescentsfrom parents reporting low amounts of problems in family functioning. Finally,higher levels of parenting stress were significantly related to higher levelsof somatisation in all three data-waves. Second, previous research too oftenignored possible dependency of included main effects. In this study, some ofthe above mentioned independent links were further explored, assessing mediation/moderation by other familyfeatures and child characteristics. It was revealed that the relationbetween general parenting behaviour dimensions and somatisation wassignificantly mediated by parenting stress (at T1, T2, and T3; study 1) and moderated by adolescents skin conductance (at T3; study 4).Other hypotheses were not supported (i.e., that general parenting behaviour dimensionswould mediate the relation between parenting stress and somatisation, study 1; that general parentingbehaviour dimensions would moderate the relation between specific parentingbehaviour dimensions and somatisation, study2; that adolescents gender and emotional distress would moderate therelation between specific parenting behaviour dimensions and somatisation, study 2).Third, previous studies mainlyfocused on cross-sectional associations. Although cross-sectional research hasits merits, it has to be complemented by longitudinalanalyses in order to provide aetiological insights. This study revealedthat the significant indirect relation between general parenting behaviour dimensionsand somatisation, intervened by parenting stress, can be longitudinallyinterpreted as parenting stress predicting both parenting behaviour andsomatisation (study 1). In addition,longitudinal analyses showed that parenting stress predicts different levels ofsomatisation, depending on the adolescents trajectory of somatisationdevelopment (study 5). For thoseadolescents in long-term high and decreased somatisation trajectories,higher levels of parenting stress predicted lower levels of somatisation, whilefor those adolescents in long-term low and increased trajectories, higher levelsof parenting stress predicted higher levels of somatisation. Other longitudinalhypotheses were not supported (i.e., the existence of backward longitudinalrelationships, study 1, study 2, study 5;the existence of a longitudinal relation between specific parenting behaviourdimensions and somatisation, study 2).In sum, the results support theimportance of including following family topics in clinical practice concerningadolescents somatisation: general parenting behaviour dimensions (warmth,psychological control, and harsh punishment), parents minimising responses tophysical complaints, family functioning, and parenting stress. In addition, therelevance of adolescents processing of family features was disclosed. Overall,the results of this study suggest the value of including a pedagogical focus inassessment and treatment of adolescents who somatise. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}status: publishe