Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?

The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically releva...

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Bibliographic Details
Published in:European child & adolescent psychiatry 2011-01, Vol.20 (1), p.39-48
Main Authors: Knook, Lidewij M. E., Konijnenberg, Antoinette Y., van der Hoeven, Joost, Kimpen, Jan L. L., Buitelaar, Jan K., van Engeland, Herman, de Graeff-Meeder, Elisabeth R.
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Anxiety disorders
Biological and medical sciences
Child
Child & adolescent psychiatry
Child and Adolescent Psychiatry
Child clinical studies
Children
Children & youth
Chronic Disease
Chronic pain
Female
Headaches
Humans
Interview, Psychological
Interviews
Male
Medical sciences
Medicine
Medicine & Public Health
Mental disorders
Mental Disorders - diagnosis
Mental Disorders - epidemiology
Mental Disorders - physiopathology
Mental Disorders - psychology
Miscellaneous
Original Contribution
Pain - diagnosis
Pain - epidemiology
Pain - psychology
Pain Clinics
Pain Measurement
Prevalence
Psychiatric disorders
Psychiatric Status Rating Scales
Psychiatrists
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychopathology
Psychopathology. Psychiatry
Questionnaires
Severity of Illness Index
Teenagers
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Summary:The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children’s hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8–17 years, using the Diagnostic Interview Schedule for Children–parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children’s Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07–8.92, p  = 0.04/adjusted OR 2.99; 95% CI 1.02–8.74, p  = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.
ISSN:1018-8827
1435-165X
1435-165X
DOI:10.1007/s00787-010-0146-0