Child Anxiety as a Mediator of the Relationship between Caregiver Anxiety and Child Somatization in Youth with Functional Abdominal Pain Disorders
By: Sarah Love, Psy.M.
Functional abdominal pain disorders (FAPD) are common pediatric pain conditions that often present with co-occurring anxiety. When youth with FAPD also present with comorbid anxiety, they may experience more adverse outcomes such as increased pain, disability, and somatization (Mahrer, Montaño, & Gold, 2012). Parents of children with abdominal pain often report higher levels of anxiety than parents of children without abdominal pain disorders (Hodges, Kline, Barbero, & Woodruff, 1985; Walker & Greene, 2013). It remains unknown how parent and child anxiety cumulatively influence outcomes in youth with FAPD. The study sought to examine the role of caregiver distress (e.g., stress, anxiety, depression) and child anxiety in relation to child pain-related outcomes (e.g., pain level, functional disability, and somatization). It was hypothesized that higher levels of child anxiety and caregiver distress would be related to poor child outcomes (e.g., pain, somatization, and functional disability). It was also hypothesized that child anxiety would mediate the relationship between caregiver distress and pain-related outcomes in youth. Participants included 96 children and their caregivers presenting to gastroenterology clinics at Cincinnati Children’s Hospital Medical Center as a part of a larger study (Natoshia Cunningham, Ph.D., PI). Youth completed the Screen for Child Anxiety Related Disorders (SCARED; Birmaher et al., 1997),the Functional Disability Inventory (FDI; Walker & Greene, 1991),the Visual Analog Scale (VAS; McGrath et al., 1998) and the Child Somatization Inventory (CSI; Walker et al., 2008). Caregivers completed the Depression Anxiety Stress Scale (DASS; Henry, & Crawford, 2005).
Correlations were conducted to examine relationships between caregiver distress (e.g., stress, anxiety, and depression), child anxiety, and child pain-related outcomes (e.g., pain, somatization, and functional disability). Pearson correlations revealed that both caregiver anxiety (r = .22, p < .05) and child anxiety (r = .26, p < .05) were positively associated with child somatization. It was also found that caregiver anxiety and child anxiety were significantly correlated with one another (r = .25, p < .05). Child anxiety, but not caregiver anxiety, was significantly correlated with child functional disability (r = .23, p < .05). The other caregiver variables (caregiver stress and depression) were not associated with the child outcome variables.
Based on the correlation findings, a mediation model was tested to explore if child anxiety mediated the association between caregiver anxiety and child somatization. When both child and caregiver anxiety were included in a model, the effect of caregiver anxiety became non-significant (b = .642, p = .14), while the effect of child anxiety remained significant (b = .224, p = .04). Additional testing suggested that child anxiety is trending as a mediator of the relationship between caregiver anxiety and child somatization in youth with FAPD (Sobel Test = 1.54, SE = .14, p = .06). Therefore, assessment and intervention focused on reducing child anxiety may be particularly beneficial to improve somatization in youth with FAPD. Future research would benefit from assessing if psychological interventions targeting pain and anxiety in youth also simultaneously reduce somatization in this population.