Abstract
Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child’s experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.
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Data availability
Reasonable requests to access the datasets analyzed will be adjudicated by the Generation R management committee.
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Acknowledgements
The Generation R Study is conducted by the Erasmus Medical Center Rotterdam in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam. The work of H.T. was supported by a NWO–VICI grant (NOW ZonMW 016.VICI.170.200).
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GK conceived the study, appraised the background literature, coordinated subsequent revisions; JvdE conducted statistical analyses on the survey database, contributed to quality assurance of the database, contributed to reviewing the manuscript and evaluating the survey database; FZT contributed to the background literature appraisal, contributed to drafting and reviewing the manuscript; TW contributed to revise the manuscript and contributed to quality assurance of the database; ID contributed to revise the manuscript and contributed to quality assurance of the database; FV conceived the study and contributed to revise the manuscript; HT conceived the study, coordinated subsequent revisions and revised the manuscript.
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Dr. Verhulst was the contributing editor of the Achenbach System of Empirically Based Assessment, from which he received remuneration. No other disclosures were reported.
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The study was conducted following the principles of the Declaration of Helsinki and its later amendments.
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Written informed consent for all children was obtained from the caregivers.
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Kolaitis, G., van der Ende, J., Zaravinos-Tsakos, F. et al. The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?. Eur Child Adolesc Psychiatry 31, 1933–1941 (2022). https://doi.org/10.1007/s00787-021-01821-7
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DOI: https://doi.org/10.1007/s00787-021-01821-7