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PEDIATRICS Vol. 113 No. 4 April 2004, pp. 817-824

Recurrent Abdominal Pain, Anxiety, and Depression in Primary Care

John V. Campo, MD*,{ddagger}, Jeff Bridge, PhD*, Mary Ehmann, BA*, Sarah Altman, BS*, Amanda Lucas, MEd, MBA*, Boris Birmaher, MD*, Carlo Di Lorenzo, MD{ddagger}, Satish Iyengar, PhD* and David A. Brent, MD*,{ddagger}

* Western Psychiatric Institute and Clinic
{ddagger} Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Objective. The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care.

Methods. Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status.

Results. RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety.

Conclusions. Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.

Key Words: abdominal pain • anxiety • depression • functional colonic diseases • primary care

Abbreviations: RAP, recurrent abdominal pain • RA, research assistant • K-SADS-PL, Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version • CBCL, Child Behavior Checklist • FET, Fisher exact test • SD, standard deviation • TCA, tricyclic antidepressant

Received for publication May 19, 2003; Accepted Sep 10, 2003.


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