The authors have declared that no competing interests exist.
Many schoolchildren experience somatic complaints such as headaches, abdominal pain and fatigue. The aim of the current research is to test the full model of previously found associations between negative affect and somatic complaints in parents and children. Participants were 199 children (aged 8-13, 47% boys) and their parents (aged 31-61, mostly mothers (87%). Self-reports of children and parents on worry, anxiety, depression and somatic complaints were used and parents’ reactions to children’s emotions wereassessed. The results of the study show that childhood negative affect and parental somatic complaints are positively associated with childhood somatic complaints. In turn, childhood negative affect is related to children’s worrying and to parents’ responses to children’s emotions. The more anxious or depressed children felt, the more they worried. Maladaptive parental responses (such as reprimands and discomfort) to child emotions were positively related to depression. It was also found that parents who experienced more negative affect, reported more somatic complaints and tended to report more maladaptive responses towards their children’s emotions.
Many schoolchildren experience somatic complaints such as headaches, abdominal pain and fatigue: prevalence rates range between 10 and 30% for recurrent or chronic complaints
Negative emotions or stress have a physiological component: the body responds in order to enable a person to fight or flight from situations that cause negative emotions or stress. According to the biobehavioral model of pediatric pain and the perseverative cognition hypothesis, negative affect in the form of depression, anxiety or worrying, is an intensified and prolonged psychological state
With respect to the second line of research, several studies have demonstrated a positive relationship between the occurrence of parental somatic complaints (particularly maternal) and child somatic complaints
It is essential to understand that the relationship between negative affect and somatic complaints described above, is not just applicable to children, it is also applicable to adults. Thus, those parents who experience somatic complaints, also often experience negative affect. Parental negative affect is seen as a risk factor for children’s functioning. After all, parents with negative affect can respond in maladaptive ways to their children. More precisely, previous research has shown that children whose mothers respond to emotions in an invalidating (e.g., restrictive or punishing) rather than validating (e.g., encouraging expression) way, have more problems with emotion regulation and experience more feelings of anxiety or depression than their peers
In conclusion, the current literature has demonstrated that negative affect is associated with somatic complaints
In the current study the aim was to address this full model of direct and indirect associations between parents’ negative affect, emotional responses and somatic complaints and children’s negative affect and somatic complaints. Simultaneously studying different types of potential influences on children’s somatic complaints has the advantage of separating independent effects of each factor that could otherwise be overestimated Based on the above described previous findings,the following associations were expected:
a positive relationship between depression, anxiety, worrying and somatic complaints for children as well as parents
a direct, positive relationship between parental somatic complaints and child somatic complaints
positive relationships between parental negative affect and maladaptive reactions to child emotions
positive relationships between maladaptive maternal reactions to child emotions and negative affect in children
Participants were 199 children (aged 8-13, mean age=10; 47% boys) and their parents (aged 31-61, mean age = 42). Almost all parental questionnaires were completed by mothers (87%). The vast majority of the families were from original Dutch descent (90%; other common ethnic backgrounds were Surinam and Indonesian). Parental levels of education were representative of the Dutch population.
Data collection was part of a larger research project. Sixteen 16 random schools in North Holland were asked to participate. Depending on school size, a minimum of one and a maximum of three classrooms were asked to participate. These were 33 classrooms grade 4 to 6 (Dutch school system group 6-8), with the inclusion of one combination classroom grades 3 /4. Parents received an information letter and were asked for informed consent. Parental consent was received for 73% of the children (
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The PRCPS and the CCNES questionnaires were presented to parents as one integrated questionnaire. All subscales had sufficient internal consistencies of .60-.85, although 4 items had to be removed in order to achieve this, which is consistent with previous research
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Parents also completed the
The data were analyzed with structural equation modeling. In our preliminary analyses, a measurement model was fitted. For the parental reactions, a principal component analyses was first performed in order to determine underlying dimensions. For the other variables, the (sub)scales were used as indicators.
Measurement error variances of the constructs that did not have multiple indicators were fixed based on the reliability estimate. A comparative fit index (CFI) > .90 and a Root Mean Square Error of Approximation of < .80 were considered as indicators of adequate model fit
In
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Somatic Complaints | Depression | Social Anxiety | Harm avoidance | Seperation/panic | Worry | |||
Parent Variables | M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | ||
M | (SD) | 1.90 (0.51) | 0.26 (0.23) | 2.00 (0.64) | 2.89 (0.45) | 1.82 (0.51) | 0.91 (0.46) | |
Somatic Complaints | 1.72 | -0.54 | .23 |
0.07 | 0.09 | 0.03 | .15 |
0.01 |
Depression | 0.22 | -0.22 | 0.12 | 0.06 | 0.09 | 0 | 0.1 | 0.05 |
Anxiety | 1.59 | -0.43 | .15 |
.14 |
0.01 | -0.03 | 0.05 | -0.04 |
Worry | 2.2 | -0.68 | .17 |
.19 |
0.03 | 0.02 | -0.01 | 0.02 |
Discomfort | 2.21 | -0.82 | 0.02 | .14 |
0.07 | 0.01 | 0.07 | 0.14 |
Reprimand | 3.38 | -0.93 | -0.04 | 0.09 | 0.07 | -0.03 | 0.03 | 0.08 |
Encouragement | 4.27 | -0.86 | 0 | -.18 |
-0.06 | 0.11 | -0.05 | 0.01 |
Socialization | 4.96 | -0.81 | -0.07 | 0.09 | 0.08 | 0.03 | 0.11 | 0.08 |
Distress | 2.03 | -0.65 | 0.09 | .19 |
0.06 | -0.06 | 0.01 | 0.13 |
Punitive | 2.08 | -0.62 | 0.06 | .16 |
0.05 | 0.01 | 0.05 | 0.1 |
Minimization | 2.72 | -0.87 | 0.05 | 0.05 | 0.08 | 0.07 | 0.09 | 0.11 |
Expressive Encouragement | 4.73 | -1 | 0.03 | -0.08 | 0.02 | .15* | 0.08 | -0.01 |
Emotion Focused | 5.19 | -0.88 | -0.05 | -0.08 | 0.05 | .16* | 0.01 | 0 |
Problem Focused | 5.66 | -0.79 | -0.01 | -0.09 | 0.05 | 0.11 | 0.01 | -0.07 |
Correlation is significant at the 0.01 level (2-tailed).
Correlation is significant at the 0.05 level (2-tailed).
Our analyses showed that worrying had no direct effect on childhood somatic complaints (z=0.26), whereas depression (z= 2.10) and anxiety (z=3.29) both predicted more somatic complaints. Notice that, as expected, worry was positively associated with anxiety and depression.
With respect to the parent variables, the only significant predictor of childhood somatic complaints was parental somatic complaints (
With respect to the question whether childhood depression and anxiety could be predicted by parental depression, anxiety, and/or parental reactions to child emotions; it was found that for child depression, positive (
In this study, effects of emotional and parental factors on childhood somatic complaints were examined. A particular strength of this study was that all variables were addressed simultaneously in a full model. Because of this, direct as well as indirect effects could be examined. The aim of the study to combine the two paths of previous research was successful. The results of the study show that childhood negative affect and parental somatic complaints are positively associated with childhood somatic complaints. In turn, childhood negative affect is related to children’s worrying and to parents responses to children’s emotions. The more anxious or depressed children felt, the more they worried. Invalidating parental responses to child emotions were positively related to depression whereas validating responses were negatively related to depression. It was also found that parents who experienced more negative affect, reported more somatic complaints and tended to report more invalidating responses towards their children’s emotions. As such, the results confirm the expectations as support the model presented in
Whereas for children, feelings of depression and anxiety showed independent relationships with somatic complaints, in the parentsonly a direct path from anxiety towards somatic complaintswas found. This result must be cautiously interpreted, however, as previous research with a larger sample has found a relationship between somatic complaints and anxiety as well as depression
Interestingly, the relationship between worry and somatic complaints was indirect: in adults it seemed to be mediated by anxiety and in children by anxiety and depression. It has been shown that worry can cause cardiac changes independent of mood changes
Whether individuals develop symptoms of depression or anxiety depends on cognitive factors, but also on biological factors (e.g., genetic, hormonal) and emotional factors (e.g., emotional reactivity or the in this study found (in)valididating responses received)
The current results further clearly demonstrate that in so far as parental reactions to child emotions are associated with somatic complaints, this relationship is indirect. As was expected, maladaptive responses to children’s emotions by parents are associated with more negative affect in children.
Parents also have a more direct influence through their own somatic complaints and this effect should be further investigated. Previous research supported that at least part of the relationship between parent and child somatic complaints is genetic
There are some limitations of this study that should be taken into consideration. First of all, a community sample was used. It was,therefore, impossibleto investigate depression, anxiety, or somatic complaints within the clinical range. In addition, we had no access to parent’s or children’s medical records. This might have resulted in an underestimation of effects on somatic complaints. After all, some complaints that were reported might be mainly explained by medical causes. A final limitation that needs to bestressed is the low response rate in parental participation. Although no differences in the child reports were found, it might be that parents who experience parenting problems are more reluctant to answer questions about how they respond to child emotions than parents who experience no such problems. This may have let to weaker associations between parental reactions to child emotions and our other variables than would have been found in the total population.
In conclusion, the current study has integrated some of the previous findings on childhood somatic complaints by combining effects of negative affect and parental factors in one model. The results confirm that there is a direct association between parental and child somatic complaints. Besides this, both child and parental somatic complaints are related to negative affect. Because parents with negative affect also are more likely to show maladaptive responses to children’s emotions, they also indirectly further increase the likelihood of children’s somatic complaints through childhood negative affect.