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Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. (Barnpsyk)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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2012 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 12, 90- p.Article in journal (Refereed) Published
Abstract [en]

Background

There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.

Methods

The total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.

Results

Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.

Conclusions

Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

Place, publisher, year, edition, pages
2012. Vol. 12, 90- p.
Keyword [en]
Adolescent depression, Long-term follow-up, Functional somatic symptoms, Anxiety and suicidal behavior
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-180071DOI: 10.1186/1471-244x-12-90ISI: 000308698500001PubMedID: 22839681OAI: oai:DiVA.org:uu-180071DiVA: diva2:547852
Projects
Långtidsuppföljning av deprimerade tonåringar
Available from: 2012-08-29 Created: 2012-08-29 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Adolescents with Depression Followed up: Prognostic Significance of Somatic Symptoms and Their Need of In-Patient Care
Open this publication in new window or tab >>Adolescents with Depression Followed up: Prognostic Significance of Somatic Symptoms and Their Need of In-Patient Care
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A dualist approach that distinguishes between mind and body is still the norm in Western medicine. Although we now know that physical and mental health are related in adults, little is known about if, or with what mechanisms, mental illnesses or depression early in life, will affect future physical and psychological health. In-between mental and somatic disorders there are somatic symptoms without medical explanation. These are symptoms that cause much suffering and impairment which are costly for society. Still little is known what they are, how they should be treated and what consequences they have for adolescents when they grow up. This study aims to investigate the long-term relationship between mental and somatic disease and the outcome of adolescents with functional somatic symptoms.

The thesis is based on a 15-year follow-up study of a population-based investigation of adolescent depression. In 1991–1993 first year students in upper secondary school (age 16–17) in Uppsala, Sweden, were screened for depression (n=2300). Adolescents with positive screening and selected peers with negative screening (n=631) were assessed regarding mental health and somatic symptoms. At around age 31, the participants were followed-up in personal interviews (n=369) and national registers (n=609). Outcomes regarding mental DSM-IV diagnosis, in-patient ICD-10 disease diagnosis from the patient register, and blood vessel wall thickness were assessed.

The most important finding is the unexpected poor short and long-term outcome in adolescents with somatic symptoms. The result proves the need for better treatment. The strong prediction of functional somatic symptoms for mental disorder, independent of adolescent depression, suggests that somatic symptoms and depression symptoms are different expressions of a common disorder. Female adolescents with depression need more psychiatric and somatic in-patient care but the males do not. Instead, they have considerably more in-patient stays due to alcohol and drug abuse. The males might be taken care of outside the health care system and seem to need special attention. In women with adolescent and recurrent adult depression there is an association with premature aging of the carotid wall. These women are at risk of developing early cardio-vascular disease and need early interventions.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 40 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 809
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-180328 (URN)978-91-554-8461-3 (ISBN)
Public defence
2012-10-20, Universitetshuset, Sal IX, S:t Olofsgatan, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-28 Created: 2012-09-03 Last updated: 2013-01-23Bibliographically approved

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Bohman, HannesJonsson, UlfPäären, Aivarvon Knorring, LarsOlsson, Gunillavon Knorring, Anne-Liis
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