Associations between abdominal pain symptom dimensions and depression among adolescents.

Background and aims The prevalence of depression is increased among patients with abdominal pain (AP) and Irritable Bowel Syndrome (IBS), but little is known about this association among adolescents in the general population. Furthermore, there is considerable uncertainty about exactly which dimensions of AP and IBS are associated with depression. The aims of this study were therefore: (a) to describe the prevalence of AP, IBS and depression in a representative sample of adolescents, (b) to analyze the association of AP and IBS with depression and lastly, (c) to analyze the relationship between depression and specific AP and IBS symptom dimensions, i.e. pain intensity, frequency, duration, and distribution, the presence of co-morbid non-abdominal pain, and the specific bowel systems distinguishing IBS from AP in general. Materials and methods Self-reported symptoms of AP (monthly or more frequent), IBS (Rome III 2006 criteria), co-morbid chronic pain and depression (The Short Mood and Feeling Questionnaire sum-score ≥11) were recorded among 961 adolescents (mean age 16.1 y and 48.8% girls), participating in a population based study in 2010-2011. Multiple logistic regression carried out to analyze the association of AP and IBS with depression, adjusting for sex, parental level of education (<college or ≥college) and co-morbid chronic pain. Among the AP cases, the association of different AP dimensions and of the specific bowel symptoms in IBS with depression were analyzed in a stepwise multiple logistic regression model. Results Monthly or more frequent AP was reported by 27% of the participants (n = 259) and 8.2% (n = 77) met the Rome III IBS criteria. The prevalence of depression was 11.5% (girls 15.9% and boys 7.3%). The prevalence of depression was higher among both AP and IBS cases compared to in controls (20.5%, 24.7% and 8.1% respectively), but there was no evidence that depression rates differed between the two case groups (IBS: OR = 2.5, 95% CI = 1.6-3.9; AP: OR = 2.4 with 95% CI = 1.3-4.4, after adjusting for sex, parental level of education and co-morbid chronic pain). In the regression analyses within the AP group, the following symptom dimensions were independently associated with depression: severe abdominal pain intensity (OR = 4.0; CI = 1.5-10.7), widespread abdominal pain (OR = 5.5; CI = 2.6-11.8) and presence of co-morbid chronic pain (OR = 3.3; CI = 1.6-6.8). Sex, parental education, and other abdominal pain symptom dimensions, including bowel symptoms that distinguish IBS from AP, were not independently associated with depression. Conclusions and implications The prevalence of depression is considerably increased among adolescents with AP and IBS in the general population, in particular among those reporting severe, widespread abdominal pain, and co-morbid chronic pain. Evaluating these symptom dimensions may be of value for identifying subgroups adolescents with AP and IBS that have greater risk of depression.