Department of Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor.
School of Nursing, University of Michigan, Ann Arbor.
JAMA Netw Open. 2023 May 1;6(5):e2314135. doi: 10.1001/jamanetworkopen.2023.14135.
Co-occurring physical and psychological symptoms during childhood and early adolescence may increase risk of symptom persistence into adulthood.
To describe co-occurring pain, psychological, and sleep disturbance symptom (pain-PSS) trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a secondary analysis of longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study, collected between 2016 and 2022 at 21 research sites across the US. Participants included children with 2 to 4 complete annual symptom assessments. Data were analyzed from November 2022 to March 2023.
Four-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain-PSS scores, including depression and anxiety, were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Nonroutine medical care and mental health care utilization were measured using medical history and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) items.
A total of 11 473 children (6018 [52.5%] male; mean [SD] age at baseline, 9.91 [0.63] years) were included in analyses. Four no pain-PSS and 5 pain-PSS trajectories were supported with good or excellent model fit (predicted probabilities, 0.87-0.96). Most children (9327 [81.3%]) had asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children (2146 [18.7%]) had moderate to high co-occurring symptom trajectories that persisted or worsened. Compared with White children, there was a lower relative risk of having moderate to high co-occurring symptom trajectories among Black children (adjusted relative risk ratio [aRRR] range, 0.15-0.38), Hispanic children (aRRR range, 0.58-0.67), and children who identified as another race (including American Indian, Asian, Native Hawaiian, and other Pacific Islader; aRRR range, 0.43-0.59). Less than half of children with moderate to high co-occurring symptom trajectories used nonroutine health care, despite higher utilization compared with asymptomatic children (nonroutine medical care: adjusted odds ratio [aOR], 2.43 [95% CI, 1.97-2.99]; mental health services: aOR, 26.84 [95% CI, 17.89-40.29]). Black children were less likely to report nonroutine medical care (aOR, 0.61 [95% CI, 0.52-0.71]) or mental health care (aOR, 0.68 [95% CI, 0.54-0.87]) than White children, while Hispanic children were less likely to have used mental health care (aOR, 0.59 [95% CI, 0.47-0.73]) than non-Hispanic children. Lower household income was associated with lower odds of nonroutine medical care (aOR, 0.87 [95% CI, 0.77-0.99]) but not mental health care.
These findings suggest there is a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.
儿童期和青春期同时出现身体和心理症状可能会增加症状持续到成年期的风险。
描述在不同种族背景的儿童中疼痛、心理和睡眠障碍症状（疼痛-PSS）的共同出现轨迹，以及症状轨迹与医疗保健利用之间的关联。
设计、地点和参与者：本队列研究是对美国青少年大脑认知发展（ABCD）研究纵向数据的二次分析，于 2016 年至 2022 年在全美 21 个研究点进行。参与者包括有 2 到 4 次完整年度症状评估的儿童。数据分析于 2022 年 11 月至 2023 年 3 月进行。
从多变量潜在增长曲线分析中得出了四年的症状轨迹。疼痛-PSS 评分包括抑郁和焦虑，使用儿童行为检查表和儿童睡眠障碍量表的子量表进行测量。非常规医疗保健和精神卫生保健的利用使用病史和精神疾病诊断与统计手册（第五版）项目进行测量。
共有 11473 名儿童（6018 [52.5%]为男性；基线时的平均[标准差]年龄为 9.91[0.63]岁）纳入分析。支持无疼痛-PSS 和 5 个疼痛-PSS 轨迹，具有良好或优秀的模型拟合度（预测概率，0.87-0.96）。大多数儿童（9327 [81.3%]）无症状或症状低、间歇性或单一症状轨迹。约 1/5 的儿童（2146 [18.7%]）有中度到高度共同出现的症状轨迹，这些轨迹持续或恶化。与白人儿童相比，黑人儿童（调整后的相对风险比[ARR]范围，0.15-0.38）、西班牙裔儿童（ARR 范围，0.58-0.67）和其他种族的儿童（包括美国印第安人、亚洲人、夏威夷原住民和其他太平洋岛屿居民；ARR 范围，0.43-0.59）中度到高度共同出现症状轨迹的相对风险较低。尽管与无症状儿童相比，中度到高度共同出现症状轨迹的儿童利用非常规医疗保健的比例较低（非常规医疗保健：调整后的优势比[aOR]，2.43[95%CI，1.97-2.99]；精神卫生服务：aOR，26.84[95%CI，17.89-40.29]）。与白人儿童相比，黑人儿童报告非常规医疗保健（aOR，0.61[95%CI，0.52-0.71]）或精神卫生保健（aOR，0.68[95%CI，0.54-0.87]）的可能性较低，而西班牙裔儿童使用精神卫生保健的可能性（aOR，0.59[95%CI，0.47-0.73]）低于非西班牙裔儿童。家庭收入较低与非常规医疗保健的可能性较低相关（aOR，0.87[95%CI，0.77-0.99]），但与精神卫生保健无关。
这些发现表明，需要采取创新和公平的干预措施，以减少青春期症状持续存在的可能性。
