Associations of Abdominal Pain and Psychosocial Distress Measures With Health-Related Quality-of-Life in Pediatric Healthy Controls and Irritable Bowel Syndrome

J Clin Gastroenterol. 2020 Jun 16. doi: 10.1097/MCG.0000000000001373. Online ahead of print.

John M Hollier 1 2, Danita I Czyzewski 2 3, Mariella M Self 2 3, Yan Liu 4, Erica M Weidler 1 5, Miranda A L van Tilburg 6 7 8, James W Varni 9, Robert J Shulman 1 2 5


Author information

1Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition.

2Texas Children's Hospital.

3Department of Pediatrics, Section of Psychology.

4Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine.

5United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Houston.

6Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek.

7Department of Medicine, University of North Carolina, Chapel Hill, NC.

8School of Social Work, University of Washington, Seattle, WA.

9Department of Pediatrics and Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX.


Background: Children with irritable bowel syndrome (IBS) have lower health-related quality-of-life (HRQOL) than healthy controls (HC). Abdominal pain and psychosocial distress are negatively associated with HRQOL, although their relative effect is unclear.

Aim: The aim of this study was to compare the relative associations of abdominal pain and psychosocial distress with HRQOL in HC and IBS.

Study: Baseline abdominal pain, psychosocial distress, and HRQOL measures were obtained from HC and IBS pediatric clinical trial participants. Regression assessed which measures were most strongly associated with Physical and Psychosocial HRQOL separately by group. Interaction analyses examined group differences in the associations of abdominal pain and psychosocial distress with HRQOL.

Results: Eight-five HC and 213 children with IBS participated. Somatization was most strongly associated with Physical HRQOL in HC, and functional disability was most strongly related in IBS. With respect to Psychosocial HRQOL, somatization was most strongly associated for both HC and IBS; depression was also significantly associated in HC. The strength of association between somatization and Physical HRQOL differed between groups; the negative association was less pronounced for IBS than HC. The association between functional disability and both Physical and Psychosocial HRQOL differed significantly between groups; the negative associations were more pronounced for IBS than HC.

Conclusions: Multiple psychosocial distress measures, including somatization, were associated with HRQOL in children with IBS; HRQOL in HC was driven consistently by somatization, to the exclusion of other psychosocial concerns. The associations of somatization and functional disability with HRQOL are distinctly different between HC and IBS. This knowledge supports utilization of psychosocial interventions to improve overall well-being for children with IBS.

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