Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5532-5541
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5532
Psychosocial mechanisms for the transmission of somatic symptoms from parents to children
Miranda AL van Tilburg, Rona L Levy, Lynn S Walker, Michael Von Korff, Lauren D Feld, Michelle Garner, Andrew D Feld, William E Whitehead
Miranda AL van Tilburg, William E Whitehead, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC 27599, United States
Rona L Levy, School of Social Work, University of Washington, Seattle, WA 98101, United States
Lynn S Walker, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37201, United States
Michael Von Korff, Group Health Research Institute, Seattle, WA 98101, United States
Lauren D Feld, Mount Sinai School of Medicine, New York, NY 10001, United States
Michelle Garner, Department of Social Work, University of Washington Tacoma, Tacoma, WA 98417, United States
Andrew D Feld, Group Health Cooperative, Spokane, WA 99255, United States
Author contributions: Levy RL, Whitehead WE, Walker LS, Feld AD and Von Korff M designed the study; Feld LD and Garner M were involved in data collection; van Tilburg MAL, Levy RL, and Whitehead WE were involved in analysis of the data and writing of the manuscript; Walker LS, Von Korff M, Feld LD, Feld AD and Garner M reviewed the manuscript.
Supported by NIH, No. RO1 HD36069, No. RO1 DK31369, and No. R24 67674.
Ethics approval: This study was reviewed and approved by the Institutional Review Boards of Group Health Cooperative, the University of Washington, and the University of North Carolina.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Miranda AL van Tilburg, PhD, Division of Gastroenterology and Hepatology and Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Campus Box 7080, Chapel Hill, NC 27599, United States.
Received: August 22, 2014
Peer-review started: August 23, 2014
First decision: September 27, 2014
Revised: November 19, 2014
Accepted: December 20, 2014
Article in press: December 22, 2014
Published online: May 14, 2015

AIM: To examine familial aggregation of irritable bowel syndrome (IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to stress.

METHODS: Mothers of children between the ages of 8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget Sound. Mothers completed questionnaires, including the Child Behavior Checklist (child psychological distress), the Family Inventory of Life Events (family exposure to stress), SCL-90R (mother psychological distress), and the Pain Response Inventory (beliefs about pain). Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire (beliefs about pain), Pain Response Inventory (coping) and Child Symptom Checklist [gastrointestinal (GI) symptoms]. In addition, health care utilization data was obtained from the automated database of Group Health Cooperative. Mothers with IBS (n = 207) and their 296 children were compared to 240 control mothers and their 335 children, while controlling for age and education.

RESULTS: Hypothesis 1: reinforcement of expression of GI problems is only related to GI symptoms, but not others (cold symptoms) in children. There was no significant correlation between parental reinforcement of symptoms and child expression of GI or other symptoms. Hypothesis 2: modeling of GI symptoms is related to GI but not non-GI symptom reporting in children. Children of parents with IBS reported more non-GI (8.97 vs 6.70, P < 0.01) as well as more GI (3.24 vs 2.27, P < 0.01) symptoms. Total health care visits made by the mother correlated with visits made by the child (rho = 0.35, P < 0.001 for cases, rho = 0.26, P < 0.001 for controls). Hypothesis 3: children learn to share the methods of coping with illness that their mothers exhibit. Methods used by children to cope with stomachaches differed from methods used by their mothers. Only 2/16 scales showed weak but significant correlations (stoicism rho = 0.13, P < 0.05; acceptance rho = 0.13, P < 0.05). Hypothesis 4: mothers and children share psychological traits such as anxiety, depression, and somatization. Child psychological distress correlated with mother’s psychological distress (rho = 0.41, P < 0.001 for cases, rho= 0.38, P < 0.001 for controls). Hypothesis 5: stress that affects the whole family might explain the similarities between mothers and their children. Family exposure to stress was not a significant predictor of children’s symptom reports. Hypothesis 6: the intergenerational transmission of GI illness behavior may be due to multiple mechanisms. Regression analysis identified multiple independent predictors of the child’s GI complaints, which were similar to the predictors of the child’s non-GI symptoms (mother’s IBS status, child psychological symptoms, child catastrophizing, and child age).

CONCLUSION: Multiple factors influence the reporting of children’s gastrointestinal and non-gastrointestinal symptoms. The clustering of illness within families is best understood using a model that incorporates all these factors.

Keywords: Abdominal pain, Coping, Illness behaviors, Psychological distress, Social learning, Stress

Core tip: Irritable bowel syndrome tends to run in families. In previous studies, we found that this phenomenon could be explained by reinforcement and modeling of gastrointestinal illness behavior by parents. The current study extend these findings by examining various psychosocial influences on intergenerational transmission. We found that multiple psychosocial similarities between the mother and child may explain familial aggregation, including the mother’s modeling of irritable bowel syndrome symptoms, shared psychological distress, and shared family stress.