title: Recurrent abdominal pain, anxiety, and depression in primary care.
abstract: OBJECTIVE
  The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care.
  
  
  METHODS
  Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status.
  
  
  RESULTS
  RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety.
  
  
  CONCLUSIONS
  Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. campojv@msx.upmc.edu
authors.forename: John V
authors.initials: JV
authors.lastname: Campo
authors.forename: Jeff
authors.initials: J
authors.lastname: Bridge
authors.forename: Mary
authors.initials: M
authors.lastname: Ehmann
authors.forename: Sarah
authors.initials: S
authors.lastname: Altman
authors.forename: Amanda
authors.initials: A
authors.lastname: Lucas
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D015746:Abdominal Pain / Q000523:psychology*; D000293:Adolescent; D017668:Age of Onset; D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology; D003866:Depressive Disorder / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012008:Recurrence