Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: a case-control study.
OBJECTIVE
To explore association between medically unexplained symptoms in children in Pakistan with emotional difficulties and functional impairments.


METHODS
We conducted a matched three-group case-control study of 186 children aged 8-16 years in Lahore, Pakistan. Cases were 62 children with chronic somatic symptoms for which no organic cause was identified after investigations. Two control groups of 62 children with chronic medical paediatric conditions, and 62 healthy children were identified. Cases and controls were matched for gender, age, and school class. Somatisation was measured with the Children's Somatisation Inventory (CSI-24) while anxiety and depression were measured with the Spencer Children's Anxiety Scale and the Short Mood and Feelings Questionnaire respectively. All questionnaires were translated into Urdu.


RESULTS
Mean age was 11.7 years (SD=2.1). Cases scored significantly higher on somatisation (CSI-24), anxiety and depression than both control groups. Paediatric controls scored significantly higher than healthy controls on all three measures. Two hierarchical linear regression models were used to explore if somatisation predicted depression and anxiety while controlling for several confounders. Somatisation (higher CSI-24 scores) independently and significantly predicted higher anxiety (β=.37, p=.0001) and depression (β=.41, p=.0001) scores.


CONCLUSIONS
This is the first study to show an association between medically unexplained symptoms and anxiety and depression in Pakistani children. This highlights the importance of screening for emotional difficulties in children presenting with unexplained somatic symptoms in this region.
Child & Family Psychiatry Department, King Edward Medical University/Mayo Hospital, Lahore, Pakistan. Electronic address: nazishimrandr@gmail.com.
Nazish
N
Imran
Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary's Hospital, Paddington, London, UK; Consultant Child and Adolescent Psychiatrist, Bracknell CAMHS, Berkshire Healthcare NHS Foundation Trust, Berkshire, UK. Electronic address: c.ani@imperial.ac.uk.
Cornelius
C
Ani
Department of Clinical Psychology, University of Management and Technology, Lahore, Pakistan. Electronic address: zmahm54084@aol.com.
Zahid
Z
Mahmood
Department of Paediatrics, Paediatrics Unit II, King Edward Medical University/Mayo Hospital, Lahore, Pakistan. Electronic address: dramjadkh@gmail.com.
Khawaja Amjad
KA
Hassan
Department of Psychiatry& Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan. Electronic address: profmrbhatti@hotmail.com.
Muhammad Riaz
MR
Bhatti
D000041:Absenteeism; D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology*; D016022:Case-Control Studies; D015984:Causality; D002648:Child; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010154:Pakistan / Q000453:epidemiology; D010555:Personality Inventory; D011159:Population Surveillance; D012044:Regression Analysis; D013001:Somatoform Disorders / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires
Anxiety; Children; Depression; Functional disability; Psychopathology; Somatisation