title: Attachment and adjustment in adolescents and young adults with a history of pediatric functional abdominal pain.
abstract: OBJECTIVE
  This study tested predictions of the Attachment-Diathesis Model (ADM) of Chronic Pain in a cross-sectional sample of adolescents and young adults with a history of childhood functional abdominal pain (FAP). ADM posits that attachment anxiety is a diathesis for poor adjustment (physical health, mental health, and functioning) in the context of chronic pain and that pain self-efficacy, pain threat appraisal, and passive coping mediate this effect.
  
  
  METHODS
  Participants (N=261) were recruited from a database of consecutive new patients evaluated for abdominal pain at a pediatric gastroenterology clinic. Participants' mean age at the follow-up assessment was 21 years. Structural equation modeling was used to test the fit of our conceptual model to the data.
  
  
  RESULTS
  Model fit was good (comparative fit index=0.971, the Tucker-Lewis index=0.940, root mean square error of approximation=0.067). Attachment anxiety significantly predicted poorer health in both the mental and physical domains. Model fit was consistent with our hypothesis that pain self-efficacy mediates the effect of attachment anxiety on passive coping and that passive coping, in turn, mediates the effect of pain self-efficacy and pain threat appraisal on mental and physical health.
  
  
  CONCLUSIONS
  Among individuals with a childhood history of FAP, those with anxious attachment may be at higher risk for poor physical and mental health. Pain beliefs and coping may mediate the relation between anxious attachment and health outcomes and may serve as effective targets for intervention in chronic pain.
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, TN.
authors.forename: Kelsey T
authors.initials: KT
authors.lastname: Laird
authors.forename: Kristopher J
authors.initials: KJ
authors.lastname: Preacher
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Walker
mesh_terms: D015746:Abdominal Pain / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007206:Individuality; D008297:Male; D008960:Models, Psychological; D010287:Parent-Child Relations; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D055815:Young Adult
references.citation: J Dev Behav Pediatr. 1998 Feb;19(1):45-53
references.pmid: 9524306
references.citation: Pain. 2003 Dec;106(3):337-345
references.pmid: 14659516
references.citation: Pain. 2011 Apr;152(4):802-808
references.pmid: 21282006
references.citation: Child Dev. 2000 May-Jun;71(3):684-9
references.pmid: 10953934
references.citation: Pain. 2010 Apr;149(1):57-63
references.pmid: 20122805
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: Pain. 2004 Apr;108(3):221-229
references.pmid: 15030941
references.citation: J Health Soc Behav. 1980 Sep;21(3):219-39
references.pmid: 7410799
references.citation: J Pediatr Gastroenterol Nutr. 2008 Sep;47(3):309-15
references.pmid: 18728527
references.citation: Behav Res Ther. 2000 Sep;38(9):863-73
references.pmid: 10957821
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2002 Feb;37(2):50-9
references.pmid: 11931088
references.citation: Fam Pract. 2000 Apr;17(2):108-13
references.pmid: 10758070
references.citation: Pain. 2000 Apr;85(3):317-332
references.pmid: 10781906
references.citation: J Behav Med. 2000 Aug;23(4):351-65
references.pmid: 10984864
references.citation: Psychosomatics. 1982 Apr;23(4):413-25
references.pmid: 7079441
references.citation: J Trauma Stress. 2012 Dec;25(6):633-40
references.pmid: 23129288
references.citation: Psychosom Med. 2002 Jul-Aug;64(4):660-7
references.pmid: 12140356
references.citation: Fam Community Health. 2003 Apr-Jun;26(2):147-56
references.pmid: 12802120
references.citation: J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):162-5
references.pmid: 21150653
references.citation: Psychol Sci. 2013 Mar 1;24(3):272-9
references.pmid: 23307944
references.citation: J Dev Behav Pediatr. 2011 Feb-Mar;32(2):153-7
references.pmid: 21200331
references.citation: Pain. 2007 Apr;128(3):195-198
references.pmid: 17321050
references.citation: Pain. 2006 Jul;123(1-2):146-54
references.pmid: 16644132
references.citation: Curr Pain Headache Rep. 2012 Apr;16(2):133-8
references.pmid: 22274663
references.citation: Med Care. 1994 Jan;32(1):40-66
references.pmid: 8277801
references.citation: Child Dev. 2000 May-Jun;71(3):690-4
references.pmid: 10953935
references.citation: Clin Psychol Rev. 2008 Mar;28(3):407-29
references.pmid: 17719157
references.citation: Gastroenterol Nurs. 2006 Jan-Feb;29(1):50-5; quiz 56-7
references.pmid: 16552300
references.citation: Psychol Bull. 2007 Jul;133(4):581-624
references.pmid: 17592957
references.citation: Pain. 2010 Sep;150(3):568-572
references.pmid: 20615615
references.citation: Aliment Pharmacol Ther. 2003 Apr 1;17(7):871-80
references.pmid: 12656689
references.citation: Pain. 2008 Jul 15;137(2):266-275
references.pmid: 17928144
references.citation: Pain. 2006 Jan;120(1-2):44-52
references.pmid: 16359795
references.citation: Health Psychol. 1994 Jul;13(4):334-45
references.pmid: 7957012
references.citation: J Pediatr Psychol. 2013 May;38(4):365-75
references.pmid: 23335355
references.citation: Psychol Psychother. 2002 Sep;75(Pt 3):313-32
references.pmid: 12396756
references.citation: Pain. 2012 Sep;153(9):1798-1806
references.pmid: 22721910
references.citation: Health Psychol. 2013 Apr;32(4):409-17
references.pmid: 22823067
references.citation: Health Psychol. 2005 Jul;24(4):364-74
references.pmid: 16045372
references.citation: Qual Life Res. 1994 Feb;3(1):7-12
references.pmid: 8142947
references.citation: Ann Intern Med. 1995 Jan 15;122(2):107-12
references.pmid: 7992984
references.citation: Pain Med. 2010 Nov;11(11):1688-97
references.pmid: 21044259
references.citation: Biol Psychol. 2013 Feb;92(2):353-8
references.pmid: 23073362
references.citation: J Fam Pract. 2000 Sep;49(9):796-804
references.pmid: 11032203
references.citation: Am J Gastroenterol. 2010 Apr;105(4):946-56
references.pmid: 20216531
references.citation: J Pers Soc Psychol. 2000 Feb;78(2):350-65
references.pmid: 10707340
references.citation: J Pediatr Gastroenterol Nutr. 2002 Nov;35(5):663-8
references.pmid: 12454583
references.citation: J Consult Clin Psychol. 2001 Feb;69(1):85-91
references.pmid: 11302281
references.citation: J Behav Med. 2013 Jun;36(3):246-58
references.pmid: 22476813
references.citation: Pain. 2005 Sep;117(1-2):51-7
references.pmid: 16043291
references.citation: J Pain. 2010 Feb;11(2):160-71
references.pmid: 19853522
references.citation: Pain. 1999 Mar;80(1-2):425-35
references.pmid: 10204758
references.citation: Pain. 2009 Jun;143(3):200-205
references.pmid: 19345016
references.citation: Gastroenterology. 2006 Apr;130(5):1377-90
references.pmid: 16678553
references.citation: Pain. 2003 Aug;104(3):627-637
references.pmid: 12927635
references.citation: Br J Gen Pract. 2006 May;56(526):334-41
references.pmid: 16638248
references.citation: Clin J Pain. 2000 Dec;16(4):360-4
references.pmid: 11153794