title: Predictors of abdominal pain in depressed pediatric inflammatory bowel disease patients.
abstract: BACKGROUND
  Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD and (2) determine predictors of abdominal pain in Crohn's disease (CD) and ulcerative colitis (UC).
  
  
  METHODS
  Seven hundred sixty-five patients aged 9 to 17 years with IBD seen over 3 years at 2 sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms.
  
  
  RESULTS
  Two hundred seventeen patients with IBD (161 CD, 56 UC) were depressed. One hundred sixty-three (120 CD, 43 UC) patients had complete abdominal pain index scores. In CD, abdominal pain was associated with depression (r = 0.33; P < 0.001), diarrhea (r = 0.34; P = 0.001), erythrocyte sedimentation rate (r = 0.22; P = 0.02), low albumin (r = 0.24; P = 0.01), weight loss (r = 0.33; P = 0.001), and abdominal tenderness (r = 0.38, P = 0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (P = 0.03), weight loss (P = 0.04), and abdominal tenderness (P = 0.01) predicted pain for patients with CD. In UC, pain was associated with depression (r = 0.46; P = 0.002) and nocturnal stools (r = 0.32; P = 0.046). In the multivariate model with these significant correlates, 23% of the variance was explained and only depression (P = 0.02) predicted pain.
  
  
  CONCLUSIONS
  The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications.
authors.affiliation: *Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Pediatric Gastroenterology, Boston Children's Hospital, Boston, Massachusetts; Departments of ‡Psychiatry, and §Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ‖Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and ¶Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Arvind I
authors.initials: AI
authors.lastname: Srinath
authors.forename: Alka
authors.initials: A
authors.lastname: Goyal
authors.forename: Lori A
authors.initials: LA
authors.lastname: Zimmerman
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Newara
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Kirshner
authors.forename: Francis Nicole
authors.initials: FN
authors.lastname: McCarthy
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: David
authors.initials: D
authors.lastname: Binion
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: David R
authors.initials: DR
authors.lastname: DeMaso
authors.forename: Ada
authors.initials: A
authors.lastname: Youk
authors.forename: Eva M
authors.initials: EM
authors.lastname: Szigethy
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D001007:Anxiety / Q000150:complications* / Q000523:psychology; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications / Q000523:psychology*; D003424:Crohn Disease / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011795:Surveys and Questionnaires; D015431:Weight Loss