title: Psychological maladjustment and quality of life in adolescents with constipation.
abstract: OBJECTIVE
  To assess psychological maladjustment in adolescents with functional constipation.
  
  
  METHODS
  We conducted a cross-sectional survey in five schools. Adolescents aged between 13 and 18 years were included in the study. Validated questionnaires were used to collect bowel habits and demographic data, health-related quality of life (HRQoL) and psychological maladjustment. Rome III criteria were used to diagnose constipation.
  
  
  RESULTS
  1697 adolescents were recruited (boys 779 (45.9%), mean age 15.06 years and SD 1.6 years). Prevalence of constipation was 6.7%, of whom 52 were boys (45.6%) and 62 were girls (54.4%). 38 adolescents (33.3%) with constipation and 230 controls (14.5%) had significant psychological maladjustment. Among seven different personality dimensions used to assess psychological maladjustment, children with constipation had significantly more deficits than controls in hostility and aggression (14.2 vs 12.6 in controls (mean difference 1.54, 95% CI (0.89 to 2.19) p<0.001), negative self-esteem (12.0 vs 10.5 in controls, mean difference 1.54 95% CI (0.96 to 2.06) p<0.001), negative self-adequacy (11.9 vs 9.8 controls, mean difference 2.07 95% CI (1.46 to 2.67) p<0.001), emotional unresponsiveness (12.9 vs 11.5 controls, mean difference 1.44 95% CI (0.84 to 2.04) p<0.001), emotional instability (17.1 vs 15.6, mean difference 1.53 95% CI (0.86 to 2.2) p<0.001) and negative world view (12.1 vs 10.2 controls, mean difference 1.91 95% CI (1.24 to 2.59) p<0.001). The total HRQoL of adolescents with constipation was lower than controls (70.6 vs 79.0 mean difference 9.48 95% CI (1.4 to 6.7) p<0.05).
  
  
  CONCLUSIONS
  A significant proportion of children with constipation are suffering from psychological maladjustment.
authors.affiliation: Department of Paediatrics, District General Hospital Killinochchi, Kilinochchi, Sri Lanka.
authors.forename: Nishadi
authors.initials: N
authors.lastname: Ranasinghe
authors.affiliation: Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Niranga Manjuri
authors.initials: NM
authors.lastname: Devanarayana
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marc Alexander
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Psychosocial Department and Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Shaman
authors.initials: S
authors.lastname: Rajindrajith
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000374:Aggression; D016022:Case-Control Studies; D003248:Constipation / Q000503:physiopathology / Q000523:psychology*; D003672:Defecation / Q000502:physiology; D004644:Emotions; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000209:etiology*; D011788:Quality of Life; D012649:Self Concept; D013188:Sri Lanka
keywords: Adolescent Health; Gastroenterology