The goal of this project is to identify psychosocial factors and social- cognitive processes associated with the development and maintenance of children's illness behavior (i.e., somatic complaints, functional disability, health service utilization). We focus particularly on levels of illness behavior that appear to be out of proportion to medical findings. This program of research is guided by a conceptual model of stress and coping, in which we hypothesize that the extent of illness behavior exhibited by a child is influenced by (1) the nature of illness behavior in that child's family, such as the level of parent somatic complaints, functional disability, and strategies for coping with pain, (2) that child's recent experience of negative life events, and (3) that child's current level of competence and perceived achievement pressure in important childhood roles, particularly those associated with school. These effects are hypothesized to be mediated by the child's pattern of appraisal and coping with stressors in relevant domains, that is, pain and school.
Our first aim i s to test the utility of this conceptual model in explaining variation in the levels of illness behavior exhibited by pediatric patients with abdominal pain at an initial clinic visit and at a one-year follow-up. In our work thus far we have found that levels of parent illness behavior are positively correlated with levels of child illness behavior, and that high levels of negative life events in interaction with low school competence predict maintenance of illness behavior one year following an initial clinic visit. Study 1 of the proposed project entails recruitment of a cohort of 200 pediatric abdominal pain patients to test the hypothesis that these effects are mediated by the child's patterns of appraisal and coping with pain and school stressors.
Our second aim i s to assess long-term outcomes for pediatric patients with medically unexplained recurrent abdominal pain (RAP) and to evaluate the influence of negative life events and school/work competence on maintenance of illness behavior five year following the initial interview.
This aim builds on our finding that RAP patients exhibit persistently higher levels of illness behavior than well children, psychiatric patients, and patients with medically explained abdominal pain, and thus represent a unique group regarding childhood illness behavior. Study 2 of the proposed project entails a five-year follow-up of 274 subjects who were originally interviewed in 1988-90 and were followed one year later with a 98% retention rate in order to test the hypotheses that (1) former RAP patients will exhibit higher levels of illness behavior than those who were well or who had organic disease at the initial interview, and (2) the interaction of higher levels of recent negative life events with lower levels of school/work competence will explain significant variance in illness behavior during adolescence and early adulthood beyond that accounted for by early levels of illness behavior.
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