Original article
Stressor, perceived stress and recurrent pain in Swedish schoolchildren

https://doi.org/10.1016/j.jpsychores.2008.07.004Get rights and content

Abstract

Objective

Stress is an important etiological factor for pain. Little is known, however, about how this process is mediated. The aim of this study is to highlight how more stress corresponds with the amount of reported perceived stress, pain symptom, and the co-occurrence of two pain symptoms— headache and abdominal pain—and how these three phenomena are related. We have also studied possible gender differences.

Methods

A cross-sectional study based on data from child supplements linked to national household surveys in Sweden during 2002–2003. Information concerning harassment, perceived stress, headache, and abdominal pain was gathered from a questionnaire. The study population consisted of a representative national sample of 2597 children aged 10–18 years.

Results

Children's reports of exposure to the stressor harassment were associated with their subjective perception of stress and recurrent pain in a stepwise manner. Having both pain symptoms was more strongly associated with the stressor harassment and perceived stress than having only one pain symptom. This was especially true of girls, who reported higher levels of stress symptoms and who had a different profile of pain symptoms than boys.

Conclusions

The stressor harassment, perceived stress, and recurrent pain are associated with each other in a stepwise fashion. The co-occurrence of headache and abdominal pain is much more closely associated with harassment and perceived stress than any of these symptoms separately, especially in girls.

Introduction

Recurrent pain is a common symptom in childhood [1], [2], [3], [4]. Abdominal pain and headache are the two most common recurrent pains. They often occur in the same child as already observed by Moro [5] in 1913 and, again, by Apley [6] in the 1950s. The co-occurrence of these pain symptoms was statistically verified for the first time by Alfvén [7] and later corroborated by Petersen et al. [8]. Other locations of recurrent pain, such as back and limb pain, are often seen in this type of patient as well [9].

Clinical observations and empirical studies have indicated that exposure to stressors is a major risk factor for recurrent pain [4], [10], [11], [12], [13]. In the lives of children, troubled relations with peers has been identified as an important stressor [14]. It has also been shown that among the potential stressors present in the school environment, harassment by peers is especially strongly associated with recurrent pain [15].

While a stressor induces a stress reaction, outside consciousness [16], [17], this reaction may be made conscious, and a perception of stress is felt [18]. Simultaneously, the body reacts in stress and sometimes also with pain in different parts of the body [18], [19]. Although little is known about the process per se in which a stressor induces pain [16], it seems probable that children's experiences of harassments may be linked with both their perception of stress and occurrence and co-occurrence of pain.

In this study, we used data from a representative national sample of schoolchildren to study how a well-known stressor, harassment, is associated with the perception of stress and recurrent pain. Is an increasing level of exposure to harassment associated with an increased perception of stress and an increased frequency and locations of pain? Is any association between stressor, perceived stress, and recurrent pain modified by gender?

Section snippets

Methods

The data concerning stressor, perceived stress, and pain are derived from the child supplement linked to the Swedish Survey of Living Conditions conducted in 2002 and 2003 [20]. The surveys consist of representative national samples of one in a thousand of the Swedish population aged 16-84. Personal interviews, conducted by professional interviewers at Statistics Sweden, were done in the respondent's home to collect information about the individual's living conditions in a broad sense. The

Occurrence of harassment, perceived stress, and pain

Having been subjected to harassment at least once a week was reported by 11.9% of the study population, with boys in Grades 3–6 reporting the highest prevalence (18.1%). Having felt stressed at least once a week was reported by 44.4% of the total study population, with girls in senior high school reporting the highest prevalence (70.9%) (see Table 1).

Headache at least once a week was reported by 29.1% of the study population, with girls in Grades 7–9 reporting the highest prevalence (41.8%) and

Discussion

In this large and nationally representative study population of Swedish school children, we have shown that increased exposure to a stressor, harassment, is associated with a gradual increase in the perception of stress and the prevalence of recurrent headache and abdominal pain. We have also shown that more stressor is followed by an increase of headache and abdominal pain. This gradient is clearly visible when focusing on children with co-occurrence. This is especially the case among girls.

Acknowledgments

The authors thank The Swedish Research Council, The Swedish Council for Working Life and Social Research, and FRF Foundation for financial support; Statistician Göran Granath for help with some of the multivariate analysis; and Isaac Austin for English checking.

References (26)

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    The child with abdominal pains

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    The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study

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