Symptom Clusters among Young Adolescents
Knishkowy, Barry, Palti, Hava, Tima, Charles, Adler, Bella, Gofin, Rosa, Adolescence
Recurrent symptoms for which no organic etiology can be found are common among adolescents. Headache, chest and abdominal pain, and chronic fatigue are some of the more frequently reported functional or "psychosomatic" symptoms (Smith, 1990). Their appearance may be an expression of depression (Carlson & Cantwell, 1980), poor psychosocial adjustment, or may be a reaction to negative life events (Robinson, Greene, & Walker, 1988). These complaints pose a challenge to the clinician, who must not only be able to exclude an organic etiology, but determine whether psychosocial stress underlies the symptom and then formulate an appropriate treatment plan.
Adolescents who complain of more than one recurring or chronic symptom may constitute a special subgroup of these individuals. Such "symptom clustering" may be even more suggestive of a psychosocial diagnosis, and decrease the likelihood that extensive medical evaluation of any specific symptom will be fruitful. The current study describes the occurrence of symptom clusters in a population of young adolescents.
The study population consisted of 279 students in the 5th and 6th grades of two West Jerusalem elementary schools during the 1988-1989 academic year. Of these, 259 (92.8%) completed the study questionnaire. Demographic data had been omitted in one case, and the other 20 students either were absent, refused to participate, or had moved to a different school since the beginning of the year.
Sociodemographic data for each pupil were obtained from school health records. There were 140 (54.3%) boys and 118 (45.7%) girls. The mean age was 11.5 years (SD = 0.7), with 124 (48.1%) in the 5th grade and 134 (51.9%) in the 6th grade. Seventy-two (27.9%) of the childrens' mothers had 0-10 years of education, 102 (39.5%) had 11-12 years, and 84 (32.6%) had 13 or more years. All of the students were Jewish, 65 (25.2%) of whose mothers were born in Asia or Africa, 43 (16.7%) in Europe, the U.S. or South Africa, and 150 (58.1%) in Israel.
A self-administered questionnaire approved by the city's Department of Education was completed by the subjects in May, 1989. The students were asked about the frequency during the past year of various symptoms according to a three-point rating scale, the response options being "never," "once or sometimes," and "often" - without quantitative specification. With the exception of dizziness/fainting and sleep problems, symptoms reported "often" by fewer than 4% of the subjects (five symptoms) were not included in the analysis.
The symptom list was divided for analysis into eight psychosomatic complaints (abdominal pain, back or limb pain, bad mood, chest pain, dizziness or fainting, headache, sleep problems, and tiredness) and eight organic complaints (asthma or breathing problems, cough, diarrhea, ear or hearing problems, eye or vision problems, rashes or other skin problems, runny or stuffed nose, and vomiting). The purpose of this division was to determine whether any differences found among the demographic groups would be true for symptom prevalence in general, or specifically for symptoms which are more likely to be considered psychosomatic. Each of the psychosomatic symptoms has been defined as such in previous works (Belmaker, 1984; Smith, 1990; Starfield et al., 1980), with the exception of "bad mood," which was included in this category because of the relationship between depression and these other symptoms. Classifying several of the symptoms as either psychosomatic or organic was not always clear-cut; for example, asthma may be considered a psychosomatic diagnosis. We have attempted to include complaints that are highly likely to have no demonstrable organic basis in the psychosomatic group, and the remainder in the organic group.
The association between symptom prevalence and sociodemographic variables was tested by cross-tabulation and chi-square analysis. …