The Relationship between Parental Somatization, Symptom Perception and Functional Morbidity in Pediatric Asthma

Abstract

Background: Somatization is a factor in an individual's physical and psychological well-being (Craig, Cox, & Klein, 2002; Crane & Martin, 2004). Previous literature indicates an intergenerational transmission of somatization involving maternal modeling and reinforcement of illness behaviors (Marshall, Jones, Ramchandani, Stein, & Bass, 2007; Walker, Garber, & Greene, 1993). This study investigates the role of parent somatization, and the influence of parental modeling on child somatization, child vulnerability and asthma morbidity. The role of somatization was also examined in its relationship to symptom perception in asthmatic children. Methods: One hundred and thirteen pediatric asthma patients aged 7-15 and their primary caregivers were recruited from outpatient clinics in hospital settings in Bronx, New York. Primary caregivers completed the Patient Health Questionnaire-15 (PHQ-15), a self-report measure of somatization, the Child Vulnerability Scale (CVS), an 8-item measure of perceived vulnerability to medical illness in the child, and the Asthma Functional Severity Scale (AFSS) a measure of asthma-related functional morbidity in the past month. The Children's Somatization Inventory (CSI), a 35-item questionnaire that assesses children's nonspecific somatic complaints during the past two weeks, was completed by the parent (P-CSI) and the child (C-CSI). Families were trained on how to monitor their children's asthma symptom perception by use of an electronic peak flow meter (AM2), which they were given to use twice daily for 5 weeks. Data from this device were used to measure the child's asthma symptom perception. The symptom perception methodology involved comparisons between recorded lung function and lung function as estimated by the child. The Asthma Risk Grid was used to determine three categories: accurate perception, over perception or under perception. Results: After controlling for child gender, parents who reported higher somatization scores were more likely to report their children as having higher somatization scores [F (2, 110) = 17.50, p < .01]. Additionally, parents who reported higher somatization scores were significantly more likely to have children who self-reported higher somatization scores [F (2, 110) = 3.44, p < .05]. After controlling for child age, parents reporting higher somatization were more likely to perceive their children as more vulnerable to medical illness [F (2, 111) = 7.28, p < .01]. Greater parental somatization scores were also significantly related to higher levels of functional asthma morbidity [F (2, 110) = 7.82, p < .01]. No between group differences were found in child somatization (parent and child report) according to ethnicity [F (2, 107) = 1.17, p = .32]. Parent somatization scores were not predictive of children's asthma symptom perception and there were no between group differences on symptom perception according to ethnicity. Conclusion: Parent somatization was strongly associated with greater child somatization (self-report and parent-report), as well as higher levels of asthma morbidity and greater perceived child vulnerability to medical illness. Parent somatization did not vary significantly according to ethnicity, nor was it predictive of symptom perception (accurate perception, over perception or under perception). The results from the present study highlight the potential role of social modeling of somatization within families and its impact on asthma outcomes for children.