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Do Childhood Adversity and Recent Social Stress Predict Health Care Use in Patients Presenting With Upper Abdominal or Chest Pain?

School of Psychiatry and Behavioural Sciences (A-M B., B.T., F.C.), Rawnsley Building, Manchester Royal Infirmary, Manchester, UK and Department of Gastroenterology (Q.A.), Clinical Sciences Building, Hope Hospital, Salford, UK.

Address for correspondence Dr. Anne-Marie Biggs, Unit of Chronic Disease Epidemiology, The Medical School, University of Manchester, Oxford Road, Manchester, M13 9PT. E-mail: Anne-Marie.Biggs{at}man.ac.uk

OBJECTIVE: A comprehensive model of health care use by patients with functional gastrointestinal disorders has not been fully tested. This study aimed to establish whether reported childhood and/or recent adversity are independent predictors of health care use when all other relevant factors are also included in the model.

MATERIALS AND METHODS: Consecutive new patients with upper abdominal or chest pain presenting to a secondary/tertiary clinic were assessed using the Childhood Experience of Care and Abuse and Life Events and Difficulties Schedules. They completed the Hospital Anxiety and Depression and Health Anxiety Questionnaires. Outcome was total number of health care visits recorded in hospital and general practice (GP) records over 18 months.

RESULTS: One hundred fifty-one patients were included (65% response rate). Health care visits were most frequent in unmarried (p < 0.0005), females (p < 0.0005), and those lacking social support (p = 0.012). In multiple regression analysis to predict number of health care visits, reported sexual abuse (p = 0.042) and death of a sibling during childhood (p = 0.026) were also independent predictors, together with SF36 subscale scores for physical function, health perception, and mental health (35% of variance explained). Childhood adversity predicted health care use in patients with functional gastrointestinal disorders and recent social stress did so in patients with demonstrated pathological findings.

CONCLUSION: After adjustment for demographic, physical, and psychological factors, childhood adversity, especially in severe form, is an independent predictor of health care use in patients with upper functional gastrointestinal disorders. The same was not true for patients consulting for demonstrable pathological abnormalities, for whom ongoing social stress was an independent predictor.

Key Words: health care use, • childhood adversity, • recent life adversity, • functional dyspepsia, • noncardiac chest pain, • gastroesophageal reflux disease, • ischemic heart disease.

Abbreviations: GERD = gastroesophageal reflux disease;; IHD = ischemic heart disease;; FD = functional dyspepsia;; NCCP = noncardiac chest pain.

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