Association between recurrent abdominal pain in sri lankan school children and exposure to stressful life events

Abstract

BACKGROUND: Approximately one tenth of school children around the world suffer from recurrent abdominal pain (RAP). It is found to be significantly higher among children exposed to emotional stress. Patients can sometimes date the onset of pain to a specific stressful event, such as change of school, birth of a sibling or separation of parents. OBJECTIVE: To study the association between RAP and exposure to stressful life events in Sri Lankan school children. DESIGN, SELLING AND METHOD: The study was across-sectional survey among a randomly selected group of school children in the Gampaha District of Sri Lanka. Information regarding demographic features and exposure to stressful events was obtained using a parental questionnaire. Diagnosis of RAP was done using Apley criteria: "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than three months". RESULTS: Eight hundred and ten questionnaires were distributed and 734 (90.6%) were returned [342 (46.6%) males, age range 5-15 years (mean 10.5 years, SD 2.7 years)]. Seventy seven (10.5%) had RAP (9.6% in males, 11.2% in females) and 657 children without RAP served as controls. Fifty five (71.4%) with RAP were exposed to stressful events compared to 274 fe.7%) controls (P<0.0001). After univariate analysis following stressful events were significantly higher in children with RAP compared to controls: change of school, being bullied at school, change in address, severe illness in a close family member, frequent punishment by parents, divorce or separation of parents and domestic fights (p<0.01). Sibling rivalry, monthly income, father's alcoholism and maternal employment were not associated with the condition (p>0.05) CONCLUSIONS: RAP was significantly high among Sri Lankan school children who were exposed to stressful life events. Several family and school related stressful events were associated with the condition.