Non-Specific Abdominal Pain as an Early Marker of Internalizing Distress: Gender Differences and Adolescent Mental Health

Sammanfattning

Non-specific abdominal pain (NSAP) is a common somatic pain expression in children and has been associated with later mental health problems, such as anxiety and depression, with females consistently showing a higher prevalence compared to males. The present study sought to investigate whether internalization of emotional distress could represent an underlying psychological mechanism of these observations, using NSAP as a proxy for internalization processes, and whether internalization, understood through gendered socialization, may help explain the observed sex differences. Data were drawn from several Swedish population-based registries with national coverage, including an almost nationwide primary health care dataset. In total, 531,029 individuals, born 1995-2000, were included. The longitudinal associations between childhood NSAP and adolescent anxiety and depression were examined using Cox proportional hazards regression models, adjusting for sex, birth year, and socioeconomic status (SES). Children with NSAP had a 45% higher risk of developing anxiety and a 42% higher risk of developing depression during adolescence compared to children without NSAP. A dose–response pattern was observed, with a 16% increase in the risk of anxiety and a 13% increase in the risk of depression for each additional NSAP diagnosis during childhood. No significant interaction between NSAP and sex was found, although descriptive data showed a higher prevalence of NSAP and mental health outcomes among females. These findings suggest that somatic pain, such as NSAP, may function as an early marker of emotional distress in childhood among both females and males, highlighting the importance of early screening for mental health problems.