Bedree, H., Tran, S. T., Fortunato, J., Koven, M., Wershil, S. J., & Essner, B. S. (2022, April). A point of intervention: The role of mood in explaining the relationships among sleep and critical gastrointestinal symptoms among youth with GI disorders. Poster presentation at the Society of Pediatric Psychology, Phoenix, AZ.
A point of intervention: Depressive symptoms mediate the relationships among sleep and gastrointestinal symptoms in youth with disorders of gut-brain interaction
Helen Bedree, MA; Susan T. Tran, PhD, DePaul University, Department of Psychology; John Fortunato, PhD, Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Marissa Koven, MA, DePaul University, Department of Psychology; Sarah Jae Wershil, George Washington University; Bonnie Essner, PhD, Ann & Robert H Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
Introduction: Sleep problems among youth with chronic abdominal pain and adults with disorders of gut-brain interaction (DGBIs) are linked with worsening of symptoms, including pain. Further, mood plays an integral role; depressive symptoms often co-occur with both sleep impairment and chronic gastrointestinal (GI) disorders and emerging evidence indicates that mood mediates the sleep-pain relation in adolescents with chronic pain. However, studies have yet to explore the probable impact of sleep on the myriad other GI-specific symptoms (e.g., nausea), extra-GI symptoms (e.g., fatigue), and functional disability that typifies the experience of pediatric patients with complex DGBIs. The current study aimed to examine: 1) relationships between sleep and pain intensity, pain interference, nausea, and fatigue; and 2) the potential mediating role of depressive symptoms in these associations.
Methods: 174 patients aged 8-18 years (Mage= 13.98, SD = 3.22; 67.35/30.61% female/male, respectively); 80.95% White/non-Hispanic), recruited at a tertiary-care pediatric motility clinic, completed measures of sleep disturbance (Pediatric Sleep Disturbance-Short Form 4a), nausea (Nausea Profile), and pain and depressive symptoms (Pediatric PROMIS-25 Profile v 2.0). Using PROCESS macro, the indirect effect was tested with 10,000 samples bootstrapping estimation procedures in four mediation models. Each model examined the predictive effect of sleep disturbance on nausea, fatigue, pain interference, and pain, with depressive symptoms entered as a potential mediator.
Results: On average, participants reported moderate sleep disturbance (T-score M = 60.32, SD = 9.37). Mediation analyses revealed that depressive symptoms partially mediated the significant, respective relationships between sleep disruption and greater nausea (indirect effect B = 0.22, SE = 0.09, 95%CI[0.04, 0.41]), fatigue (indirect effect B = 0.12, SE = 0.05, 95%CI[0.02, 0.24]), and pain-specific functional disability (indirect effectB = 0.05, SE = 0.03, 95%CI[0.01, 0.11]). The model between sleep quality and nausea had the greatest proportion of mediation by depression (26.74%), followed by fatigue (23.40%), and pain interference (7.96%). Sleep was significantly associated with pain intensity but depressive symptoms did not mediate this relationship (indirect effect B = 0.01, SE = 0.01, 95%CI[-0.0005, 0.02]).
Conclusions: Youth with complex DGBIs report moderately low sleep quality, which worsens GI and extra-GI symptoms like pain-related disability. Given that elevated depressive symptoms partially explain these relationships, addressing depressive symptoms in treatment may be another point of intervention to treat somatic symptoms and reduce functional disability. Future research should explore these relationships with objective sleep assessments.