In a recent study published in the JAMA Network Open, a group of researchers investigated the prevalence and severity of somatic symptoms among children and adolescents who have experienced traumatic events in France.
Study: Somatic and Posttraumatic Stress Symptoms in Children and Adolescents in France. Image Credit: Jan H Andersen / Shutterstock
Background
Somatic symptoms include a variety of physical complaints, such as gastrointestinal issues, body pain, cardiopulmonary disturbances, and fatigue, leading to significant functional impairment and emotional distress, often without a precise medical diagnosis. These symptoms are prevalent in 10% to 25% of adults, with higher occurrences in specialized medical settings and among at-risk groups like Latinx immigrants. There is a strong link between adverse childhood experiences (ACEs) and the development of somatic symptoms, which are associated with chronic physical and mental health problems, including posttraumatic stress disorder (PTSD). These symptoms show gender differences that intensify in adolescence. Further research is needed to better understand the mechanisms linking traumatic experiences to somatic symptoms in youth, enabling more targeted interventions and improved outcomes.
About the study
The present cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. It was conducted at the Nice Pediatric Psychotrauma Center (NPPC) in southern France. With ethical clearance from the National Ethics Committee NORTHWEST III and registration with ClinicalTrials.gov, this study forms part of a broader research program investigating the multifaceted associations of psychological trauma in children. Recruitment occurred throughout 2021, drawing participants from NPPC’s outpatient service. The center, known for its specialized, multidisciplinary approach to pediatric psycho-trauma, integrates expertise from a range of fields, including child psychiatry and psychology, neuropsychology, and pediatric nursing.
Participants in the study were children and adolescents aged 7 to 17 who had experienced at least one Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 defined traumatic event, with assessments carried out by qualified child psychologists or psychiatrists specializing in trauma. The children, alongside their parents, provided informed consent before participation. The assessment tools used included the Child PTSD Checklist (CPC) for evaluating exposure to traumatic events and the Patient Health Questionnaire (PHQ)-13 questionnaire, which measures the severity of 13 different somatic symptoms ranging from stomach and back pain to fatigue and dizziness. The PHQ-13 assesses symptom severity over the previous week using a Likert scale and has been adapted from the adult version, excluding items irrelevant to children.
Through comprehensive assessments, the research team sought to identify patterns of single versus multiple traumatic exposures and their impacts on somatic and PTSD symptoms. Statistical analyses were performed to explore these relationships, considering variables such as the number and intensity of somatic symptoms and PTSD symptom severity.
Study results
The study comprised 363 youths, with a nearly even gender distribution: 174 females (47.9%) and 189 males (52.1%). Participants ranged in age from 7 to 17 years, averaging 13.58 years. They were assessed for their exposure to potentially traumatic events, with 288 (79.3%) directly exposed, 36 (9.9%) indirectly exposed through a close relation, and 39 (10.7%) witnessing such events. The CPC identified 144 youths (39.7%) who met the criteria for PTSD.
Somatic symptoms were notably more frequent and intense among the PTSD group compared to their peers without PTSD. The most common traumatic events were man-made disasters, including the terrorist attack on July 14, 2016, affecting 200 youths (55.1%); witnessing an assault noted by 109 participants (30.0%); and hospitalization, experienced by 94 youths (25.9%).
The intensity of PTSS and associated functional impairments were quantitatively higher in the PTSD group, with average scores reflecting significant distress and disruption to daily functioning. In contrast, those in the non-PTSD group reported markedly lower levels of symptomatology and impairment.
A closer look at the somatic symptomatology revealed that the PTSD group experienced a higher mean intensity and a greater number of somatic complaints. The most significant correlations were between PTSS intensity and symptoms such as stomach pain and headaches, suggesting a direct linkage between trauma exposure and physical manifestations of stress.
Further analyses explored the impact of experiencing multiple traumatic events. Among participants with cumulative trauma exposures, those with multiple events reported higher levels of both somatic symptoms and overall symptom intensity. This group demonstrated a clear gradient, with increases in the number and severity of symptoms correlating with the number of traumatic events experienced. Lastly, the study’s multiple regression analysis, focusing on somatic symptoms significantly associated with PTSD, revealed that these symptoms could account for 6.5% of the variance in PTSS severity.
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