Skip to main content Accessibility help

Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample

  • L. Shanahan (a1), N. Zucker (a2), W. E. Copeland (a2) (a3), C. L. Bondy (a1), H. L. Egger (a2) and E. J. Costello (a2)...



Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood – and to which specific disorders – has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity.


The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4–7 times between ages 9–16 years. They were assessed again up to three times between ages 19–26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9–16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment.


Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders.


Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.


Corresponding author

* Address for correspondence: L. Shanahan, Ph.D., Department of Psychology, University of North Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA. (Email:


Hide All
APA (2000). Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition Text Revision. American Psychiatric Press: Washington, DC.
Angold, A, Costello, EJ (1995). A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychological Medicine 25, 755762.
Angold, A, Costello, EJ (2000). The Child and Adolescent Psychiatric Assessment (CAPA). Journal of the American Academy of Child and Adolescent Psychiatry 39, 3948.
Angold, A, Costello, EJ, Worthman, CM (1999 a). Pubertal changes in hormone levels and depression in girls. Psychological Medicine 29, 10431053.
Angold, A, Cox, A, Prendergast, M, Rutter, M, Simonoff, E, Costello, EJ, Ascher, BH (1999 b). The Young Adult Psychiatric Assessment (YAPA). Duke University Medical Center: Durham, NC.
Angold, A, Prendergast, M, Cox, A, Harrington, R, Simonoff, E, Rutter, M (1995). The Child and Adolescent Psychiatric Assessment (CAPA). Psychological Medicine 25, 739753.
Ascher, BH, Farmer, EMZ, Burns, BJ, Angold, A (1996). The Child and Adolescent Services Assessment (CASA): description and psychometrics. Journal of Emotional and Behavioral Disorders 4, 1220.
Beck, JE, Lipani, TA, Baber, KF, Dufton, L, Garber, J, Smith, CA, Walker, LS (2011). Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth before and after performance evaluation. Pain 152, 10611067.
Campo, JV, Di Lorenzo, C, Chiappetta, L, Bridge, J, Colborn, DK, Gartner, JCJ, Gaffney, P, Kocoshis, S, Brent, D (2001). Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it? Pediatrics 108, E1.
Campo, JV, Fritsch, SL (1994). Somatization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 33, 12231235.
Clark, LA, Watson, D (2006). Distress and fear disorders: an alternative empirically based taxonomy of the ‘mood’ and ‘anxiety’ disorders. British Journal of Psychiatry 189, 481483.
Collins, PY, Patel, V, Joestl, SS, March, D, Insel, TR, Daar, AS, Scientific Advisory Board and the Executive Committee of the Grand Challenges on Global Mental Health (2011). Grand challenges in global mental health. Nature 475, 2730.
Copeland, WE, Angold, A, Shanahan, L, Costello, EJ (2014). Longitudinal patterns of anxiety from childhood to adulthood: The Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry 53, 2133.
Copeland, WE, Shanahan, L, Costello, EJ, Angold, A (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry 66, 764772.
Copeland, WE, Wolke, D, Angold, A, Costello, EJ (2013). Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. Journal of the American Medical Association: Psychiatry 70, 419426.
Costello, EJ, Angold, A, Burns, BJ, Stangl, DK, Tweed, DL, Erkanli, A, Worthman, CM (1996). The Great Smoky Mountains Study of Youth: goals, designs, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry 53, 11291136.
Costello, EJ, Compton, SN, Keeler, G, Angold, A (2003). Relationships between poverty and psychopathology: a natural experiment. Journal of the American Medical Association 290, 20232029.
Costello, EJ, He, JP, Sampson, NA, Kessler, RC, Merikangas, KR (2014). Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey – Adolescent Supplement. Psychiatric Services 65, 359366.
Dantzer, R, O'Connor, JC, Freund, GG, Johnson, RW, Kelley, KW (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews Neuroscience 9, 4656.
Dimsdale, JE, Dantzer, R (2007). A biological substrate for somatoform disorders: importance of pathophysiology. Psychosomatic Medicine 69, 850854.
Dinan, TG, Cryan, JF (2012). Regulation of the stress response by the gut microbiota: implications for Psychoneuroendocrinology. Psychoneuroendocrinology 37, 13691378.
Dufton, LM, Dunn, MJ, Compas, BE (2009). Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders. Journal of Pediatric Psychology 34, 176186.
Dunn, KM, Jordan, KP, Mancl, L, Drangsholt, MT, Le Resche, L (2011). Trajectories of pain in adolescents: a prospective cohort study. Pain 152, 6673.
Egger, HL, Angold, A, Costello, EJ (1998). Headaches and psychopathology in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 37, 951958.
Egger, HL, Angold, A, Costello, EJ (1999). Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains and headaches. Journal of the American Academy of Child and Adolescent Psychiatry 38, 852860.
Farmer, E, Burns, B, Phillips, S, Angold, A, Costello, EJ (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services 54, 6066.
Fearon, P, Hotopf, M (2001). Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study. British Medical Journal 322, 1145.
Garber, J, Walker, LS, Zeman, J (1991). Somatization symptoms in a community sample of children and adolescents: further validation of the children's somatization inventory. Psychological Assessment 3, 588595.
Garralda, ME (2011). Unexplained physical complaints. Pediatric Clinics of North America 58, 803813.
Green, JG, McLaughlin, KA, Alegría, M, Costello, EJ, Gruber, MJ, Hoagwood, K, Leaf, PJ, Olin, S, Sampson, NA, Kessler, RC (2013). School mental health resources and adolescent mental health service use. Journal of the American Academy of Child & Adolescent Psychiatry 52, 501510.
Hoftun, GB, Romundstad, PR, Rygg, M (2013). Association of parental chronic pain with chronic pain in the adolescent and young adult: family linkage data from the HUNT Study. Journal of the American Medical Association: Pediatrics 167, 6169.
Hotopf, M, Carr, S, Mayou, R, Wadsworth, M, Wessely, S (1998). Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. British Medical Journal 316, 11961200.
Hyams, JS, Hyman, PE (1998). Recurrent abdominal pain and the biopsychosocial model of medical practice. Journal of Pediatrics 133, 473478.
Kalaydjian, A, Merikangas, K (2008). Physical and mental comorbidity of headache in a nationally representative sample of US adults. Psychosomatic Medicine 70, 773780.
Lahey, B, Rathouz, P, Van Hulle, C, Urbano, R, Krueger, R, Applegate, B, Garriock, H, Chapman, D, Waldman, I (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of Abnormal Child Psychology 36, 187206.
Luntamo, T, Sourander, A, Gyllenberg, D, Sillanmäki, L, Aromaa, M, Tamminen, T, Kumpulainen, K, Moilanen, I, Piha, J (2014). Do headache and abdominal pain in childhood predict suicides and severe suicide attempts? Finnish nationwide 1981 birth cohort study. Child Psychiatry & Human Development 45, 110118.
Luntamo, T, Sourander, A, Sillanmäki, L, Gyllenberg, D, Aromaa, M, Kumpulainen, K, Moilanen, I, Almqvist, F, Tamminen, T, Piha, J (2012). Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study. Journal of Affective Disorders 138, 153159.
National Center for Health Statistics (1988). Child Health Supplement. In Current Estimates from the National Health Interview Survey (ed. Adams, P. and Hardy, A.), Hyattsville, MD.
Raison, CL, Capuron, L, Miller, AH (2006). Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in Immunology 27, 2431.
Ramchandani, PG, Fazel, M, Stein, A, Wiles, N, Hotopf, M (2007). The impact of recurrent abdominal pain: predictors of outcome in a large population cohort. Acta Paediatrica 96, 697701.
Rief, W, Hennings, A, Riemer, S, Euteneuer, F (2010). Psychobiological differences between depression and somatization. Journal of Psychosomatic Research 68, 495502.
Rohde, P, Lewinsohn, PM, Klein, DN, Seeley, JR, Gau, JM (2013). Key characteristics of Major Depressive Disorder occurring in childhood, adolescence, emerging adulthood, and adulthood. Clinical Psychological Science 1, 4153.
Saps, M, Seshadri, R, Sztainberg, M, Schaffer, G, Marshall, BM, Di Lorenzo, C (2009). A prospective school-based study of abdominal pain and other common somatic complaints in children. Journal of Pediatrics 154, 322326.
SAS Institute Inc (2008). SAS/STAT® Software: Version 9.2. SAS Institute, Inc.: Cary, NC.
Shelby, GD, Shirkey, KC, Sherman, AL, Beck, JE, Haman, K, Shears, AR, Horst, SN, Smith, CA, Garber, J, Walker, LS (2013). Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders. Pediatrics 132, 475482.
Stanford, EA, Chambers, CT, Biesanz, JC, Chen, E (2008). The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach. Pain 138, 1121.
Walker, LS, Claar, RL, Garber, J (2002). Social consequences of children's pain: when do they encourage symptom maintenance? Journal of Pediatric Psychology 27, 689698.
Walker, LS, Garber, J, Greene, JW (1993). Psychosocial correlates of recurrent childhood pain: a comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. Journal of Abnormal Psychology 102, 248258.
Walker, LS, Garber, J, Smith, CA, Van Slyke, DA, Claar, RL (2001). The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain. Journal of Consulting and Clinical Psychology 69, 8591.
Weersing, VR, Rozenman, MS, Maher-Bridge, M, Campo, JV (2012). Anxiety, depression, and somatic distress: developing a transdiagnostic internalizing toolbox for pediatric practice. Cognitive and Behavioral Practice 19, 6882.


Type Description Title
Supplementary materials

Shanahan Supplementary Material
Supplementary Material 1

 Word (56 KB)
56 KB
Supplementary materials

Shanahan Supplementary Material
Supplementary Material 2

 Word (16 KB)
16 KB
Supplementary materials

Shanahan Supplementary Material
Supplementary Material 3

 Word (22 KB)
22 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed