key: cord-0929565-qj80d82z
authors: De Nardi, Laura; Abbracciavento, Giuseppe; Cozzi, Giorgio; Ronfani, Luca; Viola, Irene; Bigolin, Lara; Barbi, Egidio; Trombetta, Andrea
title: Adolescents with somatic symptom disorder experienced less anxiety and depression than healthy peers during the first COVID‐19 lockdown
date: 2021-04-28
journal: Acta Paediatr
DOI: 10.1111/apa.15877
sha: af8a956a201d0040b14354576fb9553fef9eb36e
doc_id: 929565
cord_uid: qj80d82z

Adolescents with mental health disorders are a high-risk population and problems during COVID-19 lockdowns have included increasing, widespread anxiety, fear, anger and uncertainty. Somatic symptom disorder (SSD) is characterised by disproportionate thoughts, feelings and behaviours about physical symptoms associated with the distress and disruption of everyday functioning. SSD accounts for 15-25% of adolescent mental health cases in primary care paediatric settings,3 and 8.6% of non-traumatic adolescent pain in emergency departments.4.

Adolescents with mental health disorders are a high-risk population, and problems during COVID-19 lockdowns have included increasing, widespread anxiety, fear, anger and uncertainty. 1, 2 Somatic symptom disorder (SSD) is characterised by disproportionate thoughts, feelings and behaviours about physical symptoms associated with the distress and disruption of everyday functioning.

SSD accounts for 15%-25% of adolescent mental health cases in primary care paediatric settings, 3 and 8.6% of non-traumatic adolescent pain in emergency departments. 4

This cross-sectional observational study evaluated how the Italian COVID-19 lockdown, from 9 March to 4 May 2020, affected Italian adolescents aged 13-18 with and without SSD. It was con- (Table 1) .

We invited 160 adolescents to complete the survey and 58 (51.7% female) with SSD and 57 controls (45.6% female) agreed.

Their means ages were 15.3 and 15.8 years, respectively.

Adolescents with SSD had slightly significant lower anxiety raw scores than the controls (50.8 and 58.6, p = 0.05), and lower mean anxiety T-scores, which were not statistically significant (0.9 vs. 1.3, p = 0.45). However, some MASC-2-SR subdomains, including the physical symptoms, social anxiety and tension and restlessness scores, were significantly lower in the SSD group (p < 0.05).

Adolescents with SSD also experienced significantly lower levels of depression than the controls, as shown by their respective mean CDI-2-SF raw scores of 49 and 55.6 (p < 0.05) and mean CDI 2-SF T-scores of 4.7 and 7.2 (p < 0.05).

This study shows that the SSD group experienced less depressive and anxiety tendencies than the healthy controls during the eight-week COVID-19 lockdown period. According to the physical symptoms domain of the MASC2-SR T-score, the SSD group also reported significantly less physical symptoms than the control group.

These results are remarkable, because all other mental health disorders have been reported to worsen during lockdown. 2 Patients affected by SSD usually experience substantial impairment in their everyday life and social withdrawal and home isolation are two common diagnostic behaviours. 4 To some extent, lockdown provided a unique and experimental setting for adolescents with SSD, because it reduced social pressure in a way that would be difficult to reproduce.

This study seems to confirm the role that exogenous stress inducers play in the origins and persistence of SSD in vulnerable adolescents. These include adults' expectations, school performance, competition with peers and extracurricular activities, such as competitive sport. Resilience is required for patients with SSD to adapt to such stressors. However, these adjustment strategies may lead to illness, physical symptoms and reduced well-being. 

Mental health status among children in home confinement during the Coronavirus disease 2019 outbreak in Hubei province

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Pediatric somatic symptom disorders

Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain

The unaware physician's role in perpetuating somatic symptom disorder