The influence of maternal anxiety, clinical diagnosis, and presentation of medical information on mothers’ responses to children’s abdominal pain

Abstract

Functional symptoms, defined as symptoms in the absence of organic disease, are common among pediatric patients. Differences exist in the clinical application of the biomedical versus biopsychosocial model in the explanation of functional symptoms. Parents perceive greater symptom severity, have more emotional distress, and more protectively parent their children when uncertainty is high and expectations are unmet for receiving diagnostic, treatment, and prognostic information for children’s symptoms. The current study examined effects of maternal trait anxiety (high versus low), diagnosis (functional versus organic), and physician’s presentation of medical information (biomedical versus biopsychosocial) on mothers’ cognitive, emotional, and behavioral responses to children’s symptoms. Mothers were hypothesized to have more negative responses to functional versus organic diagnoses presented from a biomedical versus biopsychosocial model, particularly for high anxious mothers. Mothers (N = 160) read a vignette describing a child with chronic abdominal pain and completed baseline questionnaires assessing their cognitive, emotional, and behavioral responses imagining themselves as the mother of the child in the vignette. Mothers then viewed one of four videos of a physician giving a functional versus organic diagnosis from a biomedical versus biopsychosocial presentation pertaining to the child in the vignette. Finally, mothers completed questionnaires assessing cognitive, emotional, and behavioral responses to children’s symptoms in response to the medical information received. Controlling for baseline, main effects of anxiety and diagnosis indicated that anxious mothers and those who received a functional diagnosis reported more severe symptom appraisals, pain catastrophizing, negative affect, and protective parenting after the medical evaluation vignette. Interaction effects demonstrated that anxious mothers who received a functional diagnosis presented from a biomedical framework reported significantly higher catastrophizing and negative affect than mothers in any other condition. Results underscore the importance of taking these three factors together in understanding parents’ responses to children’s symptoms, especially for cognitive and emotional variables. Identifying parent and provider characteristics that influence parents’ responses to children’s symptoms has the potential to improve the clinical encounter and enhance health outcomes for pediatric patients with functional symptoms.