Abstract
BACKGROUND: Parental psychological and behavioral factors may influence outcomes in youths with functional abdominal pain disorders (FAPDs), yet limited research has explored these associations in families referred for hospital-based psychological treatment. OBJECTIVES: To describe parental emotional and behavioral factors in families referred to internet-based cognitive behavioral therapy (ICBT) for FAPDs, and examine their associations with youth-reported outcomes. DESIGN: Cross-sectional exploratory study. METHODS: Eighty-seven parent-youth dyads (youth aged 8-17 years) enrolled in an ICBT intervention study at a Danish hospital participated. Parental factors included emotional distress (SCL-8), health anxiety by proxy (HAPYs), and behavioral responses (Adult Responses to Child Symptoms Monitor and Protect subscales). Youth-reported outcomes included gastrointestinal symptoms (Pediatric Quality of Life Gastrointestinal Symptom Scale (PedsQL-Gastro)), pain intensity (Faces Pain Rating Scale-Revised), quality of life (PedsQL), gastrointestinal-anxiety (Visceral Sensitivity Index-Child adapted short scale), and avoidance/control behaviors (BRQ-C). Associations were examined using Spearman's correlations and hierarchical linear regression models, adjusting for all parental factors and youth sex. RESULTS: Most parents were mothers, highly educated, employed, cohabiting, with a middle to high household income. They generally reported low emotional distress, moderate health anxiety by proxy (HAPY) and monitoring behavior, and low protective behavior. Parental emotional distress and HAPY were significantly correlated with lower youth-reported quality of life and higher gastrointestinal-specific anxiety, particularly among adolescents. Monitoring behavior correlated with greater pain intensity, especially in children. In adjusted analyses, higher emotional distress remained significantly associated with lower youth-reported quality of life (β = -0.95, p = 0.02) and higher gastrointestinal-specific anxiety (β = 0.63, p = 0.008). Monitoring behavior remained significantly associated with greater youth-reported pain intensity (β = 0.22, p = 0.01). HAPY and protective behavior showed no significant independent associations with adverse youth outcomes. However, in age-stratified analyses, protective behavior was associated with fewer gastrointestinal symptoms in adolescents (β = 2.84, p = 0.02). No notable significant sex differences were observed. CONCLUSION: Parental emotional distress and monitoring behavior were the most consistent parental factors associated with adverse youth outcomes and may represent key targets in intervention for pediatric FAPDs. The potential protective role of certain parental behaviors in adolescents warrants further exploration. Findings should be replicated in larger, more diverse samples.