Mental distress and functional abdominal pain: Clinical implications in the aftermath of severe negative events

The 130th Annual Meeting of APHA

3192.0: Monday, November 11, 2002 - Table 10

Abstract #47881

Michael Lo, MSPH, Florida Department of Health, Bureau of Epidemiology, Florida Epidemic Intelligence Service, Collier County Health Department, P.O. Box 429, Naples, FL 34106-0429, 239-530-5313, michael_lo@doh.state.fl.us and Michael Graven, MD MSc MPH FAAP, Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 56, Tampa, FL 33612.

In the aftermath of the terrorist attacks on September 11, 2001, demand for prescription antidepressants jumped 20% in the state of New York.¹ These severe negative events typically carry some degree of long-term threat to the patient, usually involving personal losses, that has been linked to both clinical depression and the onset of non-organic, functional abdominal pain, sometimes diagnosed as non-specific abdominal pain (NSAP), which is often mistaken as acute appendicitis.^2,3

This study examined comorbidity of mental health diagnoses with diagnoses of appendicitis and NSAP among 56,542 adult appendectomy patients in Florida between 1994 and 1999, using hospital discharge records from the state of Florida.⁴ Descriptive statistics and logistic regression were performed to determine the prevalence of mental health conditions with respect to appendicitis and NSAP.

Of the total study population, 7.5% were found to have a mental health diagnosis, most commonly non-dependent drug abuse (perhaps as an indication of mental distress), depressive and neurotic disorders. Adjusted prevalence odds of all mental disorders were higher among patients without appendicitis (OR=1.21 vs. OR=0.82, P < .0001) or with NSAP (OR=1.39 vs. OR=0.72, P=.0001).

The results of this study support previous findings of increased psychiatric morbidity in appendectomy patients not diagnosed with appendicitis. Since this phenomenon is often overlooked in medically-oriented clinical settings, it is recommended that attention also be paid to possible psychological causes of abdominal pain for effective treatment of these patients, especially in light of recent, highly-publicized negative events.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to

3. Discuss the role of severe negative events in the onset of clinical depression and functional abdominal pain.
7. Identify the three most common mental health conditions diagnosed in appendectomy patients, and describe how the likelihood of these conditions varies with the presence or absence of appendicitis.
11. Recognize the possibility that certain cases of functional abdominal pain may be psychological in nature, and understand the implications for clinical practice.

Keywords: Co-morbid, Mental Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Mental Health Roundtable II: Diversity and Depression

The 130th Annual Meeting of APHA