摘要
儿童功能性躯体化症状(Functional Somatic Symptoms, FSS)又被称为“无医学解释的躯体症状”,是儿科临床上常见的主诉,常被诊断为功能性腹痛、慢性疲劳综合症等,严重的FSS有可能符合精神病学中躯体形式障碍的诊断。儿童FSS不仅高发于临床样本中,轻微的躯体化症状在非临床社区样本中也很常见。社区样本中的儿童FSS较为轻微,未达到临床诊断的标准,但是表现形式多样,对儿童的出勤率、学业成绩、家庭关系等方面都有负面影响。儿童FSS通常没有医学设备可检测出的生理病变,而是与心理、社会环境因素密切相关。
本研究以非临床小学生和中学生为样本,采用纵向追踪和横断相结合的研究设计,使用问卷法对儿童功能性躯体化症状的发生率、发展趋势、心理发生机制和社会环境影响因素进行了探讨。研究共分为3个部分,由9个子研究组成。第一部分修订了测量儿童FSS的工具,并对本研究中使用到的研究工具的心理测量学属性进行了检验；第二部分探讨了儿童FSS的发展趋势,以及个体心理学属性,包括情绪、认知方式、行为等方面与儿童FSS之间的互动关系；第三部分探讨了家庭、班级以及负性生活事件等环境因素对儿童FSS的影响。
综合本研究结果,得出了以下结论：
1.儿童FSS在非临床儿童和青少年群体中很常见。
本研究中,仅有5.6%的被试儿童在过去3个月中没有感觉到任何躯体不适,有36.5%的被试在过去3个月中体验到“轻微”至“非常多”的躯体化症状。29.4%的被试在过去3个月中频繁体验到至少1种躯体化症状。本研究样本中发生率较高的躯体化症状依次是感觉乏力(65.3%)、肌肉酸痛(55.9%)、四肢疼痛(52.2%)、头疼(48.5%)。
2.儿童FSS随着年龄增长呈逐渐增多趋势。
本研究发现儿童FSS随着年龄增长表现出逐渐增多的趋势,并且,增长趋势存在性别和焦虑水平上的个体差异。每隔九个月,女生的躯体化症状增长速度比男生高0.41分。初始状态焦虑得分较高的儿童,比低分组儿童的躯体化症状增长速度更快。每隔9个月,初始状态焦虑高分组比低分组增加值多0.44分。
3.儿童FSS与儿童的心理健康状况之间存在密切关系。
儿童焦虑、抑郁、社交退缩、多动、攻击违纪行为、刻板行为等心理健康问题均可预测儿童FSS。躯体化症状中的“疼痛与乏力”因子与儿童心理健康之间的关系最为密切。
4.反刍思维是儿童FSS的认知易感性因素。
症状反刍、沉思、反省维度以及反刍思维可正向预测儿童FSS水平。在控制了抑郁水平之后,反刍思维对儿童FSS的预测作用依然显著。
儿童抑郁对反刍思维与儿童FSS之间的关系有调节作用,即儿童抑郁程度越高,反刍思维与儿童FSS之间的关系越密切。儿童抑郁在反刍思维与躯体化症状之间的部分中介作用亦显著,说明反刍思维对儿童FSS的影响有一部分是通过抑郁实现的。
5.儿童FSS不会导致日常功能的严重损伤。
儿童FSS不能预测儿童的日常功能损伤,躯体化症状的出现对儿童和青少年正常生活的影响不大。
6.家庭环境对儿童FSS的发生发展有影响作用。
功能性躯体症状存在着母系代际传递性,高躯体化症状水平儿童母亲不仅有较多的情绪问题,而且在敌对、偏执、恐惧等各维度及心理健康总体水平都比低躯体化症状水平儿童的母亲要差。
在家庭教养方式方面,父母的过度保护行为和父亲的拒绝行为对儿童FSS有预测作用。母亲的过度保护可以中介母亲和子女之间FSS的传递,父亲家庭教养方式对母系FSS传递无调节作用。
7.班级环境因素对儿童FSS影响较为轻微。
在诸多班级环境因素中,只有学业压力可以预测儿童FSS。
8.负性生活事件以及不良的应对方式可以预测儿童FSS。
人际关系、学业压力以及受惩罚三类青少年负性生活事件中可以正向预测儿童FSS的发生；对应激事件采取“积极的合理化解释”的方式进行应对,可以减少儿童FSS的发生发展,而“忍耐”、“发泄情绪”的方式应对则会正向预测儿童FSS的发生
Functional somatic symptoms (FSS) is defined as medically unexplained symptoms, are commonly experience by children and adolescents in clinical sample. FSS are often diagnosed as functional abdominal pain, chronic fatigue syndromes etc. by pediatrician; severe FSS could be diagnosed as somatoform disorder by psychiatrist. FSS are also common in community sample which is less severe and do not meet the clinical diagnostic criteria. However, community sample report a variety of complaints, associated with attendance rate, academic achievement and family disfunctioning. FSS usualy could not be explained medically, may induced by psychological and social factors.
The research uses sample of students from primary and secondary school; and emply crosssectional and longitudinal research design. Questionnaires are used to explore the occurrence rate, developmental tendency, psychological mechanism and related social factors of FSS. The research composed of3parts. The first part revised the questionnaire used to evaluation FSS in children and adolescents, and verified all the other tools used in this research; the second part explore the developmental trendency, and how the psychological variable affect FSS in children including emotion, cognitive style, behavior; the third part discussed how the environmental factor affect FSS in children.
Based on the results, the following conclusions could be drawn.
1. FSS in children is common in community sample.
In this research, only5.6%children did not experience any somatic symptom at all in the past3-month.36.5%experienced "slightly" or "a lot" somatic symptom in the past3months.29.4%experienced at least1symptom frequently in the past3months. The most prevalent functional somatic symptoms are fatigue (65.3%), sore muscle (55.9%), pain of limbs (52.2%) and headache (48.5%).
2. FSS in children grow along with the increase of age.
The research find growth tendency of FSS in children. Furthermore, there are gender and differences in the growth tendency. Every nine-month, FSS in girls grow faster than FSS in boys by0.41point. FSS in children with high initial anxiety grow faster than children with low initial anxiety by0.44every9month.
3. FSS in children have close relationship with mental health status.
Children's anxiety, depression, social withdrawal, hyperactivity, maladaptive behavior can predict FSS in children."pain and fatigue" FSS have closer relationship with mental health.
4. Rumination is cognitive vulnerability factor of FSS in children.
Symptom rumination, ponder, reflection and ruminant thinking dimensions could positively predict FSS in children. Controlling depression, the relationship between rumination and FSS are still significant. Depression moderated the relationship between rumination and FSS, the relationship is stronger while the depression is more severe. Children's depression partly mediated the relationship between rumination and FSS in children.
5. FSS in children would not result in severe functional disability.
FSS in children could not predict children's functional disability, FSS have slightly effect on children's daily life.
6. FSS in children were affected by family environment.
FSS maternal intergenerational transmission, mothers with more somatization symptoms not only suffered from more emotional distress, but also have more paranoid, phobia and worse overall mental health status.
Parenting style also related to FSS in children, especially parental over-protection and paternal rejection. Maternal over-protection mediated the maternal intergenerational transmission, paternal parenting style has no effect on the maternal intergenerational transmission.
7. FSS in children have slightly relationship with classroom enviroment
Among classroom environment dimensions, only academic pression could significantly predict FSS in children.
8. Life event and coping style can predict FSS in children.
Life event, specifically, Interpersonal relationship, academic pressure and punishment could positively predict the occurrence of FSS. Positive reasonable explaination of streesors can predict less FSS in children, wihle tolerance and venting emotions can predict more FSS in children.
引文
[1]余华.没有一条道路是重复的.上海：上海文艺出版社,2004.31.
[2]Peveler R, Kilkenny L, Kinmonth A. Medically unexplained physical symptoms in primary care:a comparison of self-report screening questionnaires and clinical opinion. Journal of Psychosomatic Research,1997,42:245-253
[3]Van Hemert A, Hengeveld M, Bolk J, et al. Psychological disorders in relation to medical illness among patients of a general medical outpatient clinic Psychological Medicine,1993,23:167-173
[4]Hamilton J, Campos R, Creed F. Anxiety, depression and management of medically unexplained symptoms in medical clinics. J Royal College of Physicians,1996,30:18-21
[5]Fink P. The use of hospitalizations by persistent somatizing patients Psychological Medicine,1992,22:173-80
[6]Potts S, Bass C. Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries:a long-term follow-up study. Psychological Medicine,1995,24:339-247
[7]Komaroff A, Fagiolo L, Doolittle T, et al. Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups American Journal of Medicine,1996,101:281-290
[8]Walker E A, Roy Byrne P P, Katon W J, et al. Psychiatric illness and irritable bowel syndrome:a comparison with inflammatory bowel disease. The American Journey of Psychiatry,1990,147:1656-1661
[9]Wessely S, Nimuan C, Sharpe M. Functional somatic syndromes:one or many? The Lancet,1999,354(9182):936-939
[10]Kirmayer L J, Robbins J M. Introduction:Concepts of somatization. In: Kirmayer L J, Robbins J M (Eds). Current concepts of somatization:research and clinical perspectives. Washington, DC:American Psychiatric Press,1991: 1-19
[11]Katon W, Lin E, Von Korff M, et al. Somatization:a spectrum of severity. American Journal of Psychiatry,1991,148(1):34-40
[12]Smith R C, Gardiner J C, Lyles J S, et al. Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosomatic medicine,2005,67(1):123-129.
[13]Mayou R, Kirmayer L J, Simon G, et al. Somatoform disorders:time for a new approach in DSM-V. American Journal of Psychiatry,2005,162(5):847-855
[14]Escobar J I, Manu P, Matthews D, et al. Medically unexplained physical symptoms, somatization disorder and abridged somatization:studies with the Diagnostic Interview Schedule. Psychiatric developments,1989,7(3):235.
[15]Lynch D J, McGrady A, Nagel R, et al. Somatization in family practice: comparing 5 methods of classification. Primary care companion to the Journal of clinical psychiatry,1999,1(3):85
[16]Simon G E, VonKorff M, Piccinelli M, et al. An international study of the relation between somatic symptoms and depression. New England Journal of Medicine,1999,341(18):1329-1335
[17]Goldberg D, Bridges K, Duncan-Jones P, et al. Detecting anxiety and depression in general medical settings. BMJ:British Medical Journal,1988
[18]Spitzer R L, Williams J B W, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. JAMA:the journal of the American Medical Association,1994,272(22):1749-1756
[19]Barsky A J. Amplification, somatization, and the somatoform disorders. Psychosomatics:Journal of Consultation Liaison Psychiatry; Psychosomatics: Journal of Consultation Liaison Psychiatry,1992
[20]Lesser I M. Current concepts in psychiatry:alexithymia. New England Journey of Medicine,1985(312):690-692
[21]Wessely S, Nimuan C, Sharpe M. Functional somatic syndromes:one or many?. The Lancet,1999,354(9182):936-939
[22]Burton C. Beyond somatisation:a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). The British Journal of General Practice,2003,53(488):231.
[23]邓云龙,杨德森.功能性疾病的再认识.医学与哲学,2001,22(009)：43-44.
[24]Dhossche D, Ferdinand R, van der Ende J, et al. Outcome of self-reported functional-somatic symptoms in a community sample of adolescents. Annals of Clinical Psychiatry,2001,13(4):191-199.
[25]Husain K, Browne T, Chalder T. A review of psychological models and interventions for medically unexplained somatic symptoms in children. Child and Adolescent Mental Health,2007,12(1):2-7
[26]Kozlowska K. Good children presenting with conversion disorder. Clinical child psychology and psychiatry,2001,6(4):575-591.
[27]Garber J, Walker L S, Zeman J. Somatization symptoms in a community sample of children and adolescents:Further validation of the Children's Somatization Inventory. Psychological Assessment:A Journal of Consulting and Clinical Psychology,1991,3(4):588
[28]Silber T J. Somatization disorders in children and adolescents. Pediatrics in Review,2003,24(8):255-264.
[29]Lieb R, Pfister H, Mastaler M, et al. Somatoform syndromes and disordersin a representative population sample of adolescents and young adults:prevalence, comorbidity and impairments. Acta Psychiatrica Scandinavica,2000,101(3): 194-208
[30]Dhossche D, Ferdinand R, Van der Ende J, et al. Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychological medicine,2002,32(04):619-627
[31]Brunswick A F, Boyle J M, Tarica C. Who sees the doctor? a study of urban black adolescents?. Social Science & Medicine. Part A:Medical Psychology & Medical Sociology,1979,13:45-56
[32]Walker L S, Beck J. E, Garber J, et al. Children's Somatization Inventory: Psychometric properties of the revised form (CSI-24). Journal of pediatric psychology,2009,34(4):430-440
[33]Gijsbers C F M, Kneepkens C M F, Schweizer J J, et al. Recurrent abdominal pain in 200 children:somatic causes and diagnostic criteria. Acta Paediatrica, 2011,100(11):208-214
[34]邓云龙,李武,唐秋萍.不同系统功能性躯体症状与心理症状的关系.中国医师杂志,2002,9：30-32
[35]Tamminen T M, Bredenberg P, Escartin T, et al. Psychosomatic symptoms in preadolescent children. Psychotherapy and psychosomatics,1991,56(1-2):70-77
[36]Garralda M E. Unexplained physical complaints. Child and Adolescent Psychiatric Clinics of North America,2010,19(2):199-209
[37]Bschor T. Masked depression:the rise and fall of a diagnosis]. Psychiatrische Praxis,2002,29(4):207
[38]Craig T K J, Cox A D, Klein K. Intergenerational transmission of somatization behaviour:a study of chronic somatizers and their children. Psychological medicine,2002,32(5):805-816
[39]Ginsburg G S, Riddle M A, Davies M. Somatic symptoms in children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry,2006,45(10):1179-1187
[40]McCauleye E, Carlson G A, Calderon R. The role of somatic complaints in the diagnosis of depression in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,1991,30(4):631-635
[41]Henningsen P, Zimmermann T, Sattel H. Medically unexplained physical symptoms, anxiety, and depression:a meta-analytic review. Psychosomatic Medicine,2003,65(4):528-533.
[42]Hochstrasser B, Angst J. The Zurich Study:XXII. European archives of psychiatry and clinical neuroscience,1996,246(5):261-272
[43]Mulvaney S, Lambert E W, Garber J, et al. Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain:a 5-year longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry,2006,45(6):737-744
[44]Miller A H, Maletic V, Raison C L. Inflammation and its discontents:the role of cytokines in the pathophysiology of major depression. Biological psychiatry, 2009,65(9):732-741.
[45]Campo J V, Bridge J, Lucas A, et al. Physical and emotional health of mothers of youth with functional abdominal pain. Archives of pediatrics & adolescent medicine,2007,161(2):131
[46]Kessler R C, Wang P S. Epidemiology of depression. Handbook of depression,2002:23-42.
[47]Domenech-Llaberia E, Jane C, Canals J, et al. Parental reports of somatic symptoms in preschool children:Prevalence and associations in a Spanish sample. Journal of the American Academy of Child & Adolescent Psychiatry,2004,43(5): 598-604
[48]Fritz G K, Fritsch S, Hagino O. Somatoform disorders in children and adolescents:a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry,1997,36(10):1329
[49]Walker L S, Garber J, Van Slyke D A, et al. Long-term health outcomes in patients with recurrent abdominal pain. Journal of Pediatric Psychology,1995, 20(2):233-245
[50]Rhee H. Relationships between physical symptoms and pubertal development. Journal of Pediatric Health Care,2005,19(2):95-103
[51]Reardon L E, Leen-Feldner E W, Hayward C. A critical review of the empirical literature on the relation between anxiety and puberty. Clinical psychology review,2009,29(1):1-23
[52]Locke G R, Zinsmeister A R, Talley N J, et al. Familial association in adults with functional gastrointestinal disorders[C]. Mayo Clinic Proceedings. Elsevier, 2000,75(9):907-912
[53]Walker L S, Garber J, Greene J W. Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. Journal of Consulting and Clinical Psychology; Journal of Consulting and Clinical Psychology,1994,62(6):1213
[54]van der Veek S M C, Derkx H H F, de Haan E, et al. Abdominal pain in Dutch schoolchildren:Relations with physical and psychological comorbid complaints in children and their parents. Journal of pediatric gastroenterology and nutrition,2010,51(4):481-487
[55]Ramchandani P G, Stein A, Hotopf M, et al. Early parental and child predictors of recurrent abdominal pain at school age:results of a large population-based study. Journal of the American Academy of Child & Adolescent Psychiatry,2006,45(6):729-736
[56]Campo J V, Jansen-McWilliams L, Comer D M, et al. Somatization in pediatric primary care:Association with psychopathology, functional impairment, and use of services. Journal of the American Academy of Child & Adolescent Psychiatry,1999,38(9):1093-1101
[57]Janssens K A M, Oldehinkel A J, Rosmalen J G M. Parental overprotection predicts the development of functional somatic symptoms in young adolescents. The Journal of pediatrics,2009,154(6):918-923. el.
[58]Fisher L, Chalder T. Childhood experiences of illness and parenting in adults with chronic fatigue syndrome. Journal of Psychosomatic Research,2003,54(5): 439-443
[59]Elena Garralda M, Chalder T. Practitioner Review:Chronic fatigue syndrome in childhood. Journal of Child Psychology and Psychiatry,2005, 46(11):1143-1151
[60]Walker L S, Williams S E, Smith C A, et al. Validation of a symptom provocation test for laboratory studies of abdominal pain and discomfort in children and adolescents. Journal of pediatric psychology,2006,31(7):703-713
[61]Boey C M, Goh E E. Psychosocial factors and childhood recurrent abdominal pain. Journal of gastroenterology and hepatology,2002,17(12): 1250-1253
[62]Walker L S, Garber J, Smith C A, et al. The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain. Journal of consulting and clinical psychology,2001,69(1):85
[63]Beck J E. A developmental perspective on functional somatic symptoms. Journal of Pediatric Psychology,2008,33(5):547-562
[64]Walker L S, Claar R L, Garber J. Social consequences of children's pain: When do they encourage symptom maintenance?. Journal of Pediatric Psychology,2002,27(8):689-698
[65]Campo J V, Fritsch S L. Somatization in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,1994
[66]Waller E, Scheidt C E, Hartmann A. Attachment representation and illness behavior in somatoform disorders. The Journal of nervous and mental disease, 2004,192(3):200-209
[67]Waldinger R J, Schulz M S, Barsky A J, et al. Mapping the road from childhood trauma to adult somatization:the role of attachment. Psychosomatic Medicine,2006,68(1):129-135
[68]Minuchin S, Baker L, Rosman B L, et al. A conceptual model of psychosomatic illness in children:Family organization and family therapy. Archives of General Psychiatry,1975,32(8):1031
[69]Terre L, Ghiselli W. A developmental perspective on family risk factors in somatization. Journal of psychosomatic research,1997,42(2):197-208
[70]Hardwick, P. J. Engaging families who hold strong medical beliefs in a psychosomatic approach. Clinical child psychology and psychiatry,2005,10(4): 601-616.
[71]Hotopf, M, Matthew, et al. Childhood predictors of adult medically unexplained hospitalisations Results from a national birth cohort study. The British Journal of Psychiatry,2000,176(3):273-280
[72]Jeff J, Vaughn C. The role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenia:a two-year follow-up. The British Journal of Psychiatry,1981,139(2):102-104
[73]Lask, B., Fosson, A., Frude, N., Solnit, A. J.,& Meadow, R. Childhood illness:the psychosomatic approach:children talking with their bodies[M].1989. Wiley.
[74]Fichtel A, Larsson B. Does Relaxation Treatment Have Differential Effects on Migraine and Tension-type Headache in Adolescents?. Headache:The Journal of Head and Face Pain,2001,41(3):290-296
[75]Huertas-Ceballos, A., et al. Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev.2008,1(1).
[76]Sanders M. R., et al. The treatment of recurrent abdominal pain in children:a controlled comparison of cognitive-behavioral family intervention and standard pediatric care. Journal of consulting and clinical psychology,1994,62(2):306
[77]Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes:a critical review of controlled clinical trials. Psychotherapy and psychosomatics,2000,69(4):205-215
[78]Kroenke K. Efficacy of treatment for somatoform disorders:a review of randomized controlled trials. Psychosomatic medicine,2007,69(9):881-888
[79]Husain K, Browne T, Chalder T. A review of psychological models and interventions for medically unexplained somatic symptoms in children. Child and Adolescent Mental Health,2007,12(1):2-7
[80]Humphreys P A, Gevirtz R N. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. Journal of pediatric gastroenterology and nutrition,2000,31(1):47-51
[81]Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. The Lancet,2007,369(9565):946-955
[82]Roth-Isigkeit, Angela, et al. "Pain among children and adolescents: restrictions in daily living and triggering factors." Pediatrics,2005,115(2): 152-162
[83]Birleson, P. The validity of depressive disorder in childhood and the development of a self-rating scale:A research report. Journal of Child Psychology and Psychiatry,2006,22(1):73-88.
[84]Rosenberg, Morris. Rosenberg self-esteem scale (RSE). Acceptance and Commitment Therapy. Measures Package,1965:61
[85]蔡华俭.内隐自尊效应及内隐自尊与外显自尊的关系.心理学报,2003：796-801.
[86]Birmaher, B, et al. The screen for child anxiety related emotional disorders (SCARED):Scale construction and psychometric characteristics. Journal of the American Academy of Child & Adolescent Psychiatry,1997,36(4):545-553
[87]徐韬园,等.Achenbach儿童行为量表在上海市中小学生中的应用.上海精神医学,1991,3(1)：1-3
[88]陈树林,郑全全.中学生应对方式量表的初步编制.中国临床心理学杂志,2000,8(4)：211-214.
[89]Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. Journal of abnormal psychology,1991,100(4): 569
[90]Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered:A psychometric analysis. Cognitive Therapy and Research,2003,27(3):247-259
[91]杨娟,凌宇,肖晶,等.反应量表中文版在高中生中初步运用结果分析.中国临床心理学杂志,2009,17(1)：27-28
[92]韩秀,杨宏飞.Nolen-Hoeksema反刍思维量表在中国的试用.中国临床心理学杂志,2009(005)：550-551
[93]刘贤臣,刘连启,杨杰,等.青少年生活事件量表的信度效度检验.中国临床心理学杂志,1997,5(1)：34-36.
[94]江光荣.班级社会生态环境研究[M].武汉：华中师范大学出版社,2002：125-130.
[95]Singleton L C, Asher S R. Peer preferences and social interaction among third-grade children in an integrated school district. Journal of Educational Psychology,1977,69(4):330
[96]Coie J D, Dodge K A, Coppotelli H. Dimensions and types of social status:A cross-age perspective. Developmental psychology,1982,18(4):557
[97]盖笑松,张向葵.多层线性模型在纵向研究中的运用.心理科学,2005,28(2)：429-431
[98]Silber T J. Somatization disorders in children and adolescents. Pediatrics in Review,2003,24(8):255-264
[99]肖世富.世界卫生组织初级卫生保健病人心理障碍合作研究的上海样本结果.中华精神科杂志,1997,30(002)：90-94
[100]Craig T K J, Cox.A D, Klein K. Intergenerational transmission of somatization behaviour:a study of chronic somatizers and their children. Psychological medicine,2002,32(5):805-816
[101]Campo J V, Perel J, Lucas A, et al. Citalopram treatment of pediatric recurrent abdominal pain and comorbid internalizing disorders:an exploratory study. Journal of the American Academy of Child & Adolescent Psychiatry, 2004,43(10):1234-1242
[102]邓云龙,李武.不同系统功能性躯体症状与心理症状的关系.中国医师杂志,2002,4(9)：938-940
[103]Cheung F M, Lau B W K. Situational variations in help-seeking behavior among Chinese patients. Comprehensive Psychiatry,1982,23:252-262
[104]Simon G E, VonKorff M. Somatization and psychiatric disorder. Am J Psychiatry,1991,148(1):1494-1500
[105]Raison V M C L. Neurobiology of depression, fibromyalgia and neuropathic pain. Frontiers in Bioscience,2009,14:5291-5338.
[106]Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. Journal of abnormal psychology,1991,100(4): 569
[107]郭素然,伍新春,郭幽圻,等.大学生反刍思维对消极情感和积极情感的影响——以孤独感和情绪智力为例.心理发展与教育,2011,27(3)：329-336
[108]Abela J R Z, Brozina K, Haigh E P. An examination of the response styles theory of depression in third-and seventh-grade children:A short-term longitudinal study. Journal of Abnormal Child Psychology,2002,30(5):515-527
[109]Papadakis A A, Prince R P, Jones N P, et al. Self-regulation, rumination, and vulnerability to depression in adolescent girls. Development and Psychopathology,2006,18(3):815
[110]Butler, Lisa D., Susan Nolen-Hoeksema. Gender differences in responses to depressed mood in a college sample. Sex Roles,1994,30(5):331-346
[111]Lyubomirsky S, Nolen-Hoeksema S. Self-perpetuating properties of dysphoric rumination. Journal of personality and Social Psychology,1993, 65(2):339-349
[112]Palermo T M, Chambers C T. Parent and family factors in pediatric chronic pain and disability:an integrative approach. Pain,2005,119(1-3):1-4.
[113]Walker L S, Greene J W. The functional disability inventory:measuring a neglected dimension of child health status. Journal of Pediatric Psychology,1991, 16(1):39-58.
[114]Robins P M, Smith S M, Glutting J J, et al. A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain. Journal of Pediatric Psychology,2005,30(5):397-408
[115]Logan D E, Scharff L. Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: an investigation of moderating effects on the pathway from pain to disability. Journal of Pediatric Psychology,2005,30(8):698-707.
[116]Peterson C C, Palermo T M. Parental reinforcement of recurrent pain:The moderating impact of child depression and anxiety on functional disability. Journal of Pediatric Psychology,2004,29(5):331-341
[117]Putte E, M Doornen P, Engelbert H, et al. Mirrored symptoms in mother and child with chronic fatigue syndrome. Pediatrics,2006,117:2074-2079
[118]Steinhausen C, Winkler C. Continuity of functional-somatic symptoms from late childhood to young adulthood in a community sample. Journal of Child Psychology and Psychiatry,2007,48(5):508-513
[119]Bohman H, Jonsson U, Paaren A. et al. Prognostic significance of functional somatic symptoms in adolescence:a 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC Psychiatry, 2012,12(1):90
[120]Kato K, Sullivan P, Evengard B, et al. A population-based twin study of functional somatic syndromes. Psychological Medicine,2010,39(3):497
[121]Walker L, Greene J. Psychosocial correlates of recurrent childhood pain:A comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorder. Journal of Abnormal Child Psychology,1993,102(2): 248-258
[122]Schor, E. Family pediatrics:Report of the task force on the family. Pediatrics,2003,111:1541-1571
[123]Chambers C, Craig K, Bennett S. The Impact of Maternal Behavior on Children's Pain Experiences:An Experimental Analysis. Journal of Pediatric Psychology,2002,27(3):293-301
[124]Scalzo C, Williams P, Holmbeck G. Maternal Self-Assessed Health and Emotionality Predict Maternal Response to Child Illness. Children's Health Care, 2005,34(1):61-79
[125]Garralda M, Rangel L. Childhood chronic fatigue syndrome. The American Journal of Psychiatry,2001,158(7):1161-1161
[126]Elena Garralda M, Chalder T. Practitioner Review:Chronic fatigue syndrome in childhood. Journal of Child Psychology and Psychiatry,2005, 46(11):1143-1151
[127]温忠麟,张雷,侯杰泰,等.中介效应检验程序及其应用.心理学报,2004,36(5)：614-620
[128]Baron R M, Kenny D A. The moderator-mediator variable distinction in social psychological research:Conceptual, strategic, and statistical considerations. Journal of personality and social psychology,1986,51(6):1173
[129]Rangel L, Garralda M, Jeffs J, et al. Family health and characteristics in chronic fatigue syndrome, juvenile rheumatoid arthritis, and emotional disorders of childhood. Journal of American Academic Child & Adolescence Psychiatry, 2005,44:150-158
[130]程学超,谷传华.母亲行为与小学儿童自尊的关系.心理发展与教育,2001,(4)：23-27
[131]Amato P, Gilbreth J. Nonresident Fathers and Children's Well-Being:A Meta-Analysis. Journal of Marriage and Family,1999,61(3):557-573
[132]Fraser, Barry J. Twenty years of classroom climate work:Progress and prospect. Journal of Curriculum studies,1989,21(4):307-327
[133]谭千保,陈宇.班级环境对初中生学校适应的影响.中国临床心理学杂志,2007,15(1)：51-55
[134]Pine D S, Cohen P, Johnson J G, et al. Adolescent life events as predictors of adult depression. Journal of affective disorders,2002,68(1):49-57
[135]Roy M P, Steptoe A,Kirschbaum C. Life events and social support as moderators of individual differences in cardiovascular and cortisol reactivity. Journal of Personality and Social Psychology,1998,75(5):1273
[136]王天芳,张翠珍,刘雁峰等.慢性疲劳综合征病人的疲劳,抑郁,焦虑与生活事件的特点及其相关性分析Chinese Journal of BehavioralM edical Science,2000,9(2),84-86.
[137]Fichter M., et al. From childhood to adult age:18-year longitudinal results and prediction of the course of mental disorders in the community. Social psychiatry and psychiatric epidemiology,2009,44(9):792-803
[138]方杰,张敏强,邱皓政.基于阶层线性理论的多层级中介效应.心理科学进展,2010,18(8)：1329-1338
[139]Bauer A M, Quas J A, Boyce W T. Associations between physiological reactivity and children's behavior:Advantages of a multisystem approach. Journal of Developmental & Behavioral Pediatrics,2002,23(2):102-113
[140]Kleinman A. Neurasthenia and depression:A study of somatization and culture in China. Culture, Medicine, and Psychiatry,1982,6:117-190
[141]Parker G, Chan B, Tully L, et al. Depression in the Chinese:the impact of acculturation. Psychological Medicine,2005,35:1475-1483
[142]Ryder A G, Yang J, Zhu X Z, et al. The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology,2008,117(2):300-313
1 王小波,李银河.爱你就像爱生命.上海：上海锦绣文章出版社,2008.