Are Cardiac Autonomic Nervous System Activity and Perceived Stress Related to Functional Somatic Symptoms in Adolescents? The TRAILS Study.

Karin A M Janssens,Paul F C Groot,Harriëtte Riese,Albertine J Oldehinkel,Arie M Van Roon,Joke A M Hunfeld,Judith G M Rosmalen,Nanette H Bishopric

doi:10.1371/journal.pone.0153318

Abstract

ObjectiveStressors have been related to medically insufficiently explained or functional somatic symptoms (FSS). However, the underlying mechanism of this association is largely unclear. In the current study, we examined whether FSS are associated with different perceived stress and cardiac autonomic nervous system (ANS) levels during a standardized stressful situation, and whether these associations are symptom-specific.MethodsWe examined 715 adolescents (16.1 years, 51.3% girls) from the Dutch cohort study Tracking Adolescents’ Individual Lives Sample during the Groningen Social Stress Test (GSST). FSS were assessed by the Youth Self-Report, and clustered into a cluster of overtiredness, dizziness and musculoskeletal pain and a cluster of headache and gastrointestinal symptoms. Perceived stress levels (i.e. unpleasantness and arousal) were assessed by the Self-Assessment Manikin, and cardiac ANS activity by assessing heart rate variability (HRV-HF) and pre-ejection period (PEP). Perceived stress and cardiac ANS levels before, during, and after the GSST were studied as well as cardiac ANS reactivity. Linear regression analyses were used to examine the associations.ResultsPerceived arousal levels during (beta = 0.09, p = 0.04) and after (beta = 0.07, p = 0.047) the GSST, and perceived unpleasantness levels before (beta = 0.07, p = 0.048) and during (beta = 0.12, p = 0.001) the GSST were related to FSS during the past couple of months. The association between perceived stress and FSS was stronger for the FSS cluster of overtiredness, dizziness and musculoskeletal pain than for the cluster of headache and gastrointestinal symptoms. Neither ANS activity levels before, during, and after the GSST, nor maximal HF-HRV and PEP reactivity were related to FSS.ConclusionsThis study suggests that perceived stress levels during social stress are related to FSS, whereas cardiac ANS activity and reactivity are not related to FSS.

Highlights

Functional somatic symptoms (FSS), like fatigue and chronic pain, are symptoms not fully explained by a conventional medical condition
Perceived arousal levels during and after the Groningen Social Stress Test (GSST), and perceived unpleasantness levels before and during the GSST were related to FSS during the past couple of months
This study suggests that perceived stress levels during social stress are related to FSS, whereas cardiac autonomic nervous system (ANS) activity and reactivity are not related to FSS

Summary

Introduction

Functional somatic symptoms (FSS), like fatigue and chronic pain, are symptoms not fully explained by a conventional medical condition. They are common during adolescence and can have large impact on adolescents’ lives [1,2]. High perceived stress levels have repeatedly been associated with FSS in adolescents [5,6,7,8,9]. It has recently been found that high perceived stress levels impair somatic recovery from physiological exhausting situations [9]. Unclear whether high perceived stress levels reflect anticipation stress, stronger psychological reactions during stressful situations or problems with psychological recovery, and sustained high perceived stress levels, after a stressful situation occurred

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Conclusion