Running Head: NEGATIVE LIFE EVENTS
The Relation of Negative Life Events to Symptoms and Functioning in Adolescents and
Young Adults with a Childhood History of Chronic Abdominal Pain
Gerianna Kneeland
Honors Psychology
Honors Thesis
April 7, 2010
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Prevalence and Incidence of Chronic Abdominal Pain
Chronic abdominal pain (CAP) is considered the most common form of pain
complaint across childhood. According to the American Academy of Pediatrics (2005),
between 2-4% of all pediatric clinic visits are related to chronic abdominal pain. Chronic
abdominal pain affects an estimate of 10-15% of school-aged children (Walker and
Greene, 1991). Chronic abdominal pain usually occurs in the age range of 5-16 years,
with particularly high incidence between 8-12 years of age. It is uncommon for chronic
abdominal pain to affect children under the age of 5. Although the onset of chronic
abdominal pain is during childhood, some children continue to suffer from this condition
into adolescence and eventually, adulthood (Garber, Smith, Van Slyke, Lewis Claar, and
Walker, 2001; Kristjansdottir, 1997).
Background and Significance of Problem
Chronic abdominal pain is defined as “intermittent or constant abdominal pain of
at least 3 months’ duration” (American Academy of Pediatrics, 2005). It is common for
chronic abdominal pain to begin during childhood, and increase during the period of
adolescence. In the stage of adolescence, chronic abdominal pain is more common in
girls than boys. Chronic abdominal pain may be associated with anxiety, symptoms of
depression, depressive disorders, absence from school, family disruption, and various
somatic symptoms (Apley, 1975; Walker, Garber, and Greene, 1993; Garber et al., 2001).
One of the major issues in the literature has been the defining criteria for chronic
abdominal pain. For many years, “recurrent abdominal pain” was the term used in
referring to persistent complaints of abdominal pain. Recurrent abdominal pain was
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originally defined by Apley in the 1950s as 3 or more episodes of abdominal pain, which
last for a period equivalent to 3 months or more. Apley’s research definition of recurrent
abdominal pain was used as the criteria for selecting subjects for many studies and
eventually came to be used clinically as a diagnosis for all children who have abdominal
pain without an organic etiology. Because of the inappropriate use of the term, “recurrent
abdominal pain” as a diagnosis, it has been replaced with the term “chronic abdominal
pain” which is regarded as a symptom description. This term “recurrent abdominal pain”
is no longer recommended for use in clinical practices (American Academy of Pediatrics,
2005; Walker and Greene, 1991a).
Psychosocial factors and the effect on chronic abdominal pain
Psychosocial factors have been found to influence some cases of somatic
complaints in children with chronic abdominal pain. These forms of somatic complaints
have been to linked to somatization, defined as “the tendency to express emotional
distress in the form of somatic complaints” (Garber et al., 2001). According to Walker
and Greene (1991a), many researchers have hypothesized that psychosocial factors
influence illness in chronic abdominal pain patients. Most of these studies of chronic
abdominal pain have examined stressors like school issues, illness or death of family
members, and family disruption (as cited in Stone and Barbero, 1970). The most
prominent psychosocial factors investigated in relation to CAP include child academic
and social competence, parental somatic complaints, modeling of illness behavior, and
negative life events (Walker et al., 1993; Walker et al., 1994).
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Lack of competence is a psychosocial factor that may be linked with CAP as well
as various childhood emotional disorders (Blechman, Tinsley, Carella, and McEnroe,
1985). A study by Cole and Lejune (1972) found evidence that people who distinguish
themselves as being incapable of performing certain activities may take on a sick role as
a means of coping with their academic and social difficulties. This study suggests the
possibility that low academic and social competence might contribute to child somatic
complaints and disability. Children with chronic abdominal pain who have poor social
competence are likely to exhibit more disability than children with CAP who have good
peer relationships (Claar, Walker, and Smith, 1999; Robinson, Alvarez, & Dodge, 1990).
Parent somatic complaints have been linked to child somatic complaints,
specifically complaints of chronic pain and stress-related symptoms. One of the proposed
reasons for this relationship is that parents and children can have similar inclinations for
responding to stress (Walker et al., 1994). Besides parent somatic complaints, parental
dysfunction and emotional stress are characterized with the increased use of pediatric
health services (Roghmann, and Haggerty, 1973). Another reason for the link between
parent and child symptoms is that parents’ pain behavior may be behavioral modeling for
the child (Walker et al, 1993). For example, Walker et al. (1993) noted that studies have
recently found that unexplained or regular occurrences of child pain complaints are more
likely to occur when other family members complain of pain (as cited in Osborne,
Hatcher, and Richtsmeier, 1989).
One of the most important psychosocial factors related to child somatic
complaints are negative life events, or life stress. Apley (1975) believed that episodes of
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pain are generally preceded by stressful events and followed with symptoms of emotional
distress. Apley (1975) also believed that many stressful situations occur in a child’s life
which may lead to outcomes such as acute physical illness, functional complaints, and
emotional disorders. According to Walker et al. (1994), samples taken from different
communities have found that higher levels of life stress are connected with more frequent
episodes of illness (as cited in Beautrais, Ferguson, and Shannon, 1982). A study by
Robinson et al. (1990) found that there is a relationship between stressful life events and
the onset of abdominal pain symptoms in chronic pain patients. Some research even
suggests that a family member can indirectly affect other members of the family by the
stressful life events they experience (Walker et al., 1993, Walker et al., 1994).
Several studies examine negative life events and other psychosocial factors in
pediatric patients evaluated for chronic abdominal pain in medical settings. Studies that
examined the role of psychosocial factors were conducted by Walker et al. in 1993 and
1994. In the study carried out in 1993, Walker et al. compared chronic abdominal pain
patients to patients with organic illness, patients with psychiatric diagnoses, and well
children in regard to factors including competence, negative life events, family
functioning, family illness, emotional and somatic symptomatology, and encouragement
of illness behavior. In relation to negative life events, Walker et al. (1993) found that
chronic abdominal pain patients reported less negative life events than did the psychiatric
patients and about the same number of reports as the well children. The study also found
that chronic pain patients did not report more occurrences of health-related life events
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than the other two groups. These findings suggest that negative life events alone cannot
bring about symptoms in pain patients.
Another study by Walker et al. (1994) carries the previous study further by
examining the role of negative family life events in chronic abdominal patients and three
possible moderator variables: child academic and social competence, gender, and parental
somatic complaints. Results from this study indicate that for children with low levels of
social competence, higher levels of negative life events were associated with more
somatic complaints. In children with high social competence there was no association
between life events and somatic complaints. Parental somatic symptoms also influenced
child somatic complaints. For children whose fathers reported higher levels of somatic
complaints, the child was also found to report higher levels of somatic complaints.
However, a difference was found in the effect of maternal symptoms on boys and girls.
Results found that boys report more somatic complaints when their mothers report higher
levels of somatic symptoms in response to negative life events. Maternal somatic
symptoms did no influence girls’ somatic symptoms. These findings suggest that the
higher the levels of parental somatic symptoms and family life events, the higher the
level of somatic complaints from children.
The effect of negative life events on Functional disability
Negative life events are not only associated with somatic complaints, but also
with functional disability in pain patients. Functional disability is defined as “limitations
in a person’s ability to perform activities relevant to daily life including physical, social,
and personal activities” (Palermo, Long, Lewandowski, Drotar, Quittner, and Walker,
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2008). According to Walker and Greene (1991b), there are many possible uses for
measuring functional disability, including the examination of the course of trauma or
disease on the child’s daily functioning, describing changes in the child’s daily
functioning following intervention, and examining differences in individual patient’s
functioning within certain patient groups. Walker and Greene (1991b) also noted
different measures for assessing functional disability including the Functional Disability
Inventory, questionnaires, activities of daily living scales, and instruments that examine
the patient’s total functional profile.
Limitations of current knowledge
The current body of knowledge on pain and disability that life stress places on
chronic abdominal pain patients is not without limitations. Generally, life stress has been
measured with questionnaires that assess negative life events during the previous year.
This approach poses several limitations for the study of chronic abdominal pain. Most
importantly, negative life events occur at different time intervals throughout the period of
a year, while episodes of chronic abdominal pain could occur across the span of a day
and possibly be preceded by small daily stressors that aren’t included in measures of
negative life events. Also, children’s circumstances can change over the course of a year,
which would affect the relationship of stress and illness in unpredictable ways.
Although life stress is suggested to influence the severity of somatic complaints in
chronic abdominal pain patients, it does not affect each child in the same way. Previous
research has looked at the possibility of competence as a resource that may buffer
individuals from the negative effects of life stress. For example, Compas and Phares
(1991) suggested that higher levels of competence would buffer children from the
NEGATIVE LIFE EVENTS
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negative outcomes of life stress (as cited in Walker, Garber, and Greene, 1994). This
hypothesis was tested by Walker, Garber, and Greene (1994) and results showed that
among children who reported lower levels of social competence, higher levels of negative
life events were related to more somatic complaints at follow-up. On the contrary, among
children with high levels of social competence, life events and the amount of somatic
complaints were not correlated.
The measures used to assess functional disability have limitations as well. First,
there are various ways to measure a patient’s level of functional disability, such as
questionnaires and records of school absence. However, some studies may only consider
one measure of functional disability when examining patients. Another limitation is that
some of the measures for functional disability, for example questionnaires, could be very
general without going into detail about the disability of the patient.
Topic: This study will examine the impact of life stress and perceived
competence on symptoms, emotions, and functioning in adolescents and young adults
who had chronic abdominal pain when they were children. Data analysis will test two
hypotheses: (1) higher levels of personal life stress will be associated with poorer patient
outcomes at follow-up including more emotional symptoms, somatic symptoms, and
disability; and (2) personal competence will moderate the effect of life stress on patient
outcomes, such that life stress will be associated with poorer outcomes in patients with
low competence compared to those with high competence.
Participants: Participants were recruited from the research database containing
850 patients who were participants in a research protocol when they were evaluated for
chronic abdominal pain at the Vanderbilt Pediatric Gastroenterology Clinic during the
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period from 1993 to 2007.They were invited to participate in a follow-up assessment
during the period 2006-2009. The participants were between the ages of 12 and 32 years
during 2006 through 2009 after they had completed the follow-up assessment.
Participants’ telephone numbers, addresses, and permission for additional contact were
obtained from the participants at the time of study entry.
Measures for this study
1. Life Events Questionnaire
The Life Events Questionnaire (LEQ) assesses negative life events in the past
year. This questionnaire includes both distinct life events and chronic stressors that were
experienced by the child over the course of the year. Participants are asked to indicate
which events occurred and the total scores equal the sum of the events (Walker, Garber,
& Greene, 1993, cited in Masten et al., 1988).
2. SF-36 Health Survey
The SF-36 Health Survey assesses functioning and emotions of participants. It is a
multi-purpose, short form health survey composed of only 36 questions. It yields an 8scale profile of functional health and well-being scores as well as psychometrically-based
physical and mental health summary measures. The SF-36 is a generic measure, in that it
does not target a specific age, treatment group, or disease. It has proven to be beneficial
in surveys including general and specific populations, comparing the burden of diseases,
and differentiating the health benefits produced by a number of different treatments
(Ware, Snow, Kosinski, & Gandek, 1993).
3. Child/adult Somatization Inventory (CSI)
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The Child Somatization Inventory assesses the severity of nonspecific somatic
symptoms most commonly reported by children with recurrent abdominal pain. The CSI
includes symptoms from the revised 3rd edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-III-R) and from the somatization factor of the Hopkins
Symptom Checklist. Examples of items from the CSI included “headaches,” “feeling low
in energy”, and “faintness or dizziness”. Respondents are asked to rate the extent to
which they have experienced each of the 35 symptoms in the last 2 weeks using a 5-point
scale ranging from not at all (0) to a whole lot (4). The total score from the CSI can range
from 0 to 140. The CSI reports a three-month test-retest Pearson reliability was reported
as .50 for well patients and .66 for chronic pain patients (Walker, Garber, & Greene,
1993, cited in Garber, Walker, and Zeman, 1991).
4. Functional Disability Inventory
The Functional Disability Inventory assesses the extent to which functional
disability, defined as “difficulty in physical and psychosocial functioning due to physical
health status,” limits the child in different activities. The FDI consists of 15 items
referring to the child’s disability in the past 2 weeks. It includes activities in the domains
of school, home, recreation, and social interaction. The participant rates how difficult it
was for him or her to perform each activity in the past few days along a 5-point severity
scale, ranging from 1 (no trouble) to 5 (impossible). Sample activities include walking to
the bathroom, being at school all day, reading or doing homework, and running the length
of a football field. The FDI was found to have a 3-month test-retest reliability that is
higher than .60 for chronic pain patients. (FDI; Walker & Greene, 1991).
5. Self-Perception Profile for Adolescents/Adults
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The Self-Perception Profile (SPP) for Adolescents/Adults (Harter, 1985) assesses
perceived global and domain-specific competence. For this study we administered the
scale for global self-worth. The global self-worth scale has 6 items. The SPPC has a
response format that ranges from 1 to 4. Children note the extent to which each of the
items is “true” or “not true” for them. Harter reported acceptable levels of internal
consistency and convergent validity for the SPPC. The SPPC was found to have a testretest reliability of .826.
Procedure: In order to recruit for the study, former research participants were sent a
letter introducing the study. A stamped postcard addressed to Vanderbilt was enclosed
indicating that the recipient may “opt-out” of the study by returning the card. If the card
was not returned within 10 days, participants received a recruitment phone call. In this
call, participants (or their parents if they are younger than 18) were given details about
the study and what their participation would entail. During this phone call, participant
eligibility for the study was also assessed. If participants were eligible, they were invited
to participate in the study. For participants who were between the ages of 12 and 17,
consent was obtained from the parent. If the parent gave verbal consent to participate and
to allow their son/daughter to participate, the researcher described the study to the youth
and obtained their verbal assent to participate. At the end of the call, Telephone Interview
#1 was scheduled with participants (and their parents if they were younger than 18).
Participants who could not come to Vanderbilt to complete the full protocol had the
opportunity to consent to the abbreviated protocol that entails Telephone Interview #1,
Telephone Interview #2, and Online Surveys, but does not include the laboratory
protocol.
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Telephone Interview #1
Telephone Interview #1 consisted of questions regarding the participant’s use of
health care services and physical symptoms they had experienced in the past year (for
participants under the age of 18, parents answered the questions about health care system
use). The time required for Interview #1 varied from person to person because some
people experienced many of the symptoms they are asked about and some participants
only experienced a few of the symptoms. The time required for telephone interview #1
ranged from 35 to 65 minutes.
Telephone Interview #2
Telephone Interview #2 consisted of the Anxiety Disorders Interview Schedule
(ADIS). [Participants who completed the full protocol completed the ADIS at Vanderbilt
and did not participate in Telephone Interview #2]. During Telephone Interview #2,
trained research assistants asked questions about the participants’ emotional health.
Participants who were 19 completed the adult version of the ADIS. Participants who were
under 18 completed the youth version of the ADIS and their parent completed the parentreport version of the ADIS in a separate telephone interview that was scheduled with the
parent. The time required for Interview #2 ranged from 40 to 60 minutes.
Online surveys
The Online survey consisted of several questionnaires. These questionnaires
included the McGill Pain Questionnaire, State-Trait Inventory, Center for
Epidemiological Studies-Depression Scale, Pain Beliefs Questionnaire, NEO Personality
Inventory, Self-Perception Profile, Life Events Questionnaire, and the Anger
Expressiveness Inventory.
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Data analysis
Data analysis tests two hypotheses: (1) higher levels of personal life stress
(assessed by the LEQ) is associated with poorer patient outcomes at follow-up including
more emotional symptoms (SF-36), somatic symptoms (CSI), and disability (FDI); and
(2) personal competence (SPP) moderates the effect of life stress on patient outcomes,
such that life stress is associated with poorer outcomes in patients with low competence
compared to those with high competence.
Results
Table 1 lists the Demographic characteristics of the sample from the study. There
were a total of 218 participants, ranging from 12-32 years of age. The range of scores on
the Hollingshead Index was from 9-69, indicating that participants ranged from unskilled
workers to professionals. Regarding gender, 57.8% of the participants in the study were
females, and 41.7% were males. In this study, 90.8% of the participants were Caucasian,
and 7.8% of the participants were categorized as “other”. Table 2 presents the
correlations among study variables (see end notes).
Effect of life stress and competence and their interaction on SF-36 scores, controlling for
age and gender
Table 3 shows results of a multiple regression analysis examining the effect of life
stress and competence and their interaction on the SF-36. Gender was a significant
control variable, with a significant p-value of .042 and a  of .149, showing that males
had higher SF-36 scores (better health) than females. Life events (LEQ) scores also were
significantly associated with the SF-36, with a p-value of .001 and a  score of -.292, thus
illustrating that higher life events were associated with lower SF-36 scores (poorer
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health), and low life events were associated with higher SF-36 scores (better health).
Social competence was also significantly associated with the SF-36. We reported a pvalue 0f .001 and a  of .442. This demonstrated that higher levels of social competence
were associated with higher SF-36 scores.
Effect of life stress and competence and their interaction on CSI scores, controlling for
age and gender
Table 4 illustrates the effects of life stress, competence, and their interaction on
the CSI. Both age and gender were significantly associated with CSI scores; females and
older participants had higher CSI scores. The predictor variables, life events (LEQ) and
social competence were significantly associated with CSI scores as well. We reported a
p-value of .007 and a  score of .188 for the effect of life events on CSI scores. These
results illustrate that higher levels of life stress were associated with higher CSI scores.
For social competence, we reported a p-value of .010 and a  of -.176, indicating that
higher levels of competence were associated with lower CSI scores. We also looked at
the two-way interaction between life events and social competence on CSI scores and
found that this interaction was significant. We reported a p-value of .035 and a  of -.670
for this interaction effect. Figure 1 provides a graphical representation of the two-way
interaction effect of life stress and social competence on the CSI. For participants with
high social competence, CSI scores were low regardless of their level of stress. In
contrast, for those with low social competence, higher levels of stress were associated
with higher CSI scores.
Effect of life stress, competence, and their interaction on FDI scores, controlling for age
and gender
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Table 5 shows the results of multiple regression analysis examining the effects of
life stress and competence on FDI scores. The control variables, age and gender, were
both significantly associated with FDI scores. We reported a p-value of .000 and a 
score of .261 for the relationship between age and FDI scores, indicating that older
children reported more disability than younger children. For the association of gender
with FDI scores, we reported a p-value of .002 and a  score of -.214, showing that
females had higher FDI scores than males. Social competence was also significantly
associated with FDI scores. We reported a p-value of .000 and a  score of -.254,
showing that higher social competence was associated with lower FDI scores.
Discussion
Results of this study provided support for our hypothesis that higher levels of life
stress are associated with more somatic symptoms, emotional symptoms, and disability in
individuals with a history of CAP. These results imply that negative life events are
associated with several aspects of poor health. In our second hypothesis, we looked
further to determine whether competence could serve as a moderator of the effect of life
stress on patient health. We found support for this hypothesis with respect to CSI scores
but not FDI or SF-36 scores. Specifically, participants with high social competence had
lower CSI scores regardless of whether they had low or high stress levels. In contrast,
participants with low social competence and high stress levels had higher CSI scores than
those with low social competence and low stress levels. This finding suggests
implications that life stress does not have a universal effect on individuals; the effect of
stress on somatic symptoms (CSI) is stronger for those with low social competence. This
may be because individuals with low social competence have less support for dealing
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with life stress. However, because our data are cross-sectional, we cannot rule out the
possibility that low social competence contributes to life stress. For example, people
with low social competence might not be skilled at managing relationships with their
boss or co-workers, which could create stress in their workplace.
In addition, there could be other factors not examined in this study that potentially
influence the extent to which high stress levels can have a negative effect on health,.
Other factors such as socio-economic status, peer pressure, the pressure to perform
academically, and community safety could play a role in how stress affects health.
This study had several limitations that should be considered in interpreting our
results. First, competence is a self-report measure. The SPP assesses the extent to which
individuals report whether the items are “true” or “not true”. This poses a problem
because individuals may not be able to accurately give reliable reports of their level of
competence. They could over- or under-estimate the amount of competence they possess.
Second, this was a cross-sectional study, which limits potential conclusions we may be
able to draw regarding causality. Since this study was cross-sectional, we assessed the
participant’s negative life events and health at the same time. For this reason, we do not
know the extent to which life events influenced health or health influence life events.
Third, we assessed life events for the year preceding the interview. People’s personal
situations can change significantly over the course of year, which may affect the
relationship that stress has on illness in variable ways. It is also possible that life events
may not be the actual trigger for symptoms. It could be possible that there are other
contributing events that could influence, or trigger these symptoms before the negative
life event occurs.
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Based on our findings, future studies should now look towards considering other
factors that could potentially moderate levels of stress. These studies could consider
issues such as socio-economic status, access to health care, educational background, and
community awareness and safety. These aforementioned issues can help account for the
third-variable problem such that all factors that could influence stress are considered in
the data analysis. Also, future studies should have prospective designs. Prospective
studies will allow researchers to keep track of changes in participants’ life stress and
health over time, allowing better understanding of how stress and health may influence
each other.
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“References”
Apley, J. (1975). The child with abdominal pains. London: Blackwell.
Beautrais, A., Ferguson, D., & Shannon, F. (1982). Life events and childhood
morbitdity: A prospective study. Pediatrics, 70, 935-940.
Blechman, E. A., Tinsley, B., Carella, E. T., & McEnroe, M. J. (1985). Childhood
competence and behavior problems. Journal of Abnormal Psychology, 94, 70-77.
Claar, R., Walker, L., Smith, C. (1999). Functional disability in adolescents and young
adults with symptoms of irritable bowel syndrome: the role of academic, social,
and athletic competence. Journal of Pediatric Psychology, 24, 271-280.
Cole, S., and Lejune, R. (1972). Illness and the legitimation of failure. American
Sociological Review, 37, 347-356.
Greene, J. W., Walker, L. S.. Hickson, G.. & Thompson, J. (1985). Stressful life events
and somatic complaints in adolescents. Pediatrics. 75, 19-22.
Guite, J. W., Lobato, D. J., Shalon, L., Plante, W., & Kao, B. T. (2007). Pain, disability,
with functional and symptoms among siblings of children abdominal pain.
Journal of Developmental and Behavioral Pediatrics, 28(1), 2-8.
Kristjansdottir, G. (1997). Prevalence of pain combinations and overall pain: a study of
headache, stomach pain and back pain among school-children. Scandinavian
journal of social medicine, 25, 58-63
Mulvaney, S., PhD., Warren Lambert, E., PhD., Garber, J. PhD., & Walker, L. S., PhD.
(2006). Trajectories of Symptoms Impairment for Pediatric Patients With
Functional Abdominal Pain: A 5-Year Longitudinal Study. Child Adolescent
Psychiatry, 45(6), 737-744.
Osborne, R. B., Hatcher, J. W., and Richtsmeier, A. J. (1989). The role of social
modeling in unexplained pediatric pain. Journal of Pediatric Psychology, 14, 4361.
Palermo, T. M., PhD, Long, A. C., PhD, Lewandowski, A. S., MA, Drotar, D., PhD,
Quittner, A. L., PhD, & Walker, L. S., PhD (2008). Evidence-based assessment of
health-related quality of life and Functional impairment in Pediatric Psychology.
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http://www.aap.org/healthtopics/stages.cfm#middle
Robinson, J. O., Alvarez, J. H., & Dodge, J. A. (1990). Life events and family history in
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children with recurrent abdominal pain. Journal of Psychosomatic Research, 34,
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Table 1
Demographic Characteristics of sample (n=218)
Variable
Range
Mean
Std. Deviation
Age
12-32 yrs
21.45
4.48
Hollingshead
9-69
39.14
13.10
Gender
(% female)
57.8%
Gender
(% male)
41.7%
Race
(% Caucasian)
90.8%
Race
(% other)
7.8%
Table 2
Pearson’s Product-Moment Correlations Among Variables
1.
2.
3.
4.
5.
6.
7.
Variable
1
Life stress
Competence
SF-36
CSI
FDI
Age
Gender
--
2
3
4
5
-.246** -.413** .271** .207**
-.502** -.234** -.292**
--.506** -.432**
-.758**
--
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
6
-.026**
-.034
-.052
.180**
.245**
--
7
-.173*
.008
.130
-.253**
-.174**
-.002
--
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Table 3
Effect of life stress and competence and their interaction on SF-36 scores, controlling for
age and gender
Predictor variable

Step 1: Control variables
Age
-.026
Gender
.149
Step 2: Predictor variables
Life events (LEQ)
-.292
Social competence
.442
Step 3: Two-way interaction
Life Events x Social Competence .337
T
p-value
-.361
2.050
.719
.042
-4.721
7.255
.00
.00
1.188
.236
Table 4
Effect of life stress and competence and their interaction on CSI scores, controlling for
age and gender
Predictor variable
Step 1: Control variables
Age
Gender
Step 2: Predictor variables
Life Events (LEQ)
Social competence
Step 3: Two-way interaction
Life Events x Social Competence

T
.175
-.286
2.543
-4.158
.012
.000
.188
-.176
2.713
-2.588
.007
.010
-.670
-2.129
.035*
p-value
*p < .05
Table 5
Effect of life stress and competence and their interaction on FDI scores, controlling for
age and gender
Predictor variable

Step 1: Control variables
Age
.261
Gender
-.214
Step 2: Predictor variables
Life events (LEQ)
.123
Social competence
-.254
Step 3: Two-way interaction
Life Events x Social Competence -.456
T
p-value
3.800
-3.112
.000
.002
1.797
-3.754
.074
.000
-1.453
.148
NEGATIVE LIFE EVENTS
22
Figure 1. The two-way interaction effect of stress and competence on CSI scores
C
S
I
S
C
O
R
E
S
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
HighIV2
competence
High
Low IV2
Low competence
IV 1
LowLow
stress
Highstress
IV1
High
High IV3