Family adversity and co-occurring pain, psychological, and somatic symptom trajectories from late childhood through early adolescence

This study examined the relative impact of earlier versus proximal childhood exposures to family adversities (parental health problems, family conflict, financial hardship, abuse, violence) and supportive caregiving (warm and supportive parenting behaviors) on youths' symptom trajectories across early adolescence. We used parentreported survey data to differentiate co-occurring Pain, Psychological, and Somatic Symptom (Pain-PSS) trajectories among youth in the longitudinal Adolescent Brain Cognitive Development Study (R) (2016-2022). Family adversities and supportive caregiving were derived from youth and parent surveys and coded as occurring earlier (by age 9-11yrs; baseline) or proximally (occurring during study follow-up years 1-4; by age 11-15yrs). Sequential modeling determined whether proximal exposures mediated the effects of earlier exposures on youths' Pain-PSS trajectories (data reflect adjusted relative risk ratios (adj. RRR [95% confidence interval]). Four Pain-PSS trajectories were differentiated among 7,546 youth, 14.3% of whom were classified with High Pain/ High PSS. Earlier exposure to any family adversity increased the risk for higher Pain-PSS relative to the lowest symptom trajectory (e.g., parental mental health or somatic problems increased the relative risk for a High Pain/ High PSS trajectory to 3.85 [2.84, 5.22] and 5.75 [4.36, 7.58], respectively). Most proximal exposures increased the risk for higher symptom trajectories, fully or partially mediating effects of earlier exposures. Higher proximal supportive caregiving lowered the risk for the High Pain/High PSS trajectory by 80%, fully mediating the impact of earlier caregiving. Findings suggest that family adversities and supportive caregiving may be important interventional targets to lower the risk for co-occurring symptom persistence across early adolescence.