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Childhood predictors of adult medically unexplained hospitalisations

Results from a national birth cohort study

Guy's, King's and St Thomas' Schools of Medicine and Dentistry, and the Institute of Psychiatry

CHARLOTTE WILSON-JONES, MRCPsych, Specialist Registrar in Psychiatry

Maudsley Hospital, London

RICHARD MAYOU, FCPsych, Professor of Psychiatry

Oxford University

MICHAEL WADSWORTH, PhD, Director

Medical Research Council National Survey of Health and Development and Visiting Professor at the Department of Epidemiology and Public Health, University College London Medical School

SIMON WESSELY, MD, Professor of Epidemiological and Liaison Psychiatry

Guy's, King's and St Thomas' Schools of Medicine and Dentistry, and the Institute of Psychiatry, London

Declaration of interest M.H. was funded on an MRC Clinical Training Fellowship; the MRC funds the National Survey of Health and Development.

Correspondence: Dr M. Hotopf, Department of Psychological Medicine, Guy's, King's and St Thomas' Schools of Medicine and Dentistry, and the Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ. Tel: +44 020 7740 5078; fax: +44 020 7740 5129

Background It has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood.

Aims To test these hypotheses.

Method We used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n=5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15-43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects.

Results The risk set (n=4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7-15 years was.

Conclusions Unexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.

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