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Abstract

Exploration of somatic symptoms and their correlates among adolescent and young adult African American males are limited in the empirical literature. In the current study, correlates of somatic symptoms among African American males (n = 74) transitioning from a public system of care, namely, foster care, was explored. Potential correlates assessed included indicators of child maltreatment, approach and avoidance coping strategies, as well as the following emotional and behavioral problems: oppositional defiant disorder, conduct disorder, major depressive disorder, and attention-deficit hyperactivity disorder. Results indicated that meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for conduct disorder was related to increased somatic symptoms. In addition, greater use of seeking social support as a coping strategy was related to fewer somatic symptoms. The findings provide a good foundation for further exploration of individual, situational, and contextual factors that may influence the physiological and psychological stress responses of vulnerable populations of young African American males.

Keywords

African American males somatic symptoms emotional and behavioral problems child maltreatment coping

Introduction

Research of somatic symptoms among adolescent and young adult African American males is largely absent in the published empirical literature. This is noteworthy given Franklin’s (1992) assertion that somatic complaints are a natural outgrowth of African American men’s effort to cope with sociocultural stressors. Somatic symptoms can be defined as physical symptoms that are subjectively reported such as muscle pain, headaches, and stomachaches (Hart, Hodgkinson, Belcher, Hyman, & Cooley-Strickland, 2013). Heurtin-Roberts, Snowden, and Miller (1997) suggested that Blacks “express distress in terms of a somatic idiom, such that physical complaints serve as metaphors for psychosocial situation” (p. 339). Extant research has supported this suggestion. Findings based on data from the seminal Epidemiological Catchment Area (EGA) study indicated that somatic complaints were prominent among African American help-seekers (Snowden, 1999). Studying a multiethnic sample (68% African American) of sixth to eighth grade, low-income youth from urban areas, Reynolds, O’Koon, Papademetriou, Szczgiel, and Grant (2001) reported that the most commonly reported internalizing symptom was somatization. Iwata, Turner, and Lloyd (2002), analyzing data from a population-based cohort study of adults, indicated that African Americans endorsed somatic symptomatology more prominently than affective symptomatology. Among African American males transitioning from a public system of care, namely, foster care, this study explored correlates of somatic symptoms.

The literature reviewed below will focus on a number of potential correlates of somatic symptoms, including emotional and behavioral disorders, child maltreatment, and coping. Among varied child and adolescent samples, research suggests that somatic symptoms are related to a number of emotional and behavioral disorders. For example, among boys in a rural Southeastern sample, Egger, Costello, Erkanli, and Angold (1999) reported that somatic complaints, such as stomachaches, were associated with oppositional defiant disorder and attention-deficit hyperactivity disorder (ADHD). Regarding depressive disorders, Bohman et al. (2010), among a Swedish sample of adolescents, indicated that those with depressive disorders reported significantly more somatic symptoms than those with no depressive disorder. Similarly, in a longitudinal study among Dutch adolescents, research by Janssens, Klis, Kingma, Oldehinkel, and Rosmalen (2014) indicated that those reporting greater depressive symptoms were more likely to experience persistent somatic complaints. In a study among an African American adolescent sample, greater somatic symptoms were evident among those who were highly anxious (Kingery, Ginsburg, & Alfano, 2007).

There is research also suggesting that experiencing various types of child maltreatment are related to increased somatic symptoms (Haugaard, 2004). In a study of foster care children in a residential setting, research by Kugler, Bloom, Kaercher, Truax, and Storch (2012) indicated that those who had been sexually abused reported significantly greater somatic symptoms than those with no history of sexual abuse. In this same study, no group differences in the experience of somatic symptoms were reported among children who had or had not been the victims of physical abuse, emotional abuse, or neglect. In contrast, research by Sansone, Wiederman, Tahir, and Buckner (2009), among a convenience sample of young to older male and female outpatients, indicated that those who had experienced physical abuse and emotional abuse reported significantly higher somatic scores than those who had not experienced these types of childhood trauma.

A number of factors are suggested to be consequential for psychological and physiological well-being. One of these factors is coping, which conceptually is either approach or avoidance oriented, and includes behavioral and cognitive dimensions (Roth & Cohen, 1986). Studies examining the relationship between approach and avoidance coping to somatic symptoms are not plenteous, and studies among adolescent and young adult African American males are not evident. Evident are studies among other samples of young adults and adolescents. For example, among a random sample of adults in the Netherlands, Vingerhoets and Van Heck (1990) reported that among males, planning/rational action and positive thinking coping responses were related to lower psychosomatic symptoms, whereas wishful thinking/emotionality coping responses were related to greater psychosomatic symptoms. Using a composite measure of coping responses among Zambian adolescents, Neese, Pittman, and Hunemorder (2013) reported no significant relationship between coping and somatic symptoms. In another recent study among Mexican origin adolescents, Brittian, Toomey, Gonzales, and Dumka (2013) reported that increased use of distraction coping was related to greater internalizing problems that included somatic complaints.

The Current Study

This study was guided by the following research question: What background and psychological factors are correlates of somatic symptoms among African American males transitioning from foster care? Research clearly indicates that rates of emotional and behavioral problems among foster care youth and alumni are significantly greater than their counterparts in the general population (e.g., Pecora, White, Jackson, & Wiggins, 2009). It is not evident in the literature whether foster care youth and alumni experience peculiarities in psychosomatic symptoms. Children and youth in foster care do experience unique developmental challenges (Collins, 2001; Dore, 1999) that might differentially affect their appraisals of social stressors as well as how they respond physiologically and psychologically to those stressors.

In this study, several background factors were assessed: foster care custody status and a history of physical abuse, physical neglect, emotional abuse, and sexual abuse. The psychological factors that were assessed were oppositional defiant disorder, conduct disorder, major depressive disorder, and ADHD. The following approach and avoidance coping strategies were assessed: seeking social support, hide feelings, direct action, and distraction. Due to the exploratory nature of this study, no specific hypotheses were posed.

Method

Participants and Study Procedures

From an ongoing longitudinal study of older foster care youths in the care and custody of state authorities in a Midwestern state, African American males were invited to participate in a separate study that focused on their readiness to seek help for personal, behavioral, or emotional problems upon transitioning from the foster care system. The longitudinal study at baseline consisted of 404 older foster care youth (mean age = 16.99, SD = 0.09), 97 (23.9%) of whom were African American males. Seventy-four (76.3%) of the 97 were successfully contacted and agreed to participate in this study. Results of attrition analysis indicated that the 74 African American male participants did not significantly differ from the 23 in the larger longitudinal study who could not be located on major study variables (e.g., age at entry into foster care, psychiatric history, etc.).

Participants were 18 (N = 68, 91.9%) and 19 (N = 6, 8.1%) years of age. In the larger longitudinal study, the Diagnostic Interview Schedule (Robins, Cottler, Bucholz, & Compton, 1995) was administered face-to-face by lay interviewers to older foster care youth to assess mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) diagnostic criteria. Nearly half of African American males in the present study (45.9%) met criteria for lifetime or past-year mental disorders. The most prevalent disorders were oppositional defiant disorder (28.4%), conduct disorder (20.3%), major depressive disorder (13.5%), and ADHD (13.5%).

Procedures used in the longitudinal study are reported elsewhere (McMillen et al., 2004). For the current study, the first author was provided the names and contact information of African American males in the longitudinal study and contacted them directly to solicit their participation. None of those successfully contacted refused to participate. On providing informed consent, participants were interviewed at their place of residence (n = 66, 89.2%) or by telephone (n = 8, 10.8%). Participants interviewed by phone resided in locales that were a significant distance from the project site (>100 miles). Items from the measures were read aloud to account for reading difficulties. Interviews were conducted from July 2003 to November 2004. All participants were paid $20. The study procedures were approved by a university institutional review board.

Measures

Child Maltreatment

Physical abuse, physical neglect, and emotional abuse were assessed with the Childhood Trauma Questionnaire (Bernstein & Fink, 1998). The Childhood Trauma Questionnaire uses five items to assess each type of maltreatment, with scores ranging from 5 to 25. Youth indicated the extent to which they had been victims of physical abuse (e.g., “When I was growing up, I was punished with a belt, a board, a cord, or some other hard object”), physical neglect (e.g., “When I was growing up, I didn’t have enough to eat), and emotional abuse (e.g., “When I was growing up, people in my family called me things like “stupid,” “ugly,” or “lazy”). Responses were scored on a 5-point, Likert-type scale ranging from never true (1) to very often true (5), with higher total scores indicating greater levels of each type of maltreatment. In a prior study with a sample of male and female street youth, internal reliability estimates were the following: .81 (Physical Neglect), .86 (Physical Abuse), and .83 (Emotional Abuse; Forde, Baron, Scher, & Stein, 2012). For participants in this study, the internal reliability estimates (α) were as follows: .60 for physical neglect, .80 for physical abuse, and .79 for emotional abuse.

Sexual Abuse

To assess sexual abuse history, three items adapted from Russell (1986) and used in a prior study of older foster care youth (Auslander et al., 2002) were used. Youth were asked to indicate (a) if they were ever made to touch someone’s private parts against their wishes, (b) if anyone had ever touched their private parts (breasts or genitals) against their wishes, and (c) if anyone ever had vaginal, oral, or anal sex with them against their wishes? Youth were dichotomized into two sexual abuse history groups: youth responding “yes” to any of the three questions were identified as having a history of sexual abuse (1) and youth responding “no” to all three questions were identified as having no history of sexual abuse (0).

Somatic Symptoms

The Cardiovascular Arousal and Sleep Disturbances scale (CASD; Siegel, 1982) was used to assess somatic symptoms. The CASD consists of 14 items that assess symptoms of cardiovascular arousal (10 items; e.g., shortness of breath, light-headedness) and symptoms of sleep disturbance (4 items; e.g., could not sleep well, hard to fall asleep). Participants reported the extent to which they experienced each symptom in the past 4 weeks on a 4-point, Likert-type scale ranging from never (1) to almost always (4), with higher mean scores indicating greater somatic symptoms. In a study by Johnson and Greene (1991) among a sample of 78 African American males between the ages of 14 and 16, alpha coefficients of .84 for the 10 items comprising cardiovascular arousal and .76 for the 4 items comprising sleep disturbance symptoms were obtained. The CASD also yields a total scale score. In the present study, the internal consistency coefficients (α) were as follows: .74 (cardiovascular symptoms), .74 (sleep disturbance symptoms), and .81 (total scale).

Coping Strategies

Items developed by Pearlin and Schooler (1978) and Thoits (1991) were used to measure dimensions or subtypes of approach and avoidance coping strategies in this study. Participants were asked to indicate if they generally use each of four strategies to cope with stressful situations or experiences on a 4-point Likert-type scale ranging from do not use (0) to use a great deal (3). Seeking social support was measured by three items: (a) ask for the advice of a member of my family or foster family, (b) ask for the advice of a friend, and (c) spend more time than usual doing things with family and friends. Hide feelings were measured by three items: (a) hide my feelings, (b) act as if nothing happened, and (c) wait for the situation or feelings to pass. Direct action was measured by two items: (a) try to face the situation and do something about it and (b) take action to try to change the situation. Distraction was measured by two items: (a) keep busy by doing other things (like watching television, reading books, and going places) and (b) listen to music. Cronbach’s alphas ranged from .65 to .73, indicating fair to moderate reliability.

Data Analysis

Data analysis occurred in the following steps. First, descriptive statistics were computed to provide a profile of the sample on the primary study variables. Second, t tests were conducted to examine differences in somatic symptoms based on categorical variables. Third, correlational analysis was conducted to examine the relationship of continuous variables to somatic symptoms. Simultaneous multiple regression analysis was then conducted with only those variables where a moderate-to-significant bivariate relationship (p < .10) was indicated to examine their relative contribution to somatic symptoms.

Results

Preliminary Analyses

The means, standard deviations, skewness, and ranges of the study variables are reported in Table 1. Exploration of the distributional characteristics of the study variables indicated that none deviated significantly from normality. Results of bivariate analyses (see Tables 2 and 3) indicated that the following variables were related to the experience of somatic symptoms: conduct disorder, seeking social support coping strategies, hide feelings coping strategies, and distraction coping strategies. Specifically, somatic symptoms tended to be greater among participants meeting DSM-IV diagnostic criteria for conduct disorder. In addition, greater use of seeking social support coping strategies was related to fewer somatic symptoms, whereas greater use of hide feelings and distraction coping strategies was related to increased somatic symptoms.

Table 1.

Means, Standard Deviations, Skewness, and Ranges for Primary Study Variables.

Variable	M	SD	Skewness	Obtained range	Possible range
Child maltreatment
Physical abuse—Total	9.62	5.03	0.88	.00-21.00	.00-25.00
Physical neglect—Total	9.05	4.34	0.71	.00-22.00	.00-25.00
Emotional abuse—Total	10.51	5.38	0.69	.00-25.00	.00-25.00
Coping responses
Support seeking	1.55	1.03	−0.03	.00-3.00	.00-3.00
Direct action	1.71	0.74	−0.02	.00-3.00	.00-3.00
Hide feelings	1.09	0.93	0.61	.00-3.00	.00-3.00
Distraction	2.33	0.62	−0.47	1.00-3.00	.00-3.00
Somatic symptoms
Cardiovascular/general symptoms	1.35	0.36	1.52	1.00-2.70	1.00-4.00
Sleep disturbances	1.86	0.79	.97	1.00-4.00	1.00-4.00
Overall CASD	1.50	0.42	1.16	1.00-2.86	1.00-4.00

Note. CASD = Cardiovascular Arousal and Sleep Disturbances scale.

Table 2.

T Tests of Difference in Somatic Symptoms by Categorical Variables.

Variable	Somatic symptoms, M (SD)
Custody status at baseline
Not in MCD custody (n = 29)	1.56 (0.54)
In MCD custody (n = 43)	1.45 (0.32)
Custody differences (t)	1.02
Sexual abuse history
No (n = 62)	1.50 (0.42)
Yes (n = 10)	1.44 (0.44)
Sexual abuse differences (t)	0.43
Oppositional disorder
No (n = 52)	1.46 (0.41)
Yes (n = 20)	1.58 (0.45)
Oppositional disorder differences (t)	−1.03
Conduct disorder
No (n = 59)	1.43 (0.36)
Yes (n = 13)	1.81 (0.53)
Conduct disorder differences (t)	−2.44*
Major depressive disorder
No (n = 62)	1.48 (0.43)
Yes (n = 10)	1.57 (0.33)
Major depressive disorder differences (t)	−0.66
ADHD
No (n = 62)	1.47 (0.42)
Yes (n = 10)	1.64 (0.40)
AD/HD differences (t)	−1.19

Note. ADHD = attention deficit hyperactivity disorder.

p < .05.

Table 3.

Bivariate Correlations Among Primary Continuous Study Variables.

	A	B	C	D	E	F	G	H
A. Physical abuse	—
B. Physical neglect	.29*	—
C. Emotional abuse	.71***	.32***	—
D. Seeking social support	−.02	−.03	−.11	—
E. Direct action	−.16	−.11	−.05	.04	—
F. Hide feelings	.31**	.09	.26*	.01	−.04	—
G. Distraction	.03	.14	.01	.19	.02	.39***	—
H. Somatic symptoms	.12	−.08	.09	−.24*	.19	.29*	.27*	—

p ≤ .05. **p ≤ .01. ***p ≤ .001.

Multiple Regression Analysis Predicting Somatic Symptoms

Table 4 presents results of the simultaneous multiple regression analysis for somatic symptoms with those variables that were significantly or moderately related at the bivariate level. As indicated, a significant amount of variance was explained, R² = .25, adjusted R² = .20, F(4, 66) = 5.42, p = .001. Conduct disorder and seeking social support coping were significant predictors and accounted for 11% of the explained variance, with conduct disorder emerging as the largest unique contributor. Results indicated that meeting diagnostic criteria for conduct disorder was related to increased somatic symptoms. In contrast, greater use of seeking social support coping strategies was related to fewer somatic symptoms.

Table 4.

Simultaneous Regression Results Predicting Somatic Symptoms.

	Β	SE	β	t	Sr²
Conduct disorder (yes = 1)	.27	.12	.25	2.23*	.06
Seeking social support coping	−.12	.06	−.23	−2.08*	.05
Hide feelings coping	.08	.06	.15	1.30	.02
Distraction coping	.16	−.08	.22	1.92⁺	.04

Note. Sr² = semipartial correlation.

p ≤ .05. **p ≤ .01.

Discussion

The purpose of this study was to explore correlates of somatic symptoms among African American males transitioning from a public system of care, specifically, the foster care system. This discussion will first focus on those factors unrelated to somatic symptoms that are inconsistent with previous studies. Those factors that made a significant and unique contribution to somatic symptoms are then discussed.

The degree to which participants were the victims of physical abuse, emotional abuse, and physical neglect was not related to somatic symptoms. In addition, being the victim of sexual abuse was unrelated to somatic symptoms. These findings are inconsistent with previous studies conducted with different population samples. A number of factors might have contributed to the lack of relationship between child maltreatment and somatic symptoms, including divergence in the assessment of child maltreatment as well as somatic symptoms compared to previous studies. Second, how recent the experience of abuse and/or neglect occurred may be pertinent to the experience of current somatic symptoms. Research has suggested that specific clinical outcomes are related to the time during childhood or adolescence that maltreatment occurred (e.g., Kaplow & Widom, 2007).

The duration of the abuse experiences may also be consequential for psychosomatic complaints (Spaccarelli, 1994). Relatedly, how the experience of abuse and neglect is appraised may make a more significant contribution to somatic symptoms than the experience itself. For example, findings by Spaccarelli and Fuchs (1997) in a study among a sample of 11- to 18-year-old girls who were the victims of sexual abuse indicated that the more negative their appraisal of the abuse experience, the greater their psychological symptoms. Among a sample of male inmates, findings indicated that those who met criteria for sexual abuse but did not consider themselves to be abused experienced lower rates of anxiety-based disorders (Fondacaro, Holt, & Powell, 1999). It is important that future research among African American male foster care youth and alumni account for abuse-related factors such as recency, duration, and perception to determine their interrelationships with somatic symptoms.

Conduct disorder emerged as a significant contributor to somatic symptoms. In previous research examining the relationship between emotional and behavioral disorders to somatic symptoms, significant relationships with major depressive disorder, oppositional defiant disorder, and ADHD have been indicated (e.g., Egger et al., 1999). The emergence of conduct disorder as the only significant predictor among the emotional and behavioral disorders assessed in this study might be attributable to a number of factors. The manifestations of conduct disorder are considered more serious and pronounced than other disruptive behavioral disorders with regard to behaviors that not only violate the rights of others but that are also deleterious to personal well-being (Del Valle, Kelley, & Seoanes, 2001). In their elucidation of psychosocial factors linked to disruptive behavior disorders, Burke, Loeber, and Birmaher (2002) noted research suggesting that older youths with conduct disorder tended to report greater stress and to use coping strategies that are more maladaptive. Greater somatic symptoms among older African American male foster youth who met diagnostic criteria for conduct disorder might be attributable to coexisting factors. As further suggested by Loeber and Keenan (1994, p. 515), other “comorbid conditions” explain greater physiological symptoms among those with conduct disorders. Additional research is needed to determine if the relationship between conduct disorder and somatic symptoms replicates among other samples of adolescent and young adult African American males involved with public systems of care.

Findings indicated that one of the four coping strategies contributed significantly to somatic symptoms—seeking social support. Consistent with previous research, seeking social support coping was salutary in that increased use of these strategies was related to fewer somatic symptoms. Thoits (1986) suggested that strategies of social support and methods of coping are “parallel” (p. 417). Social support involves the active participation of agents in (a) helping a person do something to rectify a stressor, (b) altering a person’s perspective about a stressor, and/or (c) helping a person adjust their reaction to a stressor (Thoits, 1986). As such, social support is facilitative of the coping efforts used.

For older foster care youth and young adults whose family and social ties may have been tenuous throughout their state managed care, support seeking may be particularly salutary. From a cultural standpoint, social support is considered an intrinsic hallmark in the African American community (Jewell, 1988). As such, Taylor, Hardison, and Chatters (1996) suggested that African Americans are likely to turn to friends and peers for transient or fluctuating problems versus family members for problems that are long-standing. Young African American males transitioning from foster care are likely to have both short-lived and long-standing problems. Having family and friends with whom they can seek for help may not only facilitate the resolution of stressors but also alleviate physiological and emotional reactivity to them.

Strengths and Limitations

This study has a number of strengths and limitations. In this study, a number of factors that have been reported as correlates of somatic symptoms among varied populations were accounted for. A major strength of the current study is its consideration of a wide range of these factors including child maltreatment and emotional and behavioral problems. A unique population, albeit not generalizable to the general population, was also the focus. African American males are disproportionately represented in child welfare (Lancaster & Fong, 2015) and are often cross-system involved in juvenile justice (Herz et al., 2012). The issues explored in this study may be relevant when considering the experiences and related responses for this population of youth and young adults.

Despite these proposed strengths, a number of limitations are important to point out. The current findings are based on a cross-sectional sample of young African American males who are not representative of those transitioning from the foster care system. Causality cannot be determined, nor can generalizations be made. In addition, a few measures had reliability estimates that were modest. Findings should be viewed with this in mind. Relatedly, a coping measure developed and validated based on an adolescent sample and/or cross-validated across different ethnic/racial populations including African Americans was not used. A central limitation of this study is that it did not account for general stress and stressful life events (e.g., Pieterse & Carter, 2007). This study also did not account for depressive symptomatology, which research indicates is a correlate of somatic symptoms (Campo, 2012; Kapfhammer, 2006). Last, it is important to note that the data collected for this study occurred over a decade ago. Results might differ among contemporary samples of African American male foster youth and alumni. Given the lack of research on somatic symptoms among this population, the findings from this study set a good foundation for future investigations.

Conclusion

Though the findings indicated that conduct disorder and seeking social support coping strategies contributed significantly to somatic symptoms, conclusions cannot be made as to whether these findings are idiosyncratic to young African American males. Similar findings might be evident among Latino and transitioning males from other ethnic and racial groups. Although studying African American males on their own terms is worthy of investigation, future comparative research will be valuable to determine whether similar correlates are evident. More contemporary research is also needed to determine whether somatic symptoms continues to be prominent among varied subpopulations of African Americans than cognitive and emotional symptoms (Hunter & Schmidt, 2010). Kirmayer and Sartorius (2007) asserted, however, that comparative analyses based on ethnic identity is inadequate to tease out ethnocultural nuances in somatic symptoms. Mediators (e.g., expression modes, cognitions, social networks) need to be carefully examined (Kirmayer & Sartorius, 2007 ).

In this study, the majority of the variance in somatic symptoms remained unexplained. There are several important directions future research might pursue. Physiological or psychological stress responses such as somatic symptoms are likely to vary among adolescent and young adult African American males based on individual factors such as their temperament, situational factors such as cognitive appraisal, and contextual factors (Ebata & Moos, 1994). As it pertains to contextual factors, evolving research indicates that stressors connected to the social status, race, and gender of young African Americans are related to negative physiological outcomes (e.g., Brody et al., 2014; Goosby, Malone, Richardson, Cheadle, & Williams, 2015; Grollman, 2012). It is important that future research account for contextual stressors, general stressful life events, as well as perceived stress to examine their relative contribution to somatic symptoms and other indicators of emotional and physical health among young African American males (e.g., Pieterse & Carter, 2007). Last, investigations of the potential moderating and mediating effects of internal factors (e.g., coping responses, helplessness and hopelessness, hostility, racial/ethnic identity) and external factors (e.g., acute and chronic stress, racism-related life events, social support) on the relationship between emotional and physiological reactivity and somatic symptoms are vital areas for future research (Clark, Anderson, Clark, & Williams, 1999; Harrell, 2000).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:

This research was supported by a grant from the National Institute of Mental Health (5R03MH067124-02).

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Correlates of Somatic Symptoms Among African American Males Transitioning From a Public System of Care

Abstract

Keywords

Introduction

The Current Study

Method

Participants and Study Procedures

Measures

Child Maltreatment

Sexual Abuse

Somatic Symptoms

Coping Strategies

Data Analysis

Results

Preliminary Analyses

Multiple Regression Analysis Predicting Somatic Symptoms

Discussion

Strengths and Limitations

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

References