Functional gastrointestinal disorders are among the most common diagnoses in paediatric medicine, encompassing conditions such as functional abdominal pain, irritable bowel syndrome, and functional constipation, defined clinically by the Rome IV criteria. Because no structural, biochemical, or inflammatory abnormality explains the symptoms, these disorders have long sat at the intersection of gastroenterology and psychology. Within the biopsychosocial framework that now dominates thinking about FGIDs, the family environment is recognised as a powerful modulator of how a child experiences and expresses symptoms. Yet most previous research compared families of affected children only with healthy families, making it impossible to tell whether elevated parental distress reflected something specific to functional illness or merely the universal stress of raising a child with a chronic gastrointestinal condition.

The Basel team, led by Anna Geser and Sebastian Weber of the Faculty of Medicine at the University of Basel, together with senior authors Margarete Bolten and Eva Unternaehrer, set out to disentangle these possibilities. Between February 2024 and February 2025, they recruited 65 parents of children aged two to twelve years whose FGIDs had been diagnosed according to Rome IV criteria. Two comparison groups were assembled at the same hospital: 62 parents of children with organic gastrointestinal diseases, in which a structural or biological cause had been identified, and 90 parents of healthy children. By including an organic disease control group, the design could separate the specific psychosocial signature of functional illness from the broader caregiving burden of chronic paediatric disease.

Each parent completed three well-validated psychometric instruments. Psychological distress was measured with the four-item Patient Health Questionnaire (PHQ-4), which screens jointly for anxiety and depression. Somatic symptom burden — the tendency to experience and report physical symptoms such as pain, fatigue, or gastrointestinal complaints — was assessed with the eight-item Somatic Symptom Scale (SSS-8). Personality traits were captured with the ten-item Big Five Inventory (BFI-10), from which the researchers extracted neuroticism, the disposition toward emotional instability and negative affect. Because the score distributions were skewed, the team applied non-parametric Kruskal–Wallis tests for initial group comparisons and then refined their estimates using covariate-adjusted negative binomial regression models, reporting incidence rate ratios with appropriate confidence intervals and checking model assumptions with variance inflation factors and Akaike information criteria.

The results were unambiguous. Parents of children with FGIDs scored significantly higher than both comparison groups on all three measures, with differences reaching statistical significance at p < 0.01. In the adjusted regression models, both the organic disease group and the healthy group showed consistently lower scores relative to the FGID group, with incidence rate ratios ranging from 0.31 to 0.77 — a substantial gap that survived correction for demographic and clinical covariates. In practical terms, parental anxiety and depression screening, based on the two subscales of the PHQ-4, yielded the highest positive rates in the FGID group, at roughly 17 percent for anxiety and about 25 percent for depression, well above the levels observed among parents of children with identifiable organic disease.

The neuroticism finding is particularly striking because personality traits are typically considered stable dispositions rather than situational responses. Elevated neuroticism among parents of children with FGIDs cannot plausibly be explained as the transient stress of hospital visits, since parents of children with equally chronic organic gastrointestinal disease did not show the same elevation. One plausible interpretation, consistent with the biopsychosocial model, is that neuroticism and functional illness cluster within families: the same dispositional sensitivity to negative emotion that shapes a parent’s own experience may influence how symptoms are perceived, interpreted, and amplified in the child. Previous research on familial aggregation of pain and somatic complaints has repeatedly suggested that children of parents with high somatic symptom reports tend to report more symptoms themselves, a pattern of modelling and reinforcement that could be especially relevant when the child’s symptoms are, by definition, not explained by observable pathology.

The somatic symptom data add an important mechanistic nuance. In the initial comparisons, parents of children with FGIDs reported a markedly higher somatic symptom burden than either control group. However, when the researchers added psychological distress as an additional covariate, the differences in somatic symptom scores were attenuated. This statistical pattern suggests that the elevated physical symptom reporting among these parents is substantially intertwined with — and possibly mediated by — their anxiety and depressive symptoms. In other words, the parents’ bodily complaints and emotional distress may represent two faces of the same underlying vulnerability, a coupling that mirrors the gut–brain interaction hypothesised to drive the children’s own functional symptoms.

The clinical implications are considerable. If parents of children with FGIDs carry a distinct psychosocial risk profile, then treating the child in isolation may miss a critical lever for recovery. The authors argue that their findings highlight the importance of family-centred approaches to paediatric FGID care, in which parental distress, somatic symptom awareness, and maladaptive illness behaviour are assessed and addressed alongside the child’s symptoms. Screening instruments as brief as the PHQ-4 could feasibly be administered during a routine paediatric gastroenterology visit, identifying families who might benefit from psychological support, psychoeducation about the gut–brain axis, or targeted interventions that reduce parental anxiety about the child’s unexplained symptoms. Such measures could interrupt the feedback loops in which parental concern heightens child symptom focus, which in turn intensifies parental distress.

The study’s cross-sectional design imposes limits on interpretation: elevated parental neuroticism, distress, and somatic symptoms could contribute to the child’s disorder, arise in response to it, or, most likely, reflect bidirectional influences over time. The modest sample sizes — 65, 62, and 90 parents — while adequate for the statistical models employed, leave room for uncertainty in subgroup estimates, and all data derive from self-report questionnaires at a single Swiss tertiary centre. Longitudinal and genetically informed designs will be needed to establish causal direction. Nevertheless, by showing that the parental psychosocial burden in paediatric FGIDs exceeds that seen in organic gastrointestinal disease of comparable chronicity, the Basel team has strengthened the case that functional disorders are genuinely systemic family phenomena. For clinicians confronting a child’s debilitating abdominal pain with no biological explanation, the message is that the family context is not background noise but an active ingredient in the illness — one that rigorous, empathetic assessment can begin to address.

Subject of Research: Parental psychological distress, somatic symptoms and neuroticism in paediatric functional gastrointestinal disorders

Article Title: Parental psychological distress, somatic symptoms and neuroticism in paediatric functional gastrointestinal disorders: comparison with organic and healthy controls

Article References: Geser, A., Weber, S., Légeret, C., Furlano, R., Bolten, M., & Unternaehrer, E. (2026). Parental psychological distress, somatic symptoms and neuroticism in paediatric functional gastrointestinal disorders: comparison with organic and healthy controls. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07681-x

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07681-x

Keywords: functional gastrointestinal disorders, gut-brain interaction, parental distress, somatic symptoms, neuroticism, paediatrics, Rome IV criteria, anxiety, depression, biopsychosocial model, Parental, psychological