Paternal bonding style of psychological denial of autonomy may contribute to subsequent chronic pain in mid-life.
Keywords: Pain course, Parental bonding, Longitudinal study, Cohort, Middle-aged adults
Abstract
Objectives:
Adverse parenting styles during childhood have been shown to contribute to influencing later pain characteristics in clinical populations with chronic pain (CP). However, few studies have addressed this question in the general population. We assessed the associations of perceived parenting styles with incident, persistent, and remitted CP during a 5-year follow-up in middle-aged community-dwellers as well as the potentially moderating effect of sex on these associations.
Methods:
Data stemmed from the 2 first follow-up (FU1, FU2) evaluations of CoLaus|PsyCoLaus, a prospective cohort study conducted in the general population of Lausanne, Switzerland. Parental bonding was assessed using the Parental Bonding Instrument (PBI). The 1,739 participants of this analysis were divided into 4 groups according to their CP status at follow-up: (1) incident CP, (2) persistent CP, (3) remitted CP, and (4) CP free (reference group). The associations between PBI categories (high vs low) and subsequent CP status were assessed using multinomial logistic regressions, controlling for confounding factors including lifetime major depressive disorder, neuroticism, and psychotropic drug use.
Results:
Sex and PBI categories did not interact regarding CP status during follow-up. The only significant main effect was between high levels of denial of autonomy by the father and a higher risk of reporting persistent CP at follow-up (odds ratio: 1.42 [1.05; 1.91] P = 0.02).
Conclusion:
Our results suggest that earlier perceived high psychological denial of autonomy by the father is associated with the subsequent risk of CP in mid-life. Prospective studies following adolescents into adulthood should determine the direction of this association.
1. Introduction
Chronic pain (CP) is a major health problem in the general population, affecting 20% to 50% of adults according to epidemiological studies.18,34 The causes of CP are complex and multifactorial, involving physical, psychological, and social factors.29 Among these, early life experiences may play a critical role in shaping an individual's vulnerability to CP in adulthood.11 One key aspect of early experiences relates to parenting styles. Both epidemiological and clinical studies indicate that exposure to adverse parenting during childhood can affect brain development6 and may increase the risk of diverse psychological8,13,33 or somatic21,22,33 disorders, or maladaptive behaviors in adulthood.26 These findings suggest that childhood environments characterized by poor parental care or overprotection may have long-lasting health implications.
As mentioned, parental “care” and “overprotection” have been identified as significant influencing factors on attachment styles during childhood development.15,31 However, much of the research exploring the relationship between attachment to parents and CP, particularly in conditions like fibromyalgia, has focused on clinical populations.25 There is a need to explore this relationship within broader community samples, where CP is also highly prevalent. In a cross-sectional study, Shibata et al.26 compared the parenting styles of 100 patients with CP aged 35 and over from psychosomatic medical care settings and 200 matched community residents with and without CP. They found higher perceived overprotection and lower perceived parental care in the psychosomatic patients. They also found that the presence of CP was associated with the father's “affectionless control” experienced during childhood after adjusting for current depression.2 Despite these insights, prior research has not fully accounted for important confounding factors, such as the use of psychotropic medications or personality traits like neuroticism that are thought to be associated with both CP and insecure attachment.1,31
Building on this background, the aims of the present study were to assess the associations of perceived parenting styles reported for the first 16 years of life with incident, persistent, and remitted CP during a 5-year follow-up in a cohort of middle-aged community-dwelling participants as well as the potentially moderating effect of sex on these associations, controlling for a series of confounding factors including lifetime major depressive disorder (MDD), neuroticism, as well as psychotropic drug use.
2. Methods
2.1. Study design
Observational Analytic Cohort study.
2.2. Participants
The present data stem from CoLaus|PsyCoLaus, a prospective community-based cohort study designed to investigate cardiovascular risk factors and mental disorders and their associations in middle-aged adults from the general population. The study methods were previously described in detail.10,24 Briefly, CoLaus|PsyCoLaus initially included a sample of 6,734 participants (age range: 35–75 years), randomly selected from the residents of the city of Lausanne, Switzerland, between 2003 and 2006. After the baseline physical and psychiatric assessments, the cohort was followed up 3 times. Since follow-up (FU) 1, which took place between 2009 and 2014, participants were invited to complete pain questionnaires during the physical investigations. Follow-up 1 followed 5.2 (SD 0.5) years after the baseline assessment, and FU2 followed 3.8 (0.4) years after FU1. The present analyses focused on the 1,739 participants who had (1) completed both the pain questionnaire and the psychiatric evaluation at FU1, (2) completed the Parental Bonding Instrument at their psychiatric baseline evaluation, and (3) again completed a pain questionnaire at FU2. The study sample was compared to the overall CoLaus|PsyCoLaus sample who fulfilled the psychiatric assessment at FU1. No significant differences were found between the 2 samples in age, sex, or educational level.
2.3. Measurements
2.3.1. Dependent variable
2.3.1.1. Pain assessments
Participants undertook pain assessments at FU1 and FU2 using the STOPNEP (Study of Prevalence of Neuropathic Pain) questionnaire, an 11-question pain inventory designed and validated for epidemiological studies.4,5 The first 2 screening questions aimed at identifying the presence of daily CP (Have you had everyday pain? For how long have you had pain?), in accordance with the International Association for the Study of Pain,30 defining CP as persistent or recurrent pain lasting for longer than 3 months more than half the time.4,6 The subsequent questions only applied to participants who answered positively to these first 2 questions. Participants had to locate their pain from a list of body parts and to report the location of the most troublesome pain. The remaining 7 questions related to the duration, intensity, and characteristics of the most troublesome pain. These questions were as follows: For how long have you had pain? Did your pain vary in the last 24 hours? Pain duration was divided into 4 categories, ie, <6 months, between 6 and 12 months, between 1 and 3 years, or ≥3 years. The subjects then specified whether the pain varied in intensity during the day and reported the highest, lowest, and average intensity of pain during the past 24 hours, on 3 numerical rating scales (0 = no pain, 10 = worst pain imaginable) from the Brief Pain Inventory.19 The questions were as follows: Can you evaluate Pain at its worst in the past 24 hours? Pain at its least in the past 24 hours? Pain on average in the past 24 hours? Participants were again asked to specify the location of their most painful body part. Subjects were then asked to complete 7 items from the Douleur Neuropathique-4 items (DN-4) scale assessing neuropathic pain characteristics and validated for epidemiological studies (Does your pain have 1 or several of the following characteristics: feeling burns, painful cold, electric shocks, tingling, pins and needles, or itching and numbness). Participants were divided into 4 groups according to the course of CP during a 5-year follow-up: incident CP (no CP at FU1 and CP at FU2), persistent CP (CP at both FU1 and FU2), remitted CP (CP at FU1 and no CP at FU2), and CP free (no CP at FU1 nor FU2).
2.3.2. Independent variables
2.3.2.1. Parental bonding assessment
The perceived parenting styles were assessed during the psychiatric baseline evaluation using the Parental Bonding Instrument (PBI), a widely used self-report questionnaire with 25 items that assess the way individuals perceive their relationships with their parents during the first 16 years of life as recalled at baseline assessment.21,22 The participants are asked to score the attitudes and behaviors of each parent (ie, mother and father) separately using a 4-point Likert scale. The original publication by Parker et al.22 defined a two-factor structure that discriminated between “care” (12 items) and “overprotection” (13 items) for each parent and had a high level of test–retest reliability and internal consistency. However, the psychometric qualities were questioned as subsequent studies suggested different factor structures and factor loadings.17,28 We used the French version of the PBI, which was validated by Mohr et al.19 in parents of school-children from the Lausanne area, yielding a 3-factor solution, including the original “care” dimension reflecting perceived parental warmth, affection, and involvement, but further subdividing the initial “overprotection” subscale into a negative “denial of psychological autonomy” dimension reflecting perceived parental psychological overcontrol and intrusion (eg, “my parent tries to control everything I do”) and a positive pole reflecting an “encouragement of behavioral freedom” dimension favoring psychological autonomy and exploration of the environment (eg, my parent likes me to make my own decisions). This French version showed satisfactory reliability estimates in parents: 0.86 for the care, 0.84 for the denial of psychological autonomy, and 0.72 the encouragement of behavioral freedom factors, respectively.19 In the present analysis, each PBI score was transformed into a binary categorical variable (high vs low) based on its median value.
2.3.3. Covariables
2.3.3.1. Psychological factors
Diagnostic information on mental disorders was elicited at each psychiatric evaluation using the French version16 of the Diagnostic Interview for Genetic Studies (DIGS).20 The French version of this instrument has adequate inter-rater and test–retest reliability for major mood disorders.23 At the follow-up evaluations, a shortened version of the DIGS was used focusing on the period since the last assessment. Lifetime diagnoses of MDD until the first pain assessment were assigned according to the Diagnostic and Statistical Manual of Mental Disorders-fourth version (DSM-IV).14 Participants were classified as currently depressed (ie, meeting DSM-IV criteria for MDD) at the time of the first pain evaluation, remitted (ie, not meeting criteria for MDD at the time of the first pain evaluation, but having previously met these criteria), and never depressed (ie, having never met lifetime criteria for MDD up to the first pain investigation). Neuroticism was assessed using the Eysenck Personality Questionnaire-Revised (EPQ-R),9 which was completed at baseline or the Neuroticism Extraversion Openness (NEO) Five-Factor Inventory (NEO-FFI-R),7 filled in at FU1. If participants had completed the 2 questionnaires, EPQ-R, data were used. To make data from the 2 questionnaires comparable for Neuroticism, the scores were normalized and z-scores were computed.
2.3.3.2. Sociodemographic factors
During the physical evaluations, information was collected on socio-demographic characteristics including age, sex, and education level. Education was categorized into 4 levels, ie, (1) compulsory school (primary education and lower secondary education), (2) apprenticeship (professional secondary education), (3) high school/college, and (4) university level.
2.3.3.3. Drug use
During the physical evaluations, information was also collected on psychotropic drug use (ie, antidepressants, antipsychotics, anxiolytics, hypnotics, psychostimulants, antiepileptics).
Interviewers were master-level psychologists trained over at least a 1-month period. An experienced senior psychologist reviewed all interviews and diagnostic assignments.
2.4. Ethics
The institutional Ethics Committee of the University of Lausanne, which afterwards became the Ethics Commission of the Canton of Vaud (www.cer-vd.ch), approved the baseline CoLaus|PsyColaus study (reference 16/03; 134-03,134-05 bis, 134-05-2 to 5 addenda 1 to 4). The approval was renewed for the first (reference 33/09; 239/09), the second (reference 26/14; 239/09 addendum 2), and the third (PB_2018-00040; 239/09 addenda 3 to 4) follow-ups. The study was performed in agreement with the Helsinki declaration and its former amendments, and in accordance with the applicable Swiss legislation. All participants signed a written informed consent before the assessments.
2.5. Statistical analysis
Participants were divided into 4 groups according to the course of CP during a 5-year follow-up: incident CP, persistent CP, remitted CP, and CP free. Continuous variables were described by means and standard deviations (SD), and ANOVAs or Kruskal–Wallis tests were used to compare the 4 CP groups. Categorical variables were described by numbers and percentages and were compared by χ2 tests. Associations of PBI categories (high vs low) and the course of CP during a 5-year follow-up were established using serially adjusted multinomial logistic regression analyses. The multinomial logistic regression models were fitted with CP free as the reference level of the four-level outcome. Model 1 was adjusted for sex, age, education level, current, and remitted MDD at FU1 and psychotropic drug use at FU1 and FU2. Model 2 was additionally adjusted for neuroticism.
The results of all the tests were considered as significant at the P < 0.05 level. All statistical analyses were conducted using the SPSS software version 21 (SPSS Software, Chicago, IL).
3. Results
3.1. Descriptive results
The baseline socio-demographic and clinical characteristics of the participants according to CP status during the 5-year follow-up are presented in Table 1. Age, sex, educational level, lifetime MDD, the use of psychotropic drugs, PBI subscores (except from care from the father), and the level of neuroticism were all significantly different across the CP groups.
Table 1.
Characteristics of the sample according to the course of chronic pain during a 5-year follow-up.
| Total | Incident CP | Persistent CP | Remittent CP | CP free | Statistic* | P | |
|---|---|---|---|---|---|---|---|
| n = 1739 | n = 508 | n = 215 | n = 306 | n = 710 | |||
| Socio-demographic factors | |||||||
| Age at FU1 (y), mean (SD) | 55.6 (9.1) | 55.6 (8.7) | 57.6 (9.0) | 55.7 (9.3) | 54.1(9.0) | F = 14.3 | <0.0001 |
| Men, n, (%) | 756 (43.5) | 98 (45.6) | 176 (34.6) | 129 (42.2) | 353 (49.7) | χ2 = 27.98 | <0.0001 |
| Education level, n (%) | |||||||
| Compulsory school | 171 (9.8) | 19 (8.8) | 61 (12.0) | 32 (10.5) | 59 (8.3) | χ2 = 31.07 | <0.0001 |
| Apprenticeship | 630 (36.2) | 72 (33.5) | 202 (39.8) | 113 (36.9) | 243 (34.2) | ||
| Higher education (except for university) | 523 (30.1) | 72 (33.5) | 164 (32.3) | 82 (26.8) | 205 (28.9) | ||
| University | 415 (23.9) | 52 (24.2) | 81 (15.9) | 79 (25.8) | 203 (28.6) | ||
| PBI subscores, mean (SD) | |||||||
| Care mother | 24.84 (8.51) | 25.19 (8.13) | 23.85 (8.98) | 25.38 (8.09) | 25.02 (8.48) | F = 33.8 | 0.02 |
| Care father | 22.01 (8.70) | 22.61 (8.24) | 21.38 (9.223) | 21.62 (8.85) | 22.31 (8.44) | F = 1.69 | 0.17 |
| Denial of autonomy mother | 6.00 (4.43) | 6.11 (4.43) | 6.52 (4.51) | 5.73 (4.38) | 5.66 (4.35) | F = 4.07 | 0.007 |
| Denial of autonomy father | 4.46 (3.64) | 4.48 (3.91) | 5.00 (3.69) | 4.40 (3.58) | 4.09 (3.47) | F = 5.92 | 0.001 |
| Encouragement of freedom mother | 9.76 (4.16) | 9.95 (4.11) | 9.26 (4.36) | 9.56 (4.04) | 10.09 (4.06) | F = 4.36 | 0.005 |
| Encouragement of freedom father | 9.88 (4.37) | 10.06 (4.26) | 9.33 (4.44) | 9.57 (4.30) | 10.27 (4.39) | F = 4.92 | 0.002 |
| Psychotropic drugs† at FU1, n (%) | 234 (13.5) | 25 (12.5) | 112 (22.0) | 37 (12.1) | 58 (8.2) | χ2 = 49.90 | <0.0001 |
| Lifetime MDD at FU1, n (%) | |||||||
| Current | 114 (6.6) | 7 (3.3) | 55 (10.9) | 18 (5.9) | 34 (4.8) | χ2 = 46.46 | <0.0001 |
| Remitted | 695 (40.1) | 79 (36.7) | 230 (45.5) | 133 (43.5) | 253 (35.8) | ||
| Never | 924 (53.3) | 129 (60.0) | 221 (43.7) | 155 (50.7) | 419 (59.3) | ||
| Neuroticism (z-score), mean (SD) | −0.18 (0.98) | −0.04 (0.83) | 0.31 (0.98) | 0.01 (0.96) | −0.25 (0.97) | F = 33.71 | <0.0001 |
| Psychotropic drugs† at FU2 n, (%) | 261 (15.0) | 34 (15.8) | 123 (24.2) | 48 (15.7) | 56 (7.9) | F = 62.18 | <0.0001 |
Statistical test for the different subgroups Anova (F); Pearson (χ2). Significant results are indicated in bold.
Psychotropic drugs: antidepressant, antipsychotics, anxiolytics, hypnotics, psychostimulants, antiepileptics.
CP free, no CP at FU1 and FU2; CP, chronic pain; FU1, follow-up 1; FU2, follow-up 2; Incident CP, no CP at follow-up (FU) 1 and CP at FU2; MDD, major depressive disorder; persistent CP, CP at both FU1 and FU2; remittent CP, CP at FU1 and no CP at FU2; PBI, parental bonding instrument; SD: standard deviation.
3.2. Relationship between parental bonding and the course of chronic pain during a 5-year follow-up
Using multinomial logistic regression models, we first tested for interactions between sex and PBI categories regarding CP status during the 5-year follow-up. However, none of the tested interaction terms reached the level of statistical significance. Hence, no subgroup analysis is presented and the models contain only the main effects.
The associations between PBI categories and CP status during the 5-year follow-up are displayed in Table 2. After adjustment for sex, age, educational level, lifetime MDD at FU1, and psychotropic drugs at FU1 and FU2, there was only 1 significant association between perceived parenting attitudes and CP status during follow-up: participants with a high paternal level of denial of autonomy reported a higher probability of persistent CP during the 5-year follow-up than those with a low level of denial of autonomy. This association also remained significant after additional adjustment for neuroticism (Model 2).
Table 2.
Association between parental bonding instrument categories at baseline and chronic pain status at the follow-ups—multinomial logistic regression models.
| PBI categories * | Model 1 OR (95% CI) | Model 2 OR (95% CI) | ||||
|---|---|---|---|---|---|---|
| Incident CP | Persistent CP | Remitted CP | Incident CP | Persistent CP | Remitted CP | |
| Care mother | 0.98 (0.71; 1.37) P = 0.92 |
0.93 (0.69; 1.25) P = 0.64 |
0.87 (0.60; 1.26) P = 0.45 |
1.03 (0.74; 1.43) P = 0.89 |
0.98 (0.73; 1.32) P = 0.90 |
0.89 (0.61; 1.29) P = 0.54 |
| Care father | 1.05 (0.76; 1.45) P = 0.78 |
0.93 (0.70; 1.24) P = 0.64 |
1.01 (0.70; 1.46) P = 0.96 |
1.08 (0.78; 1.50) P = 0.64 |
1.02 (0.76; 1.37) P = 0.88 |
1.06 (0.73; 1.54) P = 0.75 |
| Denial mother | 1.26 (0.90; 1.76) P = 0.18 |
0.95 (0.71; 1.28) P = 0.74 |
1.02 (0.70; 1.49) P = 0.91 |
1.20 (0.85; 1.68) P = 0.30 |
0.85 (0.63; 1.15) P = 0.30 |
0.97 (0.66; 1.41) P = 0.85 |
| Denial father | 1.10 (0.79; 1.54) P = 0.56 |
1.52 (1.13;2.04)
P = 0.006 |
1.09 (0.75; 1.59) P = 0.66 |
1.06 (0.76; 1.48) P = 0.74 |
1.42 (1.05;1.91)
P = 0.02 |
1.06 (0.72; 1.54) P = 0.78 |
| Freedom mother | 1.11 (0.78; 1.58) P = 0.58 |
0.99 (0.72; 1.35) P = 0.93 |
1.24 (0.83; 1.86) P = 0.30 |
1.09 (0.76; 1.55) P = 0.65 |
1.06 (0.72; 1.55) P = 0.77 |
1.24 (0.83; 1.87) P = 0.29 |
| Freedom father | 1.20 (0.84; 1.70) P = 0.31 |
1.06 (0.79; 1.45) P = 0.69 |
0.81 (0.54; 1.20) P = 0.28 |
1.17 (0.82; 1.67) P = 0.38 |
1.03 (0.75; 1.41) P = 0.86 |
0.80 (0.54; 1.19) P = 0.27 |
Model 1 was adjusted for age, sex, education, psychotropic drugs at FU1 and FU2, and lifetime MDD, and model 2 was additionally adjusted for neuroticism. The multinomial logistic regression models were fitted with no chronic pain at FU1 and FU2 as the reference level. Significant results are indicated in bold.
Each of the PBI categories were dichotomized according to their median score. Care Mother: Care from the mother; Care Father: Care from the father; Denial Mother: Denial of autonomy from the mother; Denial Father: Denial of autonomy from the father; Freedom Mother: Encouragement of freedom from the mother; Freedom Father: Encouragement of freedom from the father.
95 CI, 95% confidence interval; CP free, no CP at FU1 and FU2; CP, chronic pain; Incident CP, no CP at follow-up (FU) 1 and CP at FU2; OR, odds ratio; PBI, parental bonding instrument; persistent CP, CP at both FU1 and FU2; remitted CP, CP at FU1 and no CP at FU2; MDD, major depressive disorder.
4. Discussion
To our knowledge, the present study is among the first to assess the relationship between parental bonding and the probability of incident and persistent CP in a large sample from the general population, considering various potential confounding factors including current or remitted MDD, personality traits, and psychotropic medication use. Our main findings are that (1) a high level on the parental bonding dimension denial of autonomy by fathers reported for the first 16 years of life was associated with a higher probability of persistent CP in mid-life over a 5-year follow-up; (2) the strength of this association did not differ between men and women; and (3) this association was independent of lifetime MDD and neuroticism.
4.1. Parental bonding and chronic pain
Our findings are partly consistent with those of an earlier community study, assessing the relationship between parental bonding and the presence of CP in middle-aged adults.2 These authors combined the PBI's care and overprotection items to create categories of optimal (high care and low overprotection) and nonoptimal parenting (ie, “affectionless control” defined by low care and high overprotection, “affectionate restraint” defined by high care and high overprotection, and “neglectful parenting” defined by low care and low overprotection). A significantly higher proportion of CP was observed in the father's “affectionless control” group, compared with the optimal parenting group. No relationship was found with the mother's parenting role. These findings are compatible with our results that showed the fathers' denial of autonomy to be associated with more persistent CP, independently of depression and neuroticism. In our study, as well as in the one by Anno et al., the association between paternal bonding and CP remained significant even after adjusting for depression. It could be linked to a differential mechanism concerning the influence of both parents on the development of their offspring's coping strategies: mothers tend to favor emotional security, whereas fathers tend to encourage independence and adventureness. Fathers are more likely to promote active, autonomous, and curious attitudes in their children, encouraging them to be independent and adventurous. This coping mechanism will allow children to deal with difficult situations such as CP. Conversely, fathers who deny their children of autonomy might prevent this mechanism from developing.
We found no association between the levels of perceived maternal and paternal care and the probability of persistent CP. In a study comparing patients with fibromyalgia (FM) with healthy controls (HCs), patients with FM had lower scores on the maternal and paternal care subscales and higher scores on the maternal and paternal overprotection subscales of the PBI than HC.12,25 However, the maternal and paternal care PBI scores of our CP subjects (Table 1) were higher than those of patients with FM and were similar to those of healthy controls in previous studies.
Shibata et al. compared the rates of people with “affectionless parenting” in 4 groups of participants, ie, 2 groups of subjects from the community with and without CP and 2 groups of patients with CP recruited in pain centers.26 Conversely to our results, no significant relationship was found regarding the level of “affectionless control” between the community subjects with and without CP. But in their study, patients with CP attending pain centres reported a higher level of “affectionless control” by both the mother and the father compared to community-dwellers without pain. In the same way, Avagianou et al.3 found that in 65 adult patients with CP from a tertiary pain management unit, the patients who reported experiencing low parental care and high parental control in childhood, especially from mothers, had higher pain intensity scores than did patients with healthy parental bonding in childhood.
Uncaring parents may have an effect on a child's self-esteem as he or she is continuously seeking recognition that never comes. The child would not feel supported, buoyed by the ontological confidence conferred by loving, available, and attentive parents. If children are hurt and confronted with an inadequate parental response, either absent or excessive, they may be disoriented as to the meaning of what they are experiencing and their perceptions might be blurred. As a result, they may remain in an ambiguous relationship with their pain possibly lasting into adulthood. In sum, inconsistent and unpredictable attachment styles may disrupt the child's sense of continuity.
The overprotective parent who does not encourage independence can play a pathogenic role in the child's experience of future pain perception, with a negative impact on the ability to cope with new aversive stimuli during childhood. We can speculate that they may induce a maladaptive perception of stimuli in their children when minimizing or denying their pain. The children, once grown up, will misinterpret the origin of pain. One might also hypothesize that, in turn, overprotective parents may themselves be more sensitive to stress and prompt their children to become hypervigilant through mimicry, ultimately resulting in a decrease of their pain threshold. In the same vein, a previous study focusing on pelvic CP identified a positive correlation between maternal overprotection and pain catastrophizing, and a negative correlation between maternal and paternal care with anxiety and depression in women with pelvic CP.27
4.2. Limitations
Our research needs to be viewed in the context of several limitations. First, parental bonding was assessed retrospectively by asking participants about their experiences during childhood and adolescence. Although previous findings revealed long-term stability and adequate test–retest reliability of the PBI over time,32 we cannot rule out the possibility that recall bias might have influenced our results. Second, given that the onset of persistent CP was not assessed, we cannot determine whether paternal attitudes during childhood contributed to the persistence of CP in adulthood or whether the presence of persistent CP influenced recall of paternal parenting style. Third, we did not assess the specific causes of pain, which is of importance as primary CP (ie, CP that is driven by the pain signaling network and can exist even in the absence of tissue damage) rather than secondary CP (ie, CP related to underlying diseases) may be favoured by psychological factors such as unhealthy attachment patterns to parents.28,31
5. Conclusion
To sum it up, our cross-sectional data suggest that the paternal bonding category of high denial of autonomy reported until the age of 16 years is associated with a higher probability of persistent CP in adulthood in the general population. This association did not differ between men and women and was not explained by current or remitted MDD or neuroticism. In contrast, no other parenting attitude from either the mother or the father was associated with CP over a 5-year follow-up. Prospective studies of youngsters followed up into adulthood are needed to determine the direction of the association between paternal denial of autonomy and subsequent persistent CP.
Disclosures
The authors have no conflict of interest to declare.
Acknowledgements
The CoLaus|PsyCoLaus study was and is supported by unrestricted research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (grants 3200B0-105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468, 33CS30-148401, 33CS30_177535, and 3247730_204523) and the Swiss Personalized Health Network (grant 2018DRI01).
Data availability statement: Data sets are available from the corresponding author upon reasonable request.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Contributor Information
Jean-Michel Dorey, Email: jean-michel.dorey@ch-le-vinatier.fr.
Marie-Pierre F. Strippoli, Email: marie-pierre.strippoli@chuv.ch.
Bernard Laurent, Email: blaurent480@gmail.com.
Caroline L. Vandeleur, Email: caroline.vandeleur@chuv.ch.
Setareh Ranjbar, Email: setareh.ranjbar@chuv.ch.
Elodie Pongan, Email: elodie.pongan@chu-lyon.fr.
Armin von Gunten, Email: armin.von-gunten@chuv.ch.
Martin Preisig, Email: martin.preisig@chuv.ch.
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