Study Finds Associations Between Chronic Pain and Anxiety, Depressive Symptoms in Youths
The authors urge that screening, prevention, and treatment of anxiety and depression should be important health care priorities for youth who have chronic pain.
According to findings published in JAMA Pediatrics, young people who have chronic pain are also more likely to have anxiety or depression compared with their peers. The study shows that about a third of children under the age of 18 years with chronic pain also meet the criteria for an anxiety disorder, whereas about 1 in 8 meet the criteria for a depressive disorder.1
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The findings come from a review that included 79 studies that were deemed relevant using event rate calculations. Between-group symptom differences were calculated, and analyses were conducted using the random-effects model, with additional reporting bias and Grading of Recommendation, Assessment, Development, and Evaluation assessments being conducted. The studies and their populations were evaluated for the prevalence of anxiety and depression based on diagnosis and clinical cutoff scores, as well as differences in symptoms of anxiety and depression.2
The total sample included 22,956 youth (mean age: 13.7 years [range: 4-24]) of which 12,614 had chronic pain and the majority of youths were female (74%). Conditions in which pain is the primary symptom (eg, juvenile idiopathic arthritis, fibromyalgia), chronic diseases where pain is the secondary symptom (eg, Crohn disease, colitis), and cases where the pain has no known cause were included in the review.1,2
“Clinically, I was seeing a lot of young people with chronic pain who were also being diagnosed with anxiety and depression, but those comorbid psychological conditions weren’t showing up in the body of research on pain,” Joanne Dudeney, PhD, clinical psychologist, research fellow in the School of Psychological Sciences, Macquarie University, said in a news release.1
According to the findings, the prevalence of anxiety diagnoses among youths with chronic pain was approximately 34.6% (95% CI, 24.0%-47.0%), and the portion that surpassed clinical cutoff scores was about 23.9% (95% CI, 18.3%-30.6%). The frequency of depressive disorder diagnoses was lower, with approximately 12.2% (95% CI, 7.8%-18.7%) of youths receiving diagnoses. In addition, the portion that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%).2
Compared with controls, youths with chronic pain had greater symptoms of both anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85). The investigators add that subgroup analyses have revealed setting, pain location, as well as participant age and sex were potential moderators.2
“The findings indicate we risk doing young people a disservice if we’re not considering comorbid anxiety and depression when they’re presenting with chronic pain,” said Dudeney in the news release. “The research mostly related to fear of pain, pain anxiety, and pain catastrophization, which centers on the concern that the pain will never get better. I thought there was a gap in our understanding, and these kids were presenting with general symptoms of anxiety and depression, but because these weren’t being considered in the research for managing chronic pain, they weren’t making it into clinical practice.”1
Further, the findings highlight that late adolescence can be a significant point for prevention or intervention of anxiety and depressive symptoms. Because this is a period in which transitions from pediatric to adult health care occurs and patients can be left without appropriate access to care (because of factors such as age, geographic location, or insurance), the investigators urge that proactive and preventative actions are made to mitigate the onset of poor mental health symptoms.2
The investigators note that this review can help serve as a foundation for future investigation and research. The data present a comprehensive evaluation of characteristics that may heighten vulnerability to anxiety and depression in youths with chronic pain, and can serve as a useful tool for health care providers.1,2
“A simple way to put this into practice would be for pain practitioners to consider a short screening assessment for symptoms of anxiety and depression in young patients,” said Dudeney in the news release. “This is a vulnerable population, and if we’re not considering the mental health component, it’s likely we’re also not going to achieve the clinical improvements we want to see.”1
