One in 8 Youth With Chronic Pain Meet Criteria for Depression
Chronic pain in youth was associated with an increased risk of anxiety and depression, particularly when compared to symptoms of youth without chronic pain. Results from the systematic review and meta-analysis were published in JAMA Pediatrics.
“The results represent a major clinical comorbidity for this population,” authors noted. “As such, it is imperative that anxiety and depression be considered alongside pain and disability when assessing younger people with chronic pain and, if relevant, that younger people be provided access to timely psychological care to improve pain outcomes alongside mental health.”
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Authors searched MEDLINE, PsycINFO, CENTRAL, and Embase up to April 30, 2023, for studies that reported prevalence data or symptom scores for anxiety and/or depression in people younger than 25 years with chronic pain. Prevalence was determined using event rate calculations and between-group symptom differences were calculated using Hedges g. Analyses were conducted using the random-effects model.
In total, 79 studies were included, providing a sample of 22,965 youth (of which, 12,614 had chronic pain). Of the included youth, the mean age was 13.7 years and 74% were female. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI, 24.0%-47.0%) and the group that exceeded clinical cutoff scores was 23.9% (95% CI, 18.3%-30.6%). The prevalence of depression diagnoses was 12.2% (95% CI, 7.8%-18.7%) and the group that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%). Youth with chronic pain had greater symptoms of anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85) compared with controls. Authors concluded that 1 in 3 youth with chronic pain meet criteria for an anxiety disorder and 1 in 8 meet criteria for a depressive disorder.
Authors noted several limitations. First, the inclusion of cross-sectional data prevented an examination of the temporal relationship between anxiety, depression, and chronic pain, and the potential cyclical association remains unclear. Additionally, only half of the studies were double-rated for reporting bias, and some excluded participants with severe psychological disorders or participants undergoing psychotherapy, which may have led to underreporting. The review also encountered significant between-study heterogeneity and a lack of sufficient reporting on important moderating factors like social determinants, limiting the generalizability of the findings, which predominantly involved White participants from Western countries.