Youth with Chronic Pain Face Greater Symptoms of Depression, Anxiety than Pain-Free Peers

One in 3 youth with chronic pain meet criteria for anxiety disorder and 1 in 8 meet criteria for a depressive disorder, according to findings from a recent study published in JAMA Pediatrics. Findings also showed that youth with chronic pain experienced greater symptoms of depression and anxiety than their pain-free peers.

Authors of the systematic review and meta-analysis of 79 studies including approximately 12 600 youth with chronic pain found that the overall prevalence of anxiety was 34.6% and the overall prevalence of depression was 12.2%. “These rates are more than 3 times greater than what is seen in the community setting,” first author Joanne Dudeney, PhD, a research fellow and clinical psychologist within the School of Psychological Sciences at Macquarie University in Sydney, and colleagues wrote.

“The findings of this study suggest that anxiety and depression are common clinical comorbidities and should be considered when assessing and treating youth with chronic pain,” Dudeney and colleagues noted.

According to investigators, 1 in 5 youth aged 18 years and younger report chronic pain, and chronic pain is a leading cause of morbidity in this age group. Several studies have shown an increase in anxiety and depression in youth with chronic pain compared to those without chronic pain, but “findings vary greatly across studies, likely resulting from heterogeneous pain conditions and the use of different measuring tools,” Dudeney et al explained. “As such, research has not conclusively documented the extent to which youth with chronic pain present with heightened anxiety and depression compared with their pain-free peers.”

Researchers conducted the current systematic review and meta-analysis of 79 studies published between 1997 and 2023 that included a total of 22 956 individuals aged less than 25 years (74% girls; mean age 13.7 years; range, 4-24 years). Of the total cohort, 12 614 had chronic pain and 10 342 were controls. They determined the prevalence of anxiety and depression diagnoses using event rate calculations and calculated between-group differences in symptoms using Hedges g.

Findings

Overall prevalence of anxiety. Data from 12 studies with 780 participants showed that 34.6% (95% CI 24.0%-47.0%) of youth with chronic pain met the diagnostic criteria for anxiety disorder. Among 5355 participants from 25 studies, 23.9% (95% CI 18.3%-30.6%) met or exceeded the clinical cutoff for anxiety. Moreover, investigators observed a significant difference in the prevalence of anxiety by pain location, with a lower prevalence among youth with head pain compared with those with abdominal pain.

Overall prevalence of depression. Findings from 12 studies with 814 participants showed that 12.2% (95% CI 7.8%-18.7%) of youth with chronic pain met diagnostic criteria for depression. Data from 26 studies with 4868 participants showed that the proportion of youth who met or exceeded a clinical cutoff on depression measures was 23.5% (95% CI 18.7%-29.2%).

Between-group differences in anxiety, depression. A total of 23 studies with 30 independent comparisons reported data no anxiety symptom scores for 4605 participants with chronic pain and 9224 control participants. Results showed that the pooled effect size was significant and medium to large (g = 0.61, 95% CI 0.46-0.77), “suggesting that youth with chronic pain report more severe anxiety symptoms compared with controls,” researchers wrote. They did not find evidence of publication bias and no significant moderators were identified.

With regards to depression, 33 studies with 40 independent comparisons reported symptom scores for pain (n=5128) and control (n=9248) groups. Similar to anxiety, the pooled effect size was significant and medium to large (g = 0.74, 95% CI 0.63-0.85), indicating that participants with chronic pain had more severe symptoms of depression than their pain-free peers. There was no evidence of publication bias, but Dudeney and colleagues found in moderator analyses greater depression symptom severity among youth with chronic pain compared with controls if they were recruited from a community setting vs a clinical setting, and for youth who reported mixed pain sites vs those who reported head pain.

Investigators also noted that considerable heterogeneity was reported for all outcomes, and the studies included in the analysis had a low reporting bias and outcomes were moderate to high quality.

“The results represent a major clinical comorbidity for this population,” Dudeney et al concluded. “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.”

Reference: Dudeney J, Aaron RV, Hathway T, et al. Anxiety and depression in youth with chronic pain: A systematic review and meta-analysis. JAMA Pediatr. Published online September 9, 2024. doi: 10.1001/jamapediatrics.2024.3039