Youth With Chronic Pain May Have More Anxiety and Depression

Young people with chronic pain also have higher rates of depression and anxiety, according to a systematic review and meta-analysis.

In an analysis of 79 studies totaling almost 23,000 youth, the prevalence of anxiety was 34.6% in those with chronic pain, and the prevalence of depression was 12.2%, Joanne Dudeney, PhD, of the Macquarie University in Sydney, Australia, and colleagues reported in JAMA Pediatrics.

Those rates are more than three times greater than observed in the community setting, the authors noted.

These kids also had greater symptoms of anxiety and depression than controls, and the pooled effect size for those differences was medium to large and considered significant, the authors reported. This suggests youth with chronic pain have more severe symptoms of depression or anxiety than their peers without chronic pain, they noted.

“Rates of depression and anxiety are quite high,” co-author Rachel Aaron, PhD, of Johns Hopkins University School of Medicine in Baltimore, told MedPage Today. “A lot of kids with chronic pain are also experiencing these distressing symptoms of depression and anxiety.”

While depression and anxiety appear to overlap with chronic pain at a high level, she noted that the majority of kids with chronic pain don’t have these symptoms. “They’re able to maintain good mental health despite the presence of chronic pain,” she said. “It tells us that chronic pain, in and of itself, is not depressing.”

Still, Aaron said the results suggest the need to improve screening, prevention, and treatment of mental health for youth with chronic pain. Healthcare settings that expect to see youth with chronic pain should also have a streamlined mental health referral program, and mental health providers should seek out training and resources for treating patients with chronic pain as well, she added.

Future research should include more clinical trials dedicated to finding optimal treatment for depression and anxiety that come with chronic pain, Aaron said.

“The psychological therapies that we have for pain to date are not designed to treat depression and anxiety, and there haven’t been a lot of studies that have really developed treatments that are appropriate for kids who have chronic pain and depression,” Aaron said.

To conduct the systematic review and meta-analysis, the authors collected data from 79 studies based on literature searches of MEDLINE, PsycINFO, CENTRAL, and Embase from inception until April 30, 2023. They included 22,956 youth age 25 years — 12,614 of whom had chronic pain and 10,342 controls. The majority were female (74%) and mean age was 13.7 years, with an age range of 4 to 24 years.

They noted that 23.9% of kids with chronic pain had anxiety that exceeded clinical cutoff scores, and 23.5% had depression that exceeded clinical cutoff scores.

Seven diagnostic methods were used in the studies, with the Kiddie Schedule for Affective Disorders and Schizophrenia used most frequently; 24 symptom questionnaires were used, with the Children’s Depression Inventory and Revised Child Anxiety and Depression Scale being the most common.

The authors also noted that some factors may moderate symptoms of anxiety and depression, including a patient’s sex, age, and the location of their pain. They also noted that considerable heterogeneity was reported for all outcomes, and the studies included had low reporting bias overall with moderate-to-high quality outcomes.

The study had several limitations. First, the authors were not able to examine the onset of anxiety and depression symptoms compared with chronic pain because they used cross-sectional data. Some studies in the analysis excluded youth with more severe psychiatric conditions and needs, such as suicidality, severe psychological disorders, or those undergoing psychotherapy. The authors noted those exclusions may have led to underreporting of depression and anxiety prevalence.