What’s the Link Between Chronic Pain and Anxiety, Depression in Youth?

Among youth with vs without chronic pain, anxiety and depression rates are higher, according to the findings of a systematic review and meta-analysis published in the Journal of the American Medical Association Pediatrics.

While increased anxiety and depression has been shown in youth with vs without, the extent to which these individuals differ in their conditions is inconclusive. Further, it is unknown whether other factors that may increase the risk for anxiety and depression in youth moderate this risk.

Researchers sought to identify the prevalence of anxiety and depression in youth with chronic pain and explore whether study and patient characteristics moderate these prevalence rates.

The researchers conducted a systematic review and meta-analysis of MEDLINE, CENTRAL, PsycINFO, and Embase databases from inception through April 2023 for studies in English reporting prevalence data or symptom scores for anxiety and/or depression among individuals younger than age 25 who experience chronic pain. The researchers also assessed reporting bias and the quality of the evidence.

A total of 79 studies (N=12,614 individuals with chronic pain; 10,342 control individuals) were included in analyses (mean [SD] years, 13.7 [2.1] years; age range, 4-24; 74% girls/women). Most studies were conducted in North America. Recruitment was primarily from hospital or tertiary outpatient clinics (52 studies).

Over 12 studies (N=780), the researchers estimated an anxiety diagnosis prevalence of 34.6% (95% CI, 24.0%-47.0%). Across 26 samples from 25 studies (n=5355) reporting on participants who met or exceeded a clinical cutoff on anxiety measures, there was a prevalence estimate of 23.9% (95% CI, 18.3%-30.6%). A greater prevalence of anxiety was noted in samples with a greater ratio of boys/men to girls/women (β = −0.02; P =.03) according to meta-regressions.

Similarly, across 12 studies (N=814) the overall depression diagnoses prevalence estimate was 12.2% (95% CI, 7.8%-18.7%). In 26 studies (N=4868) reporting on participants who met or exceeded a clinical cutoff on depression measures, there was a prevalence estimate of 23.5% (95% CI, 18.7%-29.2%). A higher prevalence of depression above the clinical cutoff was noted in samples that included older youth (β = 0.23; P =.04).

Compared with control individuals, youth with chronic pain had greater symptoms of anxiety (Hedges g, 0.61; 95% CI, 0.46-0.77) and depression (g, 0.74; 95% CI, 0.63-0.85). The researchers noted anxiety and depression may be moderated with sex, age, pain location, and recruitment sample.

All outcomes showed considerable heterogeneity, included studies had a low reporting bias, and outcomes were considered moderate-to-high quality.

Systematic review and meta-analysis limitations included the use of cross-sectional data (unable to examine the onset of anxiety/depression compared with chronic pain), some studies excluded youth suicidality or severe psychological disorders, and the considerable between-study heterogeneity.

The researchers concluded that among youth with chronic pain, “[G]ood mental health and access to timely and effective treatment for youth with chronic pain are critical. Our findings emphasize the importance of screening for anxiety and depression in youth with chronic pain.”

This article originally appeared on Psychiatry Advisor