according to findings published in JAMA Pediatricsyouth with chronic pain are more likely to develop anxiety or depression than their peers. The study shows that about a third of children under 18 with chronic pain also meet criteria for an anxiety disorder, while about 1/8 meet criteria for a depressive disorder.1
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The findings come from a review of 79 studies that were considered relevant based on event number calculations. Between-group differences in symptoms were calculated and analyzes were performed using a random-effects model with additional reporting bias and recommendations, assessment, development and evaluation assessments. The prevalence of anxiety and depression across studies and their populations was estimated based on diagnosis and clinical cut-offs and differences in symptoms of anxiety and depression.2
The sample included 22,956 young people (average age 13.7 years). [range: 4-24]), of whom 12,614 had chronic pain and the majority of young people were women (74%). The review included conditions in which pain is the primary symptom (eg, juvenile idiopathic arthritis, fibromyalgia), chronic diseases in which pain is a secondary symptom (eg, Crohn’s disease, colitis) and cases where the pain has no known cause.1,2
“Clinically, I saw many young people with chronic pain who were also diagnosed with anxiety and depression, but these co-occurring psychological conditions did not show up in pain studies,” said Joanne Dudeney, Ph.D., a clinical psychologist. , a researcher at Macquarie University’s School of Psychological Sciences, said in a press release.1
According to the results, the prevalence of anxiety diagnoses among youth with chronic pain was approximately 34.6% (95% CI, 24.0%-47.0%) and the proportion exceeding clinical cut-offs was approximately 23.9% (95% CI, 18.3%). -30.6%). The frequency of diagnosis of a depressive disorder was lower, with approximately 12.2% (95% CI, 7.8%-18.7%) of youth diagnosed. In addition, the proportion exceeding clinical cut-off scores was 23.5% (95% CI, 18.7%-29.2%).2
Compared to controls, youth with chronic pain had higher 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 researchers add that subgroup analyzes indicated that setting, pain location, as well as participant age and gender were potential moderators.2
“The findings suggest that we risk doing young people a disservice if we don’t address the accompanying anxiety and depression when they have chronic pain,” Dudeney said in a news release. “The studies were mostly about fear of pain, anxiety about pain, and catastrophizing of pain, which focuses on the worry that the pain will never get better. I thought there was a gap in our understanding, and these kids were showing general symptoms of anxiety and depression, but because they weren’t included in the chronic pain management studies into account, they did not get it into clinical practice.1
In addition, the findings suggest that late adolescence may be an important point in the prevention or intervention of anxiety and depressive symptoms. Because this is a period of transition from pediatric to adult healthcare, and patients may be left without appropriate access to care (eg, age, geographic location, or insurance), researchers call for preventive and preventative measures. alleviate symptoms of poor mental health.2
The researchers note that this review can inform future investigation and research. The data provide a comprehensive assessment of characteristics that may increase vulnerability to anxiety and depression in youth with chronic pain and may provide useful tools for health care providers.1,2
“A simple way to implement this would be for pain physicians to consider a brief screening for anxiety and depression symptoms in young patients,” Dudeney said in a news release. “This is a vulnerable population, and if we don’t address the mental health component, chances are we won’t make the clinical improvements we want to see.”1
REFERENCES
1. Macquarie University. Anxiety and depression associated with chronic pain in children. News publication. 9 September 2024. Accessed 11 September 2024. https://www.eurekalert.org/news-releases/1057184
2. Dudeney J, Aaron RV, Hathway T, et al. Anxiety and depression in youth with chronic pain: a systematic review and meta-analysis. JAMA Pediatrics.Published online 09 Sep 2024. doi:10.1001/jamapediatrics.2024.3039
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