1 in 3 youth with chronic pain diagnosed with anxiety

Key takeaways:

• Among youth with chronic pain, 1 in 3 was diagnosed with anxiety and 1 in 8 was diagnosed with depression.
• Youth with chronic pain had more severe anxiety and depression symptoms than the control group.

Youth with chronic pain experience anxiety and depression symptoms more often and more intensely than their peers without chronic pain, according to findings published in JAMA Pediatrics.

“Many studies report increased anxiety and depression in youth with chronic pain compared with those without. However, findings vary greatly across studies, likely resulting from heterogeneous pain conditions and the use of different measuring tools,” Joanne Dudeney, PhD, a research fellow in the school of psychological sciences at Macquarie University in Sydney, and colleagues wrote. “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.”

Dudeney and colleagues conducted a systematic review and meta-analysis of 79 studies published between 1997 and 2023. The studies included 22,956 youth (74% girls; mean age 13.7 years; range, 4 to 24 years) — 12,614 youth with chronic pain and 10,342 controls.

The researchers investigated the prevalence of mental health conditions like anxiety and depression among youth with chronic pain and calculated the Hedges’ g difference vs. the control group.

According to data from 12 studies with 780 participants, 34.6% (95% CI, 24%-47%) of youth with chronic pain met the diagnostic criteria for anxiety disorder. In addition, among 5,355 participants from 25 studies, 23.9% (95% CI, 18.3%-30.6%) met or exceeded the clinical cutoff for anxiety. Anxiety was less prevalent among youth with head pain compared with youth with abdominal pain.

In 12 studies with 814 participants, 12.2% of youth with chronic pain were diagnosed with a depressive disorder (95% CI, 7.8%-18.7%). The proportion of youth who met or exceeded the clinical cutoff for anxiety was 23.5% (95% CI, 18.7%-29.2%), based on 26 studies with 4,868 participants.

Youth with chronic pain had more severe anxiety and depression symptoms than the control group (g = 0.61; 95% CI, 0.46-0.77; and g = 0.74; 95% CI , 0.63-0.85, respectively).

Age, sex, pain location and recruitment setting appeared to affect symptom severity.

“Of youth with chronic pain presenting for care, one in three will also meet the criteria for an anxiety disorder, and one in eight will meet the criteria for a depressive disorder,” Dudeney and colleagues wrote. “Our findings emphasize the importance of screening for anxiety and depression in youth with chronic pain.”