Exploring the associations between the presence, characteristics, and biopsychosocial covariates of pain and lifetime depression in adolescents: A cross-sectional ABCD study analysis.

Introduction: Depression and pain co-occur, even during adolescence. However, there is limited knowledge on the association between pain and lifetime depression, and which biopsychosocial measures are associated with this co-occurrence.

Methods: Cross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) two-year follow-up. We explored associations between the presence and characteristics of past month pain (intensity, duration, activity limitations, and number of pain sites) and lifetime depression using logistic regression. We explored associations of brain structure, physical, behavioural, emotional, social, and cognitive measures with lifetime depression and past month pain compared to having had one or neither condition using multinomial logistic regression.

Results: A total of 5211 adolescents (mean age = 12.0 years) who had: (1) no lifetime mental ill-health and no pain (n = 3327); (2) pain only (n = 1407); (3) lifetime depressive disorder but no pain (n = 272); and (4) lifetime depressive disorder and pain (n = 205) were included. Pain presence was associated with lifetime depression (OR[95%CI]: 1.76 [1.45, 2.13], p < 0.001). Pain-related activity limitations (1.13 [1.06, 1.21], p < 0.001) and the number of pain sites (1.06 [1.02, 1.09], p < 0.001) were associated with lifetime depression. Various behavioural, emotional, social, and cognitive, but not brain structure or physical measures, were associated with lifetime depression and past month pain.

Limitations: Longitudinal analyses should validate prognostic markers for predicting co-occurring depression and pain.

Conclusions: Results support an association between the presence and characteristics of pain and lifetime depression during adolescence and could indicate the need for more integrated recognition and clinical care of youth experiencing both depression and pain.