Background & Aims
Chronic or recurrent musculoskeletal pain and depression are highly prevalent and related problems among adolescents. Results show that over 30% of adolescents reporting neck/shoulder pain also reported co-occurring depressive symptoms. Chronic pain can result in negative consequences on functioning in various domains of life. There is some evidence that depression and pain-related functioning correlate. However, uncertainty remains on how they relate to one another. Theoretically, according to the fear avoidance model, depressive symptoms may be a consequence of pain-related functioning, as well as pain-related functioning may be a consequence of depressive symptoms. Earlier studies are mainly cross-sectional, which does not enable to disentangle the temporal associations. Therefore, the aim of this study was to analyse the temporal association between depression and pain-related functioning in adolescents with musculoskeletal pain in longitudinal study design in a general population
Methods
This study uses a subsample of data from the Three-cities study, a five-year longitudinal study, including over 3000 youths in 18 lower secondary schools in three cities in mid-Sweden. A self-report survey was filled in yearly in the classroom. This study included youth who were in 7th grade (age m=13.7 (sd=.67) at study start, reporting musculoskeletal pain once a week, or more, during the last six months (n=617). The youths were followed yearly until grade 9. Depressive symptoms were assessed with Center for Epidemiology Studies Depression Child version. Functioning was assessed with three questions assessing problems in school, leisure activities and contact with friends due to pain. Four cross panel regression models were estimated to find the best fitting model for the association between depression and functioning across time: Autoregressive (the basic model); depression predicting functioning; functioning predicting depression; a bidirectional model. Covariate: gender.
Results
Analyses showed that depression and pain-related functioning, among youths with musculoskeletal pain, were correlated across time. The model where depression predicted pain-related functioning provided the best model fit.
Conclusions
In this cohort of youth with recurrent musculoskeletal pain from a general population, depressive symptoms had a larger impact on future pain-related functioning than pain-related functioning had on the development of depressive symptoms. The results supports a theoretical model where depressive symptoms drive pain-related functioning more than the other way around, which stresses the importance of screening for depression in adolescents with chronic pain. In addition, targeting depressive symptoms might be important in affecting pain and its functional consequences. Future studies should focus on possible mechanisms linking depressive symptoms to pain-related functioning, such as avoidance.
References
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Presenting Author
Tove Axelsson-Landberg
Poster Authors
Tove Axelsson-Landberg
MSc Physiotherapy, PhD-student
School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Lead Author
Christiana Owiredua
MSc Psychology
Center for Health and Medical Psychology (CHAMP), School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
Lead Author
Emma Nilsing-Stridh
RPT & Associate professor
University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Lead Author
Anna Duberg
RPT & PhD
University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Lead Author
Katja Boersma
PhD
Center for Health and Medical Psychology (CHAMP), School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
Lead Author
Topics
- Pain in Special Populations: Adolescents