Background & Aims
There is a robust body of evidence showing that depression symptoms are associated with increased functional disability in youth with pain-related conditions. While it is well-documented that young people with pain can often experience substantial functional difficulties, research outlining models that explain the nature of relationships between pain and functional disability in youth are more sparse. Understanding casual factors that facilitate functional deficits in pediatric pain is an essential component of designing effective intervention approaches. Despite the ample body of research documenting associations between depression, pain, and functional disability, the precise nature and directionality of the relationships between these factors have not yet been clarified. Therefore, the present study seeks to investigate the role of depression as a mediator of the relationship between somatic symptom severity and functional disability in youth with persistent pain.
Methods
Data was collected by administration of questionnaires to youth patients and their parents presenting to an interdisciplinary chronic pain clinic at a children’s hospital. The sample included 81 youth ages 8-18 and their parents. All youth had chronic pain conditions, most prominently Amplified Musculoskeletal Pain Syndrome and Complex Regional Pain Syndrome. Symptom severity was assessed by the Somatic Symptom Scale-8, which was selected to encompass the full experience of symptoms in chronic pain conditions. Depression symptoms were assessed by the Patient Health Questionnaire for Adolescents. Functional disability was assessed by the Functional Disability Inventory. Parent-report data was used for all variables of interest. A mediation analysis was performed using PROCESS package in SPSS. The outcome variable for analysis was functional disability and the predictor variable was somatic symptom severity with depression symptoms as the mediator.
Results
The first step of our analysis demonstrated that the effect of somatic symptom severity on depression was significant (?=0.51, t(79) = 5.84, p<0.05). The second step of our analysis showed that the effect of depression on functional disability was also significant (?=0.63, t(78) = 3.17, p<0.05). Lastly, the significance of the indirect effect was assessed using bootstrapping procedures. Unstandardized indirect effects were computed for each of 5,000 bootstrapped samples and the 95% confidence interval ranged from 0.11 to 0.56 demonstrating statistical significance. The standardized indirect effect was ?=0.51.
Conclusions
Results of mediation analyses demonstrated that depression symptoms mediate the relationship between somatic symptom severity and functional disability in youth with chronic pain conditions. This finding supports the importance of comprehensive evaluation of mental health concerns, including depressive symptoms, in youth seeking care for persistent pain. While previous studies have identified clear relationships between symptom severity, depression, and disability in this population, our results provide additional information about the directionality and nature of this relationship. Demonstrating the important role of depression in the relationship between somatic symptoms and functional disability provides support for including addressing mental health comorbidities in interventions that aim to promote functioning in pediatric patients with persistent pain.
References
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Presenting Author
Corinne Espinoza
Poster Authors
Corinne Espinoza
PhD
University of Utah Department of Pediatrics
Lead Author
Deirdre Caplin
PhD
University of Utah School of Medicine
Lead Author
Stanley Brewer
DO
University of Utah School of Medicine
Lead Author
Kirti Sivakoti
MD
University of Utah School of Medicine
Lead Author
Shauna Skog
NP
Primary Children's Hospital
Lead Author
Topics
- Pain in Special Populations: Adolescents