ImportanceFor youth with chronic pain, anxiety and depression are reported as consequences of experiencing pain and maintaining factors of ongoing pain and disability. However, prevalence estimates of anxiety and depression remain unclear.ObjectiveTo report the prevalence of clinical anxiety and depression for youth with chronic pain and compare symptoms of anxiety and depression between youth with and without chronic pain.Data SourcesMEDLINE, PsycINFO, CENTRAL, and Embase from inception to April 30, 2023.Study SelectionIncluded studies that reported prevalence data or symptom scores for anxiety and/or depression in individuals younger than 25 years (mean, ≤18 years) with chronic pain and were published in English.Data Extraction and SynthesisFrom 9648 nonduplicate records, 801 full-text articles were screened. Screening and data extraction occurred in duplicate. Prevalence was determined using event rate calculations. Between-group symptom differences were calculated using Hedges g. Analyses were conducted using the random-effects model. Reporting bias and Grading of Recommendation, Assessment, Development, and Evaluation assessments were conducted.Main Outcomes and MeasuresPrevalence of anxiety and depression (based on diagnosis and clinical cutoff scores) and differences in anxiety and depression symptoms. Moderators of prevalence and symptom differences were analyzed when data allowed.ResultsA total of 79 studies were included with a total sample of 22 956 youth (n = 12 614 with chronic pain). Most youth were female (mean, 74%), with an age range of 4 to 24 (mean [SD], 13.7 [2.10]) years. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI, 24.0%-47.0%) and the portion that exceeded clinical cutoff scores was 23.9% (95% CI, 18.3%-30.6%). The prevalence of depression diagnoses was 12.2% (95% CI, 7.8%-18.7%) and the portion that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%). Youth with chronic pain had greater symptoms of anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85) compared with controls. Sex, age, pain location, and recruitment sample may moderate anxiety and depression. Considerable heterogeneity was reported for all outcomes. Studies had a low reporting bias, and outcomes were moderate to high quality.Conclusions and RelevanceThe findings of this meta-analysis suggest that 1 in 3 youth with chronic pain meet criteria for anxiety disorder, and 1 in 8 meet criteria for a depressive disorder. This represents a major clinical comorbidity. Moving forward, screening, prevention, and treatment of mental health should be important health care priorities for youth with chronic pain.

中文翻译：

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患有慢性疼痛的青少年的焦虑和抑郁


重要性对于患有慢性疼痛的青少年来说，焦虑和抑郁是经历疼痛和维持持续疼痛和残疾因素的后果。然而，焦虑和抑郁的患病率估计仍不清楚。目的报告患有慢性疼痛的青少年临床焦虑和抑郁的患病率，并比较有和没有慢性疼痛的青少年的焦虑和抑郁症状。数据来源从建库到 2023 年 4 月 30 日的MEDLINE、PsycINFO、CENTRAL 和 Embase.研究选择纳入的研究报告了 25 岁以下（平均 ≤18 岁）患有慢性疼痛的个体的焦虑和/或抑郁的患病率数据或症状评分，并以英文发表。数据提取和综合从 9648 条非重复记录中筛选了 801 篇全文文章。筛选和数据提取一式两份进行。使用事件率计算确定患病率。使用 Hedges g 计算组间症状差异。使用随机效应模型进行分析。对推荐、评估、开发和评价评估进行了报告偏倚和分级。主要结局和措施焦虑和抑郁的患病率（基于诊断和临床临界分数）以及焦虑和抑郁症状的差异。在数据允许的情况下，分析患病率和症状差异的调节因子。结果共纳入 79 项研究，总样本为 22 956 名青年 （n = 12 614 名患有慢性疼痛）。大多数青年是女性 （平均值，74%），年龄范围为 4 至 24 岁 （平均值 [SD]，13.7 [2.10]） 岁。焦虑诊断的患病率估计为 34.6% （95% CI， 24.0%-47.0%） ，超过临床临界分数的部分为 23.9% （95% CI， 18.3%-30.6%）。 抑郁诊断的患病率为 12.2% （95% CI，7.8%-18.7%），超过临床临界分数的部分为 23.5% （95% CI，18.7%-29.2%）。与对照组相比，患有慢性疼痛的青少年具有更严重的焦虑 （g = 0.61;95% CI，0.46-0.77） 和抑郁 （g = 0.74;95% CI，0.63-0.85） 症状。性别、年龄、疼痛部位和募集样本可能会缓解焦虑和抑郁。所有结局均报告了相当大的异质性。研究的报告偏倚较低，结局为中等到高质量。结论和相关性这项荟萃分析的结果表明，每 3 名患有慢性疼痛的青少年中就有 1 名符合焦虑症的标准，每 8 名青少年中就有 1 名符合抑郁症的标准。这代表了一种主要的临床合并症。展望未来，心理健康的筛查、预防和治疗应该是患有慢性疼痛的青少年的重要医疗保健优先事项。