Traditional and cyber-victimization among adolescents with and without chronic pain

Anxiety and Depression in Youth With Chronic Pain: A Systematic Review and Meta-Analysis

Importance

For 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.

Objective

To 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 Sources

MEDLINE, PsycINFO, CENTRAL, and Embase from inception to April 30, 2023.

Study Selection

Included 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 Synthesis

From 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 Measures

Prevalence 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.

Results

A 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 Relevance

The 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.

Peer Victimization, Posttraumatic Stress Symptoms, and Chronic Pain: A Longitudinal Examination

Chronic pain and posttraumatic stress disorder symptoms (PTSS) co-occur at high rates in youth and are linked to worse pain outcomes and quality of life. While peer victimization has been posited as a mechanism underlying the PTSS-pain relationship in youth, empirical evidence suggests that it may exacerbate both PTSS and pain. The present study aimed to longitudinally examine PTSS as a mediator in the relationship between peer victimization at baseline and pain-related outcomes at 3 months in youth with chronic pain. Participants included 182 youth aged 10 to 18 years recruited from a tertiary-level children's hospital in Western Canada. At baseline, participants completed measures to assess pain (intensity and interference), peer victimization (relational and overt), and PTSS. The pain was reassessed at a 3-month follow-up. Primary hypotheses were tested utilizing a series of mediation analyses with PTSS as a proposed mediator in the associations between peer victimization and pain outcomes. Youth PTSS mediated the relationship between higher baseline relational victimization and higher 3-month pain interference while controlling for baseline pain interference. Three-month pain intensity was not correlated with peer victimization; thus, pain intensity was not included in the analyses. These findings reveal that PTSS may be an underlying factor in the co-occurrence of peer victimization and chronic pain in youth. Further research is needed to better understand the role of peer victimization in the maintenance of chronic pain to ensure appropriate, effective, and timely interventions that address the social and mental health issues impacting the lives of these youth as well as their pain. PERSPECTIVE: PTSS may be an underlying factor in the co-occurrence between peer victimization and chronic pain in youth, highlighting the need to assess for both peer relationship problems and PTSS in youth with chronic pain.

School bullying and peer relationships in children with chronic pain

ABSTRACT

Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.

Bullying among children with heart conditions, National Survey of Children's Health, 2018-2020

Children with chronic illnesses report being bullied by peers, yet little is known about bullying among children with heart conditions. Using 2018-2020 National Survey of Children's Health data, the prevalence and frequency of being bullied in the past year (never; annually or monthly; weekly or daily) were compared between children aged 6-17 years with and without heart conditions. Among children with heart conditions, associations between demographic and health characteristics and being bullied, and prevalence of diagnosed anxiety or depression by bullying status were examined. Differences were assessed with chi-square tests and multivariable logistic regression using predicted marginals to produce adjusted prevalence ratios and 95% confidence intervals. Weights yielded national estimates. Of 69,428 children, 2.2% had heart conditions. Children with heart conditions, compared to those without, were more likely to be bullied (56.3% and 43.3% respectively; adjusted prevalence ratio [95% confidence interval] = 1.3 [1.2, 1.4]) and bullied more frequently (weekly or daily = 11.2% and 5.3%; p < 0.001). Among children with heart conditions, characteristics associated with greater odds of weekly or daily bullying included ages 9-11 years compared to 15-17 years (3.4 [2.0, 5.7]), other genetic or inherited condition (1.7 [1.0, 3.0]), ever overweight (1.7 [1.0, 2.8]), and a functional limitation (4.8 [2.7, 8.5]). Children with heart conditions who were bullied, compared to never, more commonly had anxiety (40.1%, 25.9%, and 12.8%, respectively) and depression (18.0%, 9.3%, and 4.7%; p < 0.01 for both). Findings highlight the social and psychological needs of children with heart conditions.

Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort

We aimed to quantify the prospective association between bullying and physical pain in a population-based cohort of adolescents. We assessed 4,049 participants of the 10 and 13 years waves of the Generation XXI birth cohort study in Portugal. Pain history was collected using the Luebeck pain screening questionnaire. A subsample of 1,727 adolescents underwent computerized cuff pressure algometry to estimate pain detection/tolerance thresholds, temporal pain summation and conditioned pain modulation. Participants completed the Bully Scale Survey and were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Associations were quantified using Poisson or linear regression, adjusted for sex and adverse childhood experiences. When compared to adolescents "not involved", participants classified as "victim only" or "both victim and aggressor" at age 10 had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration, with relative risks between 1.21 (95% confidence interval: .99, 1.49) and 2.17 (1.57, 3.01). "Victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years (linear regression coefficients: -1.81 [-3.29, -.33] and -2.73 [-5.17, -.29] kPa, respectively), as well as higher pain intensity ratings (.37 [.07, .68] and .39 [.06, .72] mm), when compared with adolescents not involved. No differences were seen for the remaining bullying profiles or sensory measures. Our findings suggest that bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with responses to painful stimuli. PERSPECTIVE: We found prospective evidence that bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.

Parental experiences related to pediatric and adolescent chronic non-cancer pain: A qualitative exploration

PURPOSE

To explore parental experiences in personal functioning and parenting associated with having a child experiencing chronic non-cancer pain.

METHODS

Parents with children experiencing chronic pain were asked to fill out a survey prior to their initial Pediatric Pain Clinic or Pain Psychology appointment at a children's hospital in the southeastern United States. A retrospective analysis of qualitative data was conducted. Qualitative results from open-ended survey questions will be focused on within this manuscript.

FINDINGS

A total of 288 surveys were collected in this study, with 243 participants answering at least one qualitative question. Of participants who responded to open-ended survey questions, there were 88 responses to a question related to parental change, 73 to parental impact, and 239 to goals of the visit. Through thematic analysis, five qualitative themes were identified: Pain Central: The Hub, Juggling Life, Suffering Side by Side, Unrealized Dreams, and Gettin' it Under Control.

DISCUSSION

Parents do experience alterations in personal functioning and parenting as a result of having a child that experiences chronic non-cancer pain. Parents face struggles in many aspects of life including emotions, work, and interpersonal relationships. Theoretical considerations were discussed.

APPLICATION TO PRACTICE

Understanding the experiences parents have in raising a child with chronic pain is important in helping health care providers to recognize that this population may need interventions. This also assists in informing patient treatment, improving patient and parent care outcomes, and educating clinicians on how to better support parents.

Cyberbullying and Cyberhate as Two Interlinked Instances of Cyber-Aggression in Adolescence: A Systematic Review

In this paper we present the results of a systematic review aimed at investigating what the literature reports on cyberbullying and cyberhate, whether and to what extent the connection between the two phenomena is made explicit, and whether it is possible to identify overlapping factors in the description of the phenomena. Specifically, for each of the 24 selected papers, we have identified the predictors of cyberbullying behaviors and the consequences of cyberbullying acts on the victims; the same analysis has been carried out with reference to cyberhate. Then, by comparing what emerged from the literature on cyberbullying with what emerged from the literature on cyberhate, we verify to what extent the two phenomena overlap in terms of predictors and consequences. Results show that the cyberhate issue related to adolescents is less investigated than cyberbullying, and most of the papers focusing on one of them do not refer to the other. Nevertheless, by comparing the predictors and outcomes of cyberbullying and cyberhate as reported in the literature, an overlap between the two concepts emerges, with reference to: the parent-child relationship to reduce the risk of cyber-aggression; the link between sexuality and cyber-attacks; the protective role of the families and of good quality friendship relationships; the impact of cyberbullying and cyberhate on adolescents' individuals' well-being and emotions; meaningful analogies between the coping strategies put in practice by victims of cyberbullying and cyberhate. We argue that the results of this review can stimulate a holistic approach for future studies on cyberbullying and cyberhate where the two phenomena are analyzed as two interlinked instances of cyber-aggression. Similarly, prevention and intervention programs on a responsible and safe use of social media should refer to both cyberbullying and cyberhate issues, as they share many predictors as well as consequences on adolescents' wellbeing, thus making it diminishing to afford them separately.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021239461.

Are They Still Friends? Friendship Stability of Adolescents With Chronic Pain: 1-Year Follow-Up

Most adolescents identify their best friend as their main source of social support. Adolescents with chronic pain (ACP) report the loss of friendships due to pain. Friendships protect against loneliness and depression, yet adolescents with pain experience increased levels of loneliness and depression compared to peers. This longitudinal study examines the friendship stability of dyads that included an adolescent with chronic pain compared to non-pain friendship dyads as well as the factors contributing to a friendship breakup. Eighty-three participants from 61 same-sex friendship dyads across 3 sites participated in a 1-year follow-up survey designed to capture friendship features, indices of social-emotional well-being, pain characteristics, and friendship stability. Chi-square, repeated measures ANOVA, and logistic regression were used to analyze the data. Dyads that included an ACP experienced higher rates of friendship breakup. The shorter length of friendship and having chronic pain predicted a friendship breakup at time 2. ACP continues to experience worse scores on indices of social-emotional well-being that are not predicted with a friendship breakup. Understanding what contributes to positive long-term friendships for those with pain may inform strategies to maintain and improve friendships for those with pain and who experience social challenges.

Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review

OBJECTIVE

Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10-24 years with chronic pain.

METHODS

A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized.

RESULTS

Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored.

CONCLUSIONS

Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social-developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs.

The Scarcity of Literature on the Psychological, Social, and Emotional Effects of Gastroparesis in Children

Gastroparesis (GP) is a chronic, gastric dysmotility disorder with significant morbidity and mortality. The hallmark of GP is the delayed emptying of the contents of the stomach in the absence of any mechanical obstruction. Patients most commonly report chronic symptoms of nausea, vomiting, feeling full quickly when eating, bloating, and abdominal pain. Treatments are limited with relatively poor efficacy. As such, children with GP are at significant risk for the development of psychological co-morbidities. In this paper, we provide a topical review of the scientific literature on the psychological, social, and emotional impacts of gastroparesis in pediatric patients. We aim to document the current state of research, identify gaps in our knowledge with appropriate recommendations for future research directions, and highlight the unique challenges pediatric patients with GP and their families may face as they manage this disease. Based on the current review, research into the psychosocial impacts in children with GP is essentially non-existent. However, when considering research in children with other chronic digestive diseases, children with GP are likely to face multiple psychosocial challenges, including increased risk for anxiety and depression, stigma, and reduced quality of life. These significant gaps in the current understanding of effects of GP across domains of childhood functioning allow for ample opportunities for future studies to address psychosocial outcomes.

The correlation of functional pain and psychological distress: a study in Italian school students

Background

Functional Pain (not detectable organic cause) is often associated with psychological problems and, according to literature, it can lead to severe manifestations.

The purpose of the study was to investigate the correlation between functional pain and psychological disagreement, in a series of school students.

Methods

An observational questionnaire-based study was performed.

A questionnaire was given to a group of students of primary school; the following data were collected in the questionnaire: a) sex and age; b) functional pain; c) relation with relatives, teachers and schoolfellows: d) school failure.

Statistical methods: P-value of concordance test and P-value of correlation have been performed with MINITAB 15.1 software.

Results

Eight hundred nine students, 354 females, 455 males, median age 14 years, participated to the study.

Functional Pain was referred from 537/809 students (66%): 265 Females, 272 males: p = 0.155. The difference between the number of pain episodes in females vs. males was statistically significant (p = 0,511), as pain intensity vs. the number of episodes in females (p = 0.001).

The most frequent location of pain was abdomen in females, limbs in males.

Psychological disagreement was referred from 513/809 students (63%) (260 females; 253 males: p = 0,150).

Psychological disagreement was reported with parents (19); siblings (22); other relatives (18); teachers: 42, schoolfellows: 366, relatives as well as school fellows: 46.

The correlation between disagreement and functional pain in all the students included in the study was statistically significant (p < 0.001).

Conclusions

most students reported psychological disagreement and pain. The most frequent cause of disagreement was schoolfellows’ behaviour. The study shows a student’s lack of discussing of their problems with parents, teachers, peer. According to literature, confiance would be a useful treatment for avoiding psychological disagreements and functional pain.

Daily Peer Victimization Experiences of Adolescents With and Without Chronic Pain: Associations With Mood, Sleep, Pain, and Activity Limitations

This study aims to 1) examine the temporal influence of peer victimization on mood, sleep quality, pain, and activity limitations in clinical and community samples of youth, and 2) test mood and sleep as mediators of peer victimization-pain pathways. One hundred fifty-six adolescents (n = 74 chronic pain group) completed a week of online diary monitoring assessing their daily peer victimization experiences, negative mood, sleep quality, pain intensity, and pain-related activity limitations. In multilevel models controlling for group status, person-mean peer victimization (averaged across days) significantly predicted worse mood, pain, and activity limitations (all Ps < .01) while daily victimization predicted worse mood (P < .05). Results from within-person mediation indicated a significant indirect effect of daily peer victimization on next-day activity limitations, through daily negative mood. Results from between-person mediation indicated that negative mood significantly mediated the relation between peer victimization and pain and the relation between peer victimization and activity limitations. Peer victimization is associated with negative health indicators in clinical and community samples of youth and may exert its influence on pain and pain-related activity limitations through negative mood. PERSPECTIVE: This article examines the temporal influence of peer victimization on pain in adolescents with and without chronic pain, and examines mood and sleep quality as mechanisms linking victimization to pain. This information may be useful for pain prevention researchers as well as providers who assess and treat pain in childhood.