Depressive Symptoms Are Related to Poorer Psychological Functioning in Youth with Functional Abdominal Pain Disorders

Abstract

Functional abdominal pain disorders, recurrent abdominal pain conditions without an identifiable organic cause, impact approximately 10% of children. These youth can experience significant impairment in functioning (e.g., school absences) and are at increased risk for mental health challenges, including the development of depression. This study examines the relationship between depressive symptoms, pain-related impairment, and broader psychological functioning in youth with FAPD. We predict higher levels of depressive symptoms are related to increased pain-related impairment and poorer mental health functioning. Ninety-four participants diagnosed with FAPD per Rome IV criteria between the ages of 9 and 14 (59.6% female, 40.4% male, 91% non-Hispanic white) were recruited from GI clinics as part of a larger psychological treatment study (NCT03134950). Validated questionnaires assessed depressive symptoms (Children's Depression Inventory 2, [CDI2]), anxiety (Screen for Child Anxiety Related Disorders [SCARED]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), pain-related impairment (e.g., functional disability (Functional Disability Inventory, [FDI])), and average pain intensity (0-10 rating via a visual analogue scale). Descriptive data and multiple regressions, controlling for age and sex assigned at birth, were used to examine associations between depressive symptoms and physical (FDI, pain levels) and mental health (SCARED, PCS) functioning. Bonferroni corrections (p<0.05/4=0.0125) were applied to control for multiple analyses. The sample was broadly categorized by moderate levels of pain, functional disability, and mental health symptoms. All study variables were positively correlated with depressive symptoms (all p's<0.05), and females expressed significantly higher depressive symptoms than males (t(92)=2.365, p=0.020). Multiple regressions revealed higher rates of depressive symptoms predicted higher levels of anxiety (F(3, 89)=12.69, p<0.001) and pain catastrophizing (F(3, 90)=15.607, p<0.001), but were not associated with physical health related impairment. Findings suggest the importance of screening youth with FAPD for depressive symptoms to better understand their mental health-related functioning. Grant support from Sharon S. Keller American Pain Society Grant and the Cincinnati Children's Hospital Place Outcomes Award.