211: Momentary associations between depressive affect, pain intensity, and functioning in young people

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology, Epidemiology, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Depression and chronic pain often co-occur in young people, with co-occurrence associated with reduced efficacy of common treatments [1]. Recent qualitative evidence found young people explained their co-occurring depression and chronic pain as a never ending cycle that impacted physical functioning [2]. Both depression [3] and chronic pain [4] have fluctuating symptoms that can change moment-to-moment. Yet there is limited evidence on the moment-to-moment associations between depressive affect, pain intensity, and physical function. We aimed to estimate between- and within-participant associations between depressive affect, pain intensity, and physical function in young people help-seeking for depression with chronic pain.

Methods: A four-week longitudinal cohort study recruited thirty young people (aged 12-25 years) help-seeking for depression with chronic pain. Depressive affect, pain intensity, and physical function were captured three times a day for 28 days. Exposures were centred to separate between- (level 2 time invariant exposure) and within-participant (level 1 time-varying exposure) effects. Concurrent multilevel linear mixed models estimated the between- and within-participant effect of pain intensity on depressive affect and vice versa, as well as on physical function. Exploratory time lagged models estimated the within-participant effect of each exposure at the prior assessment on the outcome at the subsequent assessment.

Results: Twenty-nine participants completed 1,758 surveys. Between participants, elevated depressive affect associated with greater pain intensity (β[95%CI]: 0.42 [0.22-0.62]) and worse functioning (0.31 [0.08-0.55]). Higher pain intensity associated with greater depressive affect (0.93 [0.49-1.36]) and worse functioning (0.67 [0.37-0.98]). Within participants, depressive affect increases associated with pain intensity increases (0.28 [0.23-0.33]) and worse physical function (0.22 [0.17-0.26]). Pain intensity increases associated with depressive affect increases (0.27 [0.22-0.31]) and worse functioning (0.46 [0.41-0.50]). Pain intensity increases associated with subsequently worse functioning (0.17 [0.11-0.24]).

Conclusions: Concurrently, depressive affect, pain intensity, and physical function are strongly associated, while increases pain intensity may have a within-day lagged effect on worsening physical function, in young people help seeking for depression with chronic pain. Importantly, depression and pain conditions are leading causes of global disability in young people at a critical period of their development. Our results indicate a need for improved integrated support of co occurring depression and chronic pain to effectively reduce the inequitable disability burden experienced by young people with both conditions.

References: [1] Oosterwijk VA, Gao CX, Menssink J, et al. Psychological Medicine 2025;55:e207.
[2] Klem N-R, Briggs AM, Rowbotham S, et al. The Journal of Pain 2025;32:105412.
[3] Kwong ASF, Manley D, Timpson NJ, et al. J Youth Adolescence 2019;48:815–27.
[4] Dunn KM, Jordan KP, Mancl L, et al. Pain 2011;152:66–73.

Presenting Author: Dr Scott Tagliaferri
Submitting Author: Scott Tagliaferri

Senior Author: Prof Lianne Schmaal

IASP 2026 Global Year theme of Neuropathic Pain: No

• Chelsea Chum: MSc - Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
• Connie Markulev: MPsych - Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
• Dr Sonya Morrissey: GP - Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
• Dr Valentina Bianchi: PhD - Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
• Prof Peter Koval: PhD - Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
• Dr Tess Jaeger: PhD - Turner Institute for Brain and Mental Health, Monash School of Psychological Sciences, Monash University
• Dr Hayley Leake: PhD - IIMPACT in Health, Adelaide University, Adelaide, SA, Australia
• Dr Nardia-Rose Klem: PhD - Curtin University School of Allied Health, Faculty of Health Sciences, Perth, WA, Australia
• Prof Melanie Noel: PhD - Department of Psychology, University of Calgary, Calgary, AB, Canada
• Prof Lianne Schmaal: PhD - Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia