285: The Dual Burden of Mental Health and Pain in Youth During COVID-19: Clinical Implications

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

Background and Aims: The COVID-19 pandemic had a profound impact on the wellbeing of youth, especially those with chronic pain. Chronic pain is known to co-occur with symptoms of mental health, including anxiety and depressive disorders (1). Considering the negative impacts of the COVID-19 pandemic on chronic pain and mental health (2,3), understanding the clinical overlap in these experiences is critical to ensure appropriate clinical support is offered to youth, especially given the chronicity of pain and mental health disorders. Experiences of pain and mental health are heterogenous (4); however, specific patterns of mental health symptoms occurring concurrently with chronic pain have yet to be identified. Creating such profiles can improve how youths’ pain and mental health symptoms are assessed and treated. This work aimed to explore patterns in experiences of pain and mental health symptoms among youth during the COVID-19 pandemic, with a view toward offering clinical considerations for supporting these youth.

Methods: A cross-sectional survey design was administered to Canadian youth between the ages of 8 to 18 years with a diagnosis of chronic pain during the first three waves of the COVID-19 pandemic (August 2020 to April 2021). Youth self-reported pain (i.e., intensity, interference), mental health symptoms (i.e., depression, anxiety), post-traumatic stress symptoms, insomnia, health-related quality of life, and the impact of COVID-19 (e.g., health, social outcomes). A latent profile analysis (LPA) was conducted to explore the presence of heterogeneity of pain and mental health symptoms. LPA was also used to determine how many profiles would best explain the connection between experiences of mental health and pain symptoms to inform clinical recommendations for management of pain and mental health.

Results: Five distinct subgroups of youth with chronic pain were determined based on co-occurring mental health symptoms: 1) subclinical mental health symptoms/low pain (42.2%); 2) moderate mental health symptoms/moderate pain; 3) subclinical mental health symptoms/high pain (12.5%); 4) elevated mental health symptoms/high pain without clinical PTSD (6.6%); and 5) elevated mental health symptoms/high pain (4.1%). Clinically, these results suggest that youth with elevated mental health symptoms also appear to experience greater pain intensity. Based on these findings, three clinical recommendations are proposed. First, routine mental health screening among youth with chronic pain is essential to identify those in need of specialized support. Additionally, youth with co-occurring high-intensity pain and mental health symptoms should be prioritized to receive psychological interventions. Finally, given the critical role of socio-contextual factors on chronic pain and mental health, resources to support family members of youth with chronic pain should be made available.

Conclusions: The COVID-19 pandemic significantly impacted the mental health of many youth across Canada. These results highlight a subset of youth who experienced significant pain and mental health symptoms, who may also be at risk of developing high-impact chronic pain given the potential impact on daily functioning. While it has been established that pain and mental health symptoms co-occur, this study is among the first to characterize different profiles of chronic pain and mental health symptoms among youth in the aftermath of the COVID-19 pandemic. These profiles provide important clinical guidance, urging clinicians who see patients with chronic pain to assess for mental health, especially among youth who have lived through stressful or traumatic circumstances more broadly. Moreover, these results encourage clinicians, including psychologists and allied health colleagues, to support the timely delivery of evidence-based practices for mental health and chronic pain for both the youth and their family.

References: 1. Noel M, Groenewald CB, Beals-Erickson SE, Gebert JT, Palermo TM. Chronic pain in adolescence and internalizing mental health disorders: a nationally representative study. PAIN. 2016;157(6). https://journals.lww.com/pain/Fulltext/2016/06000/Chronic_pain_in_adolescence_and_internalizing.20.aspx
2. Craig S, Ames M, Bondi B, Pepler D. Canadian adolescents’ mental health and substance use during the COVID-19 pandemic: Associations with COVID-19 stressors. Canadian Journal of Behavioural Science. 55(1):46.
3. Dozois DJA. Anxiety and depression in Canada during the COVID-19 pandemic: A national survey. Canadian Psychology. Published online 2020. doi:10.1037/cap0000251
4. Meulders A, Vlaeyen JWS, Evers AWM, et al. Chronic primary pain in the COVID-19 pandemic: how uncertainty and stress impact on functioning and suffering. PAIN. 2022;163(4). https://journals.lww.com/pain/fulltext/2022/04000/chronic_primary_pain_in_the_covid_19_pandemic__how.2.aspx

Presenting Author: Nicole MacKenzie
Submitting Author: Nicole MacKenzie

Senior Author: Jennifer Stinson

IASP 2026 Global Year theme of Neuropathic Pain: No

• Nicole MacKenzie: PhD, MEd - The Hospital for Sick Children
• Fareha Nishat: MPH, H.B.Sc. - The Hospital for Sick Children
• Sarah Brennenstuhl: PhD - University of Toronto
• Kathryn Birnie: PhD - University of Calgary
• Melanie Noel: PhD - University of Calgary
• Chitra Lalloo: PhD - The Hospital for Sick Children
• Sabine Soltani: PhD - University of Calgary
• Jennifer Stinson: PhD - The Hospital for Sick Children