Depression and Anxiety Among Adults With Chronic Pain

"Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis" published in JAMA Network Open in March 2025

Study Objectives:

The primary objectives of this comprehensive meta-analysis were to:

1. Evaluate the overall prevalence of depression and anxiety among adults with chronic pain.

2. Identify factors that moderate this prevalence.

Methodology:

• Data Sources: A thorough literature search was conducted across major databases including MEDLINE, Embase, PsycINFO, and Cochrane Library. The search covered studies published from January 2013 to October 2023.

• Study Selection: Included studies reported the prevalence of depression or anxiety using a validated assessment tool in adult populations with chronic pain (excluding chronic headache disorders).

• Data Extraction & Synthesis:

  • 31,159 initial records were identified, and 5,177 full texts were screened for eligibility.

  • Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

  • Two independent reviewers screened abstracts, reviewed full texts, extracted data, and assessed the risk of bias.

  • Random-effects meta-analyses were used to pool prevalence estimates, assess moderation, and compare prevalence rates in chronic pain samples versus control groups.

• Main Outcomes: The prevalence of depression and anxiety was assessed based on clinically significant symptoms or formal diagnosis. Moderators analyzed included pain condition, recruitment setting, continent, age, percentage of female participants, and pain duration.

Key Findings in Detail:

• Overall Prevalence:

  • The meta-analysis included 376 studies from 50 countries, comprising 347,468 individuals with chronic pain (mean age 51.3 years; 70.0% female).

  • Clinical symptoms of depression were present in 39.3% (95% CI, 37.3%-41.1%).

  • Clinical symptoms of anxiety were present in 40.2% (95% CI, 38.0%-42.4%).

• Prevalence by Diagnosis (DSM-5 criteria):

  • Major Depressive Disorder (MDD): 36.7% (95% CI, 29.0%-45.1%)

  • Generalized Anxiety Disorder (GAD): 16.7% (95% CI, 11.8%-23.2%)

  • Persistent Depressive Disorder (PDD): 6.3%

  • Panic Disorder (PD): 7.5%

  • Social Anxiety Disorder (SAD): 2.2%

• Moderating Factors:

  • Pain Condition:

    • Highest prevalence of both depression (54.0%) and anxiety (55.5%) was found in samples of people with fibromyalgia.

    • Lowest prevalence was observed in people with arthritis conditions (e.g., osteoarthritis: depression 29.1%, anxiety 17.5%).

    • Other conditions like complex regional pain syndrome, temporomandibular disorder, chronic neuropathic pain, chronic pelvic pain, and chronic low back pain also showed substantial prevalence rates, typically ranging from 30% to 47%.

  • Demographics:

    • Women were more likely to have depression and anxiety.

    • Younger people were more likely to have depression and anxiety.

  • Pain Characteristics:

    • Individuals with nociplastic pain (pain arising from altered nociception without tissue damage) were particularly prone to depression and anxiety.

    • Longer pain duration was also associated with higher prevalence.

• Comparison to Control Groups: The prevalences of depression and anxiety were significantly higher among individuals with chronic pain compared to both clinical and non-clinical control groups.

Conclusions and Relevance:

This meta-analysis powerfully demonstrates that the co-occurrence of chronic pain with depression and anxiety is a significant and widespread public health concern. The authors strongly recommend:

• Routine screening for mental health symptoms in clinical settings where people with chronic pain are treated.

• Ensuring equitable access to specialty care.

• Fostering the development of innovative treatments that specifically target this comorbidity.

• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831134