Pain Complaints in Adolescent Patients With Affective Disorders Versus Adolescent Psychiatric Controls

Objective: To ascertain the frequencies of 4 prospectively determined pain complaints among adolescents meeting the criteria for major depressive episode (MDE) relative to nonaffectively ill controls.

Method: In a community mental health clinic for the indigent situated on the border of the United States and Mexico (Rio Grande City, Tex.), adolescents (age range, 12-17 years) who consecutively presented to the clinic from August 2001 to November 2003 received structured psychiatric diagnostic screens for depression and mania using the modules from the DSM-IV. Subsequently, all subjects were asked whether they had had significant (distressing or bothersome) backache, abdominal pain, headaches, or myalgia in the last 7 days. We compared patients meeting the criteria for MDE with individuals without affective symptomatology. Significance of the differences between groups was assessed using the Fisher exact test and multivariate logistic regression analysis. The odds ratios were adjusted for age and sex.

Results: One hundred thirty-two subjects met the criteria for MDE. Forty-eight had nonaffective disorders. Seventy-six percent of the subjects meeting the criteria for MDE had at least 1 pain complaint compared to 33% of the control subjects (p < .0001). Fifty percent of the subjects in the midst of a MDE had at least 2 pain complaints compared to 6% of the control subjects (p < .0001). Twenty-nine percent of the subjects in the midst of a MDE had at least 3 pain complaints compared to 2% of the control subjects (p < .0001). Fourteen percent of the subjects in the midst of a MDE had all 4 pain complaints compared to none of the control subjects (p = .002). The odds ratio of subjects with a MDE having a pain complaint relative to control subjects was 5.8 (p < .0001).

Conclusion: That in excess of three fourths of clinically depressed adolescents had 1 or more pain complaints has important implications for adolescent psychiatry and primary care, as well as somatic medicine.