Anxiety and Depression Symptoms Mediate the Relationship between Adverse Childhood Experiences and Persistent/Recurrent Adolescent Pain

Anxiety and depression symptoms may be key modifiable mechanisms through which adverse childhood experiences (ACEs) affect persistent/recurrent pain (PRP). This study described direct and indirect effects of ACEs on PRP across early adolescence, using four years of data from the Adolescent Brain Cognitive Development Study®. Pain frequency, anxiety, and depression symptoms were measured annually using the Child Behavior Checklist; youth with pain for 3-4 years were classified with PRP. Early (up to age 9-10, reported at baseline) and interim (reported at age 10-11) ACEs were derived from parent and participant completed surveys. Structural equation modeling estimated direct and indirect associations among ACEs, anxiety/depression symptoms, and pain outcomes, with annual anxiety and depression symptoms modeled as latent variables. Among 7,951 healthy youth, 2,540 (31.9%) were classified with PRP. Each additional early ACE exposure was associated with an 11% greater likelihood of having PRP (95% Confidence Interval [CI] 1.01, 1.21). This effect was mediated through higher interim anxiety symptoms (adj. Odds Ratio (OR) 1.21 [95% CI 1.14, 1.27]). There was also an indirect effect of early ACEs on PRP through higher interim depression symptoms (adj.OR 1.06 [95% CI 1.01, 1.12]). Early ACEs had an indirect effect on subsequent pain frequency through higher interim anxiety symptoms (adj.β 0.01 [0.00, 0.01]), while interim ACEs directly affected subsequent pain frequency (adj.β 0.03 [0.01, 0.05]). Our findings suggest the potential importance of anxiety and depression symptoms as mechanistic interventional targets to mitigate PRP for ACE-exposed youth. Funded by the National Institute of Nursing Research (1F31NR020837-01).