Anxiety and Depression Symptoms, Adverse Childhood Experiences, and Persistent/Recurrent Pain Across Early Adolescence

To determine whether anxiety and depression symptoms are mechanisms through which adverse childhood experiences (ACEs) contribute toward persistent/recurrent pain (PRP) across early adolescence. This study described the direct and indirect (ie, mediated) effects of ACEs on PRP across early adolescence, using 4 years of Adolescent Brain Cognitive Development Study data. Annual pain frequency, anxiety, and depression symptoms were measured using the Child Behavior Checklist, and youth with pain for ≥3 of the 4-year study period were classified with PRP. Early (up to age 9–10 years; reported at baseline) and recent (at age 10–11 years; reported at year 1) ACE exposures were derived from parent and youth completed surveys. Structural equation modeling estimated the direct and indirect associations among early and recent ACEs, pain outcomes, and anxiety/depression symptoms reported in the year(s) in between. Among 7951 youth, 2540 (31.9%) were classified with PRP. Higher levels of early ACE exposure were associated with an increased probability of having PRP (adj. β 0.65 [95% confidence interval {CI} 0.07, 1.22). Early ACEs also had indirect effects on PRP via higher interim anxiety (adj. β 5.36 [95% CI 3.45, 7.26]) and depression symptoms (adj. β 4.57 [95% CI 3.01, 6.13]). Early and recent ACE exposures predicted higher pain frequency scores in subsequent years, with mixed results regarding the role of anxiety and depression in the relationships between ACEs and pain frequency scores. Anxiety and depression symptoms are potentially important interventional targets to lower the risk for PRP among youth exposed to ACEs.