Establishing the longitudinal association between pain characteristics and clinical outcomes in young people with mental ill-health

Introduction: Mental ill-health has a major impact on young people. Pain often co-occurs and may impact recovery from mental ill-health. We explored the prevalence and clinical impact of pain in young people with mental ill-health.Methods: A secondary analysis using longitudinal data (baseline and three-month follow-up) of 1,107 Australian young people (aged 12-25 years) attending one of five youth mental health centres with a first presentation of mental ill-health. Multi-level linear mixed models explored associations between pain characteristics (frequency, intensity, limitations) and clinical outcomes (depression and anxiety symptoms, suicidal ideation, functioning, and substance use) with false discovery rate (FDR) p-value adjustment. Pain characteristics were baseline-centred to evaluate if: (1) the baseline score (level 2 predictor; between-participant effect) and/or (2) change from baseline (level 1 predictor; within participant effect) was associated with outcomes over time.Results: At baseline, 16% experienced serious pain more than three days per week, 51% reported at least moderate pain, and 25% experienced pain-related activity limitations. For between-participant effects, serious pain frequency was associated with anxiety symptoms (β[95%CI] = 0.90 [0.45, 1.35], FDR-p=0.001), pain intensity was associated with symptoms of depression (1.50 [0.71, 2.28], FDR p=0.001), anxiety (1.22 [0.56, 1.89], FDR-p=0.002), and suicidal ideation (3.47 [0.98, 5.96], FDR p=0.020), and pain limitations were associated with depressive symptoms (1.13 [0.63, 1.63], FDR p<0.001). For within-participant effects, change in pain intensity was associated with change in tobacco use risk (1.09 [0.48, 1.70], FDR-p=0.002), and change in pain limitations were associated with change in depressive symptoms (0.99 [0.54, 1.43], FDR-p<0.001) and functioning (-1.08 [-1.78, -0.38], FDR-p=0.009).Conclusions: Pain is common and has a meaningful influence on young people with mental ill-health. Youth mental health services should screen for pain and develop integrated pain services.