Temporal associations between pain and anxiety/depression in young people: A systematic review and meta-analysis of longitudinal, prospective, population- and community-based studies

Pain, anxiety, and depression are common among young people, frequently co-occur with each other, and may be longitudinally related. This systematic review and meta-analysis aimed to synthesise the direction and strength of the temporal associations between pain and anxiety/depression among young people. PsycINFO, Web of Science, Scopus, PubMed, Proquest Dissertations and Theses, Google Scholar, and OSF Preprints were searched from inception until 3 July 2026. Additional studies were identified through citation searching and references of existing systematic reviews. Longitudinal, prospective, population- or community-based studies examining temporal associations between pain and anxiety/depression among young people (0-24 years) were included. Two independent reviewers screened studies, extracted data, assessed risk of bias using ROBINS-E, and evaluated certainty of evidence using GRADE. Data were synthesised using three-level meta-analysis and narrative synthesis. Forty-two studies from 31 longitudinal cohorts were included. Anxiety, depression, and combined anxiety/depression were positively associated with subsequent pain. However, after adjustment for confounders, only depression remained significantly associated. Pain was positively associated with subsequent anxiety, depression, and combined anxiety/depression both before and after confounder adjustment. Heterogeneity was moderate to considerable and was partly explained by sex, baseline age, follow-up duration, pain type, pain informant, pain and anxiety/depression operationalisation, and risk of bias. Two of 14 outcomes had high quality of evidence, whereas the remainder ranged from very low to moderate quality. These findings highlight longitudinal associations between pain and anxiety/depression among young people and should be considered in the screening, treatment, and public health management of these problems.