Chronic Abdominal Pain and Depressive Symptoms: Analysis of the National Longitudinal Study of Adolescent Health

Background & Aims: Abdominal pain is common in adolescence. The aim of this study was to determine the prevalence of depressive symptoms in a large cohort of patients with frequent abdominal pain. Methods: A prospective, cross-sectional, nationally representative sample of children aged 13 to 18 years (mean age, 16.2 ± 1.7 y; 49% male) completed in-home interviews and separate in-school questionnaires for the National Longitudinal Study in Adolescent Health (the Add Health Study). Depressed mood was assessed with the Center for Epidemiologic Studies Depression Scale. Subjective measures of abdominal pain were reported by 20,745 adolescents from wave 1 of the Add Health Study. Frequency of abdominal pain over the previous 1 year was rated as rare (0–1 episode/wk), moderate (2–3 episodes/wk), or daily (≥4 episodes/wk). Results: Daily pain is reported in 3.2% of adolescents, with an additional 14% reporting pain as moderate in frequency. Sixteen percent of all adolescents are at risk for developing depression. The risk for depression goes from 16% to 45% (P < .001) when the pain is daily. Compared with rare pain, children with daily pain were more likely to miss school 10 or more times per year (46% vs 19%, P < .001), cry (12.1% vs 1%, P < .001), feel sad (25.2% vs 5.3%, P < .001), and lonely (25.2% vs 6.4%, P < .001). Children with daily pain were likely to consider life a failure versus those with no pain (10.2% vs 3.3%, P < .001). Conclusions: Adolescents with frequent abdominal pain are at increased risk for depressive symptoms, social isolation, and missing school.

Abbreviations used in this paper: Add Health, National Longitudinal Study in Adolescent Health, CES-D, Center for Epidemiologic Studies Depression Scale