A global systematic review and meta-analysis of 376 studies found that 39.3% of adults with chronic pain experience clinically significant symptoms of depression and 40.2% experience anxiety.
The analysis, which included 347,468 individuals from 50 countries, was published in JAMA Network Open.
Compared with control samples from 94 studies (65 nonclinical, 28 clinical, 1 mixed) comprising 160,564 participants, the prevalence of depression (13.9%) and anxiety (16.4%) was significantly lower, with moderate to large effect sizes (Hedges g = 0.63 and 0.82, respectively).
Among diagnosed psychiatric conditions, 36.7% of adults with chronic pain met criteria for major depressive disorder (MDD), while 16.7% met criteria for generalized anxiety disorder (GAD). Less prevalent disorders included persistent depressive disorder, panic disorder, and social anxiety disorder.
Psychological symptoms were most prevalent in patients with nociplastic pain conditions (pain arising from altered nociception without tissue damage) such as fibromyalgia, complex regional pain syndrome, and temporomandibular disorder. Among individuals with fibromyalgia, 54.0% reported depression and 55.5% reported anxiety. In contrast, osteoarthritis was associated with the lowest prevalence of depression and anxiety.
Subgroup analyses revealed that younger participants and women had significantly higher prevalence of both depression (β = −0.02 and β = 0.69, respectively; P < .001) and anxiety (β = −0.02 and β = 0.90, respectively; P < .001). The overall mean age was 51.3 years, and 70% of the chronic pain sample were women.
Recruitment setting was also associated with variation in prevalence. Depression was more common in clinical settings (41.3%) than in community samples (30.6%), and GAD was similarly more prevalent in clinical settings (22.2%) than community settings (3.9%).
Study quality was variable: 57% were rated as low quality, 21% medium, and 22% high, based on an adapted Joanna Briggs Institute checklist. Inadequate reporting of participant and setting characteristics was the most frequent limitation.
Evidence of publication bias was identified via Egger tests, but trim-and-fill analyses found no missing studies. Heterogeneity was substantial (I² > 98%) for most estimates.
"The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development," said Rachel V. Aaron PhD, one of the authors, from the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.
The authors recommend systematic screening for depression and anxiety in clinical settings where people with chronic pain are treated, emphasizing that early detection and appropriate treatment are essential for improved outcomes.
The review excluded studies focused on chronic headache and migraine. Data on race, ethnicity, income, and gender diversity were limited, with only 24.1% of studies reporting race or ethnicity and just two reporting nonbinary gender identities.
The review was registered in PROSPERO (CRD42022370083) and followed PRISMA guidelines. The study was supported by grant K23HD104934 from the National Institutes of Health (Dr. Aaron) and a Macquarie University Research Fellowship (Dr. Dudeney).
Conflict of interest disclosures can be found in the study.